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Impact of specific training in anaphylaxis of the Triage nursing staff in a Tertiary Hospital’s Paediatric Emergency Department

Arroabarren E1, Alvarez-García J2, Anda M1, de Prada M2, Ponce C2, Alvarez-Puebla MJ1

1Department of Allergy. Complejo Hospitalario de Navarra. CS Conde Oliveto.
2Pediatric Emergency Unit. Department of Pediatrics. Complejo Hospitalario de Navarra. 

J Investig Allergol Clin Immunol 2018; Vol. 28(6)
doi: 10.18176/jiaci.0271

Background: After a diagnosis of anaphylaxis, patients receive action management plans to prevent and treat new episodes, including attending the Emergency Departments (ED) for control or further treatment. In a previous study, we observed that more than half of the children with anaphylaxis were incorrectly prioritized in our Paediatrics Emergency Unit (PEU), delaying their treatment. In conjunction with our PEU staff we designed a basic educational intervention (BEI) to try to solve this problem. We analyzed the effect of this intervention in the effective triage of the subsequent children diagnosed with anaphylaxis.
Methods: Our BEI consisted of a formative lecture given to the PEU triage nurses and the design of a Reference Card highlighting anaphylaxis symptoms and risk factors.
We included 138 children with medical diagnosis of anaphylaxis and assessed modifications in their triage priority level and waiting times for physician (WT) after our intervention. According to the EI implementation date, 69 children were diagnosed before (G1) and 69 after (G2). Clinical data were compared to assess the severity of the episodes.
Results: There were no differences between groups. The WT diminished (from 8 to 1 minute [p: 0.03]), and the number of correctly identified patients increased (36.2% [G1] and 72.2% [G2][p= 0.0001]) after the BEI.
Conclusions: Our BEI has been effective, improving the identification and priorization of children with anaphylaxis and reducing their WT. We need to pay attention to the functioning of our patients´ reference ED and establish interdisciplinary measures that allow optimizing anaphylaxis´ management.

Key words: Triage, anaphylaxis management, children, educational intervention, specific education non-medical staff, multidisciplinary, Paediatric Canadian Triage and Acuity Scale (PaedCTAS)