A systematic review of patients', parents' and healthcare professionals' adrenaline auto-injector administration techniques

Abstract

IntroductionIn order to enable fast treatment response to anaphylactic reactions, adrenaline auto-injectors (AAI) have been developed and manufactured. It has been reported in several studies that administration technique is suboptimal. The primary purpose of this study was to review the nature and extent of the deficiencies in administration technique among patients, parents/caregivers and healthcare professionals.MethodsRelevant publications were identified between 1998 and 2015 using two search methods: a keyword search in Embase, PubMed, British Nursing Index and Cumulative Index to Nursing and Allied Health Literature and a search of reference lists of relevant articles.ResultsTwenty-three studies met the inclusion criteria. Overall, 37% of patients, 32% of parents/caregivers and 21% of healthcare professionals demonstrated correct administration technique. For studies which employed a before-and-after training study design, correct technique was achieved in 77% of patients, 79% of caregivers and 65% of healthcare professionals. The most consistently observed error was the failure to hold the device in place for the recommended time. For patients, factors associated with good technique were being aged over 18 years, trained in AAI administration by an allergist, prescribed an AAI for more than 30 months, having a history of severe anaphylaxis and membership of a support group. For parents/caregivers in addition to those mentioned, being given a training device with which to practice, improved technique.DiscussionThere was wide variation in administration techniques reported. However, studies designed using before-and-after training show that even a brief demonstration and educational intervention can improve technique. Further studies are required to design and pilot acceptable and cost-effective educational materials.

Interventions for caregivers of children with food allergy: A systematic review

“…As studies eligible for this review incorporated both qualitative and quantitative designs, quality assessment was guided by the Mixed Methods Appraisal Tool (MMAT) 17 . This is an effective and practical tool for systematic reviews that include varied study designs and mixed methods and has been used in recent reviews in the allergy literature 18 . The tool consists of two screening questions, followed by four criteria for appraising study design.…”

“…17 This is an effective and practical tool for systematic reviews that include varied study designs and mixed methods and has been used in recent reviews in the allergy literature. 18 The tool consists of two screening questions, followed by four criteria for appraising study design. The MMAT scores range from 0% to 100% (where all four criteria are met).…”

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“…Interestingly young people commented on the disadvantage of changes to AAI design as people were familiar with the somewhat undesirable, existing devices. The importance of device familiarity is probably over-rated given that study after study has demonstrated that patients' , careers' and health professionals' are unfamiliar with the administration of even the most commonly prescribed AAIs [21]. There is very little evidence to suggest that the threatened loss of 'familiarity' with existing devices should ever be used as an excuse to impede the development of better AAIs.…”

Favorable clinical efficacy of mepolizumab on the upper and lower airways in severe eosinophilic asthma: a 48-week pilot study

“…In addition, there was unwillingness of some community pharmacists to be interviewed or to reply to certain questions, perhaps because they thought that they were tested for their knowledge, and less that they were participating in a scientific study with the aim of informing future policies that will benefit the population. Deficiencies in the correct administration technique of EAI by patients, parents / caregivers, and health-care professionals (including physicians) have been recorded in many studies in the past (2,(6)(7)(8)11,12). Factors that increase the correct use of EAI included patients' age over 18 years, training offered by an allergologist, prescription of an EAI for more than 30 months, anamnesis of severe anaphylaxis, and membership in a support group (11).…”