Quality standard

Quality statement 4: Ongoing training in adrenaline auto-injector use

Quality statement 4: Ongoing training in adrenaline auto-injector use

Quality statement

People who have received treatment for anaphylaxis are retrained on the use of their adrenaline auto-injector each time it is represcribed. [2016, updated 2024]

Rationale

Recurrence of anaphylaxis can occur a long time after the adrenaline auto-injector (AAI) is first prescribed. It is therefore important that the person who has received treatment for anaphylaxis, or their parents or carers if applicable, has regular training in its use to ensure it can be used effectively when needed.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

Proportion of people who have received treatment for anaphylaxis who are retrained on the use of their AAI each time it is represcribed.

Numerator – the number in the denominator who are retrained to use their AAI.

Denominator – the number of people who have received treatment for anaphylaxis who are represcribed an AAI.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records and pharmacy dispensing records.

What the quality statement means for different audiences

Service providers (such as pharmacies, and paediatric and adult medical services) ensure that healthcare professionals can provide brand-specific training on the use of AAI each time they are represcribed to people who have received treatment for anaphylaxis.

Healthcare professionals (such as pharmacists and members of paediatric and adult medical services) provide brand-specific training for people who have received treatment for anaphylaxis, or their parents or carers if applicable, when an AAI is represcribed. They also ensure that the person is retrained with a trainer AAI on each represcription and remind them that AAIs expire and to check the date when they collect their prescription.

Commissioners ensure that services train people who have received treatment for anaphylaxis, or their parents or carers if applicable, how to use their AAI each time it is represcribed.

People who have received treatment for anaphylaxis, or their parents or carers if applicable, are shown how to use their specific brand of adrenaline auto-injector (AAI), with a trainer AAI, each time it is represcribed to ensure they know how to use it if needed. They are also reminded that AAIs expire and that they need to check the date when they collect their prescription.

Definitions of terms used in this quality statement

Training in when to use an adrenaline auto-injector

There are a number of possible signs of anaphylaxis. People should be informed that any 1 of the following signs or symptoms is enough to warrant immediate use of an AAI:

  • Airway (A): swelling in the throat, tongue or upper airways (tightening of the throat, hoarse voice, difficulty swallowing).

  • Breathing (B): sudden-onset wheezing, breathing difficulty, noisy breathing.

  • Circulation (C): dizziness, feeling faint, sudden sleepiness, tiredness, confusion, pale clammy skin, loss of consciousness.

People should be informed that if they experience any of the above signs or symptoms, they should not delay in administering an AAI, even if they also have signs that they would normally associate with a milder reaction (such as an itchy throat or swelling of the lips). They should take notice of severe signs and symptoms, regardless of what else is happening. If in any doubt about severity, or if previous reactions have been severe, an AAI should be used.

If there is no improvement 5 minutes after the first injection, or if there is a deterioration after an initial improvement, the second AAI should be used while waiting for the ambulance. Other medicines such as antihistamines and inhalers can be given as necessary.

The Medicines and Healthcare products Regulatory Agency (MHRA) has produced a video for people with anaphylaxis explaining what they should do if they experience an episode of anaphylaxis. This link can be provided to people when they are being shown how and when to use an AAI. [Adapted from the MHRA and Commission on Human Medicines' Public Assessment Report of the Commission on Human Medicines' Adrenaline Auto-injector Expert Working Group: Recommendations to support the effective and safe use of adrenaline auto-injectors and MHRA's guidance on adrenaline auto-injectors]

Training in how to use an adrenaline auto-injector

This includes:

  • Ensuring the person knows they should carry 2 AAIs with them at all times.

  • Providing a brand-specific demonstration of using an AAI and practise using a training device.

  • Encouraging the person to get familiar with the device by getting a trainer AAI from the manufacturer to practise with.

  • Providing advice on lying down after using the AAI (or propping themselves up slightly if they are struggling to breathe). It is imperative to avoid any sudden change in posture and above all, the person must not stand up, or sit in a chair, even if they are feeling better due to the risk of cardiac arrest.

[Adapted from NICE's guideline on anaphylaxis, recommendation 1.1.11, and the MHRA and Commission on Human Medicines' Public Assessment Report of the Commission on Human Medicines' Adrenaline Auto-injector Expert Working Group: Recommendations to support the effective and safe use of adrenaline auto-injectors (2021)]

Key information for people who have had an anaphylactic episode

What to do in an emergency:

  • Use your AAI immediately if you have any signs of anaphylaxis. If in doubt, use. Do not delay.

  • Dial 999 – say anaphylaxis ("ana-fill-axis") – straight after using your auto-injector.

  • Lie down and raise your legs.

  • Sit up if you are struggling to breathe, but do not change position suddenly.

  • Lie down again as soon as you can.

  • Stay lying down even if you are feeling better.

  • You must not stand up even if someone encourages you to.

  • Use your second AAI if you have not improved after 5 minutes.

Be prepared:

  • Carry 2 AAIs with you at all times.

  • You must use your AAI as soon as you notice any signs of anaphylaxis.

  • Make sure you know beforehand what the signs are so you can act swiftly.

  • Make sure you know how to use your AAI before you need to. Get familiar with it. Get a trainer AAI from the manufacturer. Practise. If you change brand, get familiar with the new one. Each one is used differently.

[Adapted from the MHRA and Commission on Human Medicines' Public Assessment Report of the Commission on Human Medicines' Adrenaline Auto-injector Expert Working Group: Recommendations to support the effective and safe use of adrenaline auto-injectors (2021)]

Equality and diversity considerations

People should be provided with information about using AAIs that they can easily read and understand themselves, or with support, so they can communicate effectively with health and social care services. Information should be in a format that suits their needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate and age appropriate. People should have access to an interpreter or advocate if needed.

For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.