ORIGINAL ARTICLE
Pitfalls in the use of epinephrine for anaphylaxis: patient and provider opportunities for improvement
Michael B. Cohen MD,
Stefanie S. Saunders MD, MS,
Sarah K. Wise MD, MSCR,
Samih Nassif BS,
Michael P. Platt MD, MSc,
Michael B. Cohen MD
Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, MA
Division of Otolaryngology, Department of Surgery, Veterans’ Affairs Boston Healthcare System, Boston, MA
Search for more papers by this authorStefanie S. Saunders MD, MS
Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, MA
Search for more papers by this authorSarah K. Wise MD, MSCR
Department of Otolaryngology–Head and Neck Surgery, Emory University, Atlanta, GA
Search for more papers by this authorSamih Nassif BS
School of Medicine, Boston University, Boston, MA
Search for more papers by this authorCorresponding Author
Michael P. Platt MD, MSc
Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, MA
School of Medicine, Boston University, Boston, MA
Correspondence to: Michael P. Platt, MD, MSc, 820 Harrison Avenue, Boston, MA 02118; e-mail: [email protected]Search for more papers by this authorMichael B. Cohen MD,
Stefanie S. Saunders MD, MS,
Sarah K. Wise MD, MSCR,
Samih Nassif BS,
Michael P. Platt MD, MSc,
Michael B. Cohen MD
Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, MA
Division of Otolaryngology, Department of Surgery, Veterans’ Affairs Boston Healthcare System, Boston, MA
Search for more papers by this authorStefanie S. Saunders MD, MS
Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, MA
Search for more papers by this authorSarah K. Wise MD, MSCR
Department of Otolaryngology–Head and Neck Surgery, Emory University, Atlanta, GA
Search for more papers by this authorSamih Nassif BS
School of Medicine, Boston University, Boston, MA
Search for more papers by this authorCorresponding Author
Michael P. Platt MD, MSc
Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, Boston, MA
School of Medicine, Boston University, Boston, MA
Correspondence to: Michael P. Platt, MD, MSc, 820 Harrison Avenue, Boston, MA 02118; e-mail: [email protected]Search for more papers by this authorPotential conflict of interest: S.K.W.: Consultant Merck, Medtronic; Scientific Advisory Board Greer Labs; Research Support Genentech. M.B.C.: Consultant GI Reviewers.
Abstract
Background
Epinephrine remains the mainstay of treatment for life-threatening allergic reactions. A number of challenges are encountered with epinephrine, resulting in underutilization and misutilization of epinephrine. The purpose of this study was to identify the scope of epinephrine pitfalls and opportunities for improvement in the management of allergy emergencies.
Methods
A PubMed search from 1990 to 2015 was performed to identify all cases and reports pertaining to the use and misuse of epinephrine for anaphylaxis. Studies were assessed for obstacles or complications related to proper administration of epinephrine for treatment of allergic reactions, and were divided into problems originating with patients compared to healthcare providers.
Results
There were 1840 publications related to epinephrine use, of which 61 reports met inclusion criteria for pitfalls in the use of epinephrine. The most common problems reported related to lack of autoinjector availability (22), inadequate education of patients or providers (9), uncertainty about when or how to administer epinephrine (9), concern for systemic effects (13), failure to administer (8), and accidental administration (2). Responsibility for errors was divided among patients (18), providers (39), or both (4).
Conclusion
Epinephrine is a potent medication with lifesaving indications and is the standard of care for treatment of anaphylaxis. The delivery of epinephrine in both trained and untrained populations carries certain pitfalls and complications that can have serious consequences. Identification of the scope of the problem is an important step in improving education for both providers and patients who are tasked with use of epinephrine for allergy emergencies.
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