Access to a personal adrenaline injector in all healthcare settings

If you have a personal adrenaline injector (such as an EpiPen or Anapen) and know how to use it, you should:

• Keep it close by while you are being treated in a health service, hospital, ambulance or clinic
• Tell your healthcare team that you have an adrenaline injector and arrange with them to keep it near you during your care
• Keep the adrenaline injector with your ASCIA Action Plan for Anaphylaxis in an unlocked location that you can easily reach.

If your child is admitted to hospital, their adrenaline injector can be kept at their bedside for you or staff to use if necessary.

Your healthcare team may want to confirm that you know how and when to use your adrenaline injector, and that it is safe to use.

If you believe you are having an allergic reaction and experience symptoms such as breathing difficulties, faintness, swelling of your tongue or tightness of your throat while in health care, lie down (or sit with your legs outstretched if breathing is difficult), use your adrenaline injector without delay and alert a staff member immediately.

For adrenaline to be given as soon as possible after the onset of symptoms of anaphylaxis, it is important for the patient (or their carer) to be able to immediately administer their own adrenaline injector, regardless of the setting. A readily accessible adrenaline injector may also be used by a clinician if necessary.

If a patient has an adrenaline injector, as soon as possible following presentation or admission, assess their capacity to safely use it during the healthcare encounter. This includes:

• Checking their capacity, physical capability and willingness to use their personal adrenaline injector and their ability to recognise the symptoms of anaphylaxis
• Considering medicines administered during the healthcare visit that may impair the patient’s usual ability to recognise and treat anaphylaxis
• Involving a parent, guardian or carer in the assessment when in the paediatric setting
• Involving a family member or carer in the assessment, if appropriate, when a patient is cognitively impaired or lives with a disability.

As part of the assessment, identify a safe place for the adrenaline injector to be kept that allows ease of access for the patient, is in an unlocked location, and maximises the safety of others. Before making the adrenaline injector available, ensure it is suitable for use: check the expiry date, check the viewing window to make sure the solution is clear and that the device has not been used, and ask the patient how it has been stored. If in doubt, make arrangements for the patient to obtain a new device.

The adrenaline injector should be:

• Kept with the patient’s ASCIA Action Plan for Anaphylaxis
• Labelled with the patient’s name.

Notify all staff that the patient has an allergy and has an adrenaline injector with them. This includes at clinical handover in the ward or when the patient temporarily leaves the ward, such as for scans or other tests. Add an allergy alert to the patient’s records, including the electronic medical record (EMR) and electronic patient journey boards.

Ensure a policy, and the necessary protocols, are in place to allow a patient who has a personal adrenaline injector to maintain easy access to it at all times in a manner that is safe to others. The policy should describe steps for:

• Checking the expiry date of the adrenaline injector
• Checking the device to make sure the solution is clear, does not appear to have been used, and has been stored appropriately
• Obtaining a replacement device if there are doubts about the integrity of the patient’s injector
• Assessing the patient’s capacity to administer the injector safely during their hospital admission
• Involving the parent, guardian or carer, if appropriate
• Identifying a readily accessible location
• Ensuring that access does not compromise the safety of others.

Ensure clinical communication processes are in place for alerting staff to the patient’s allergy and anaphylaxis risk (for example, via EMR and patient records) at clinical handover and during transitions of care, and of the need to ensure the patient has access to the adrenaline injector for self-administration at all times, including while in the hospital. In addition, the policy should ensure that nurses are aware the patient has their own adrenaline injector device and that hospital staff can administer the device in an emergency, if this is the closest available adrenaline.

The Safer Care Victoria change package, Use of a patient’s own adrenaline (epinephrine) autoinjector in hospital, includes an in-hospital checklist for assessing the ability of patients to use their own adrenaline injectors.

See bettersafercare.vic.gov.au/clinical-guidance/emergency/use-of-a-patients-own-adrenaline-epinephrine-autoinjector-in-hospital