BROCKTON AREA MULTI-SERVICES, INC. MEDICAL PROCEDURE GUIDE. Date(s) Reviewed/Revised:

Transcription

1 Page 1 of 5 PROCEDURE FOR: MAP-certified staff and RN/LPN MAP-certified staff are to be trained in the use of epinephrine administration via pre-filled autoinjector devices(s) annually. Certified staff should be approved separately for each individual that they work with who is at risk of anaphylactic shock and may require epinephrine via prefilled auto-injector. A Health Care Provider, Registered Nurse (RN), or Physician Assistant (PA), must conduct the specialized training in administration of epinephrine via pre-filled auto-injector device. A Licensed Practical Nurse (LPN) who is able to demonstrate initial and continued competence may provide subsequent annual epinephrine administration via auto-injector device competency reviews. Trainings must be individual-specific, with a review of the signs and symptoms of the individual s allergic response to certain stimuli. Individual-specific training must be provided yearly or as many times as necessary to ensure competency. The determination of competency is solely the decision of the trainer. PURPOSE: Epinephrine auto-injector devices (0.3 and 0.15 mg epinephrine) are for the emergency treatment of severe allergic reactions (anaphylaxis) caused by allergens, exercise, or unknown triggers, and for individuals who are at increased risk for these reactions. Epinephrine auto-injector devices are designed to be used immediately to treat an allergic reaction fast, and to give more time to get to a hospital or medical center. Epinephrine auto-injector devices are not a substitute for emergency medical treatment. EQUIPMENT: Epinephrine Auto-Injector Device INFORMATION: 1. MAP policy requires a physician s order for the administration of all medications. All MAP policy regulations apply to the use of this medication. 2. Unless otherwise indicated, the epinephrine auto injector device must be stored in a locked medication room, at room temperature, away from moisture, heat, and light. Do not refrigerate this medication, and do not store it in a car. Any individual that is able to self-

2 Page 2 of 5 administer may keep the epinephrine auto injection device on their person. Individuals may need a physician s order to keep the epinephrine auto injector on their person. If an individual attends a day program, staff must coordinate with the program such as making sure the day program has an order and an epinephrine auto injector device is on site. 3. The epinephrine auto injector is checked daily for expiration. Do not use the medication if it has changed colors or has any particles in it, or if the expiration date on the label has passed. Expired or discontinued epinephrine auto injectors must be disposed of per policy. The auto injector must be disposed of in a sharps container and documented in the disposal log. Call a doctor for a new prescription. 4. Epinephrine is a medication that is used in emergencies to treat very serious allergic reactions to insect stings/bites, foods, drugs, or other substances. Epinephrine acts quickly to improve breathing; stimulate the heart; raise a dropping blood pressure; reverse hives; and reduce swelling of the face, lips, and throat. All staff must be aware of the individual specific reasons for the epinephrine auto injection. 5. An allergic reaction can be provoked by skin contact with poison plants, chemicals, and animal scratches, as well as by insect stings. Ingesting or inhaling substances like pollen, animal dander, molds and mildew, dust, nuts, and shellfish may also cause allergic reaction. Allergy symptoms vary, but may include: Breathing problems (coughing, shortness of breath) Burning, tearing, or itchy eyes Conjunctivitis (red, swollen eyes) Coughing Diarrhea Headache Hives Itching of the nose, mouth, throat, skin, or any other area Runny nose Skin rashes Stomach cramps Vomiting Wheezing

3 Page 3 of 5 The part of the body that is contacted by the allergen plays a role in the symptoms developed. For example: Allergens that are breathed in often cause a stuffy nose, itchy nose and throat, mucus production, cough, or wheezing. Allergens that touch the eyes may cause itchy, watery, red, swollen eyes. Eating something an individual is allergic to can cause nausea, vomiting, abdominal pain, cramping, diarrhea, or a severe, life-threatening reaction. Allergens that touch the skin can cause a skin rash, hives, itching, blisters, or even skin peeling. Drug allergies usually involve the whole body and can lead to a variety of symptoms. Anaphylaxis is a severe allergic reaction marked by swelling of the throat or tongue, hives, and trouble breathing. When it strikes, life is at risk. Time is critical. Anaphylaxis symptoms usually occur within minutes of exposure to an allergen. Sometimes, however, anaphylaxis can occur a half-hour or longer after exposure. Anaphylaxis symptoms include: Skin reactions, including hives along with itching and flushed or pale skin (almost always present with anaphylaxis) A feeling of warmth The sensation of a lump in your throat Constriction of the airways and a swollen tongue or throat, which can cause wheezing and trouble breathing A feeling of impending doom A weak and rapid pulse Nausea, vomiting, or diarrhea Dizziness or fainting

4 Page 4 of 5 PROCEDURE: 1. Remove the safety cap. Never put your fingers over the tip when removing the safety cap or after the safety cap has been removed. 2. Form a fist around the auto-injector with the black tip pointing down. 3. Place the black tip against the fleshy portion of the outer thigh. You may give the injection directly through clothing. Do not put your thumb over the end of the unit. 4. With a quick motion, push the auto-injector firmly against the thigh. This will release the spring-loaded needle that injects the dose of epinephrine. Hold the auto-injector in place for a few seconds after activation. 5. Remove the auto-injector from thigh. Carefully re-insert the used device needle-first into the carrying tube. 6. Use each auto-injector only one time. Re-cap the epinephrine auto-injector device, and show to the EMT when they arrive. Throw away after one use, in the sharps disposal container, even if there is still some medicine left in it. 7. Notify 911 immediately. 8. Stay with the individual. 9. Make sure you verbally tell EMTs that the individual received the epinephrine auto injection and what the allergen is, if you know. Show the EMTs the epinephrine auto injector device. Remember, every time the epinephrine auto-injector is used to prevent an anaphylactic reaction:

5 Page 5 of must be utilized. 2. The individual must be sent to the hospital for an evaluation. The effectiveness of the epinephrine lasts about minutes. Side effects of epinephrine may include: Increase in heart rate Stronger or irregular heartbeat Sweating Nausea and vomiting Difficulty breathing Paleness Weakness or shakiness Headache Apprehension Nervousness Dizziness Anxiety These side effects usually go away quickly, especially with rest. If the individual has high blood pressure or an overactive thyroid, these side effects may be more severe or longerlasting. If the individual has heart disease, they could experience chest pain (angina). If they have diabetes, their blood sugar levels may increase after use. If they have Parkinson's disease, their symptoms may temporarily get worse. TRAININGS: The Individual Specific Competency Tool must be utilized for trainings. The signed Individual Specific Competency Tool must be kept at the program. DOCUMENTATION: Document in the MAR, and document the effectiveness of the medication. A note must be written in the Medical Progress Notes. Note must include a description of the full incident. Note must also include call to 911, and call to the PCP. Program manager and/or program nurse must be notified. If off-hours/weekends, utilize the on-call system.