Pharmacists’ response to anaphylaxis in the community (PRAC): a randomised, simulated patient study of pharmacist practice

Abstract

ObjectiveTo evaluate how community pharmacists manage patients with anaphylaxis.DesignA randomised, cross-sectional, simulated patient study of community pharmacist practice.Setting300 metropolitan pharmacies located in Perth Australia, randomised to three groups of 100 pharmacies. Each group corresponded to a different epinephrine autoinjector: original EpiPen, new-look EpiPen or Anapen.Participants300 pharmacies were visited with 271 simulated patient visits included in the final analysis (88=original EpiPen, 92=new-look EpiPen, 91=Anapen).Outcome measuresPrimary anaphylaxis preparedness (readiness to treat acute anaphylaxis). Secondary anaphylaxis engagement (willingness to engage the patient in a discussion about their anaphylaxis).MethodsSimulated patients approached pharmacists, using a standardised scenario, for assistance with epinephrine autoinjector use and advice about the use of antihistamines in anaphylaxis. Scores for each outcome were obtained based on the number of predefined statements addressed by the pharmacist during the consultation (maximum score=5 for preparedness and 8 for engagement).ResultsThe mean anaphylaxis preparedness score was 2.39 points (SD 1.17). Scores for new-look EpiPen were significantly higher than for original EpiPen and Anapen (2.75 vs 2.38 points, p=0.027; 2.75 vs 2.03 points, p<0.001, respectively). Overall, 17.3% of pharmacists correctly demonstrated the epinephrine autoinjector. The mean anaphylaxis engagement score was 3.11 points (SD 1.73). Scores for new-look EpiPen were similar to original EpiPen and Anapen (3.11 vs 3.32 points; 3.11 vs 2.90 points, both p=0.42). Engagement was associated with preparedness. For each additional engagement point, preparedness increased by 7% (0.357 points; 95% CI 0.291 to 0.424; p<0.001).ConclusionsPharmacists demonstrated reasonable knowledge of anaphylaxis symptoms and emergency care, but had poor epinephrine autoinjector technique and rarely discussed anaphylaxis action plans. Pharmacists who had a more comprehensive discussion about anaphylaxis with patients, were more prepared for anaphylaxis emergencies. Future research should evaluate the nature and significance of errors in pharmacists’ autoinjector technique.

A systematic review of the use of simulated patient methodology in pharmacy practice research from 2006 to 2016

“…Out of the 1107 papers in the original search and two added due to quoting the 2006 review, 148 papers met the criteria . Extraction of relevant papers from those found by the search strategy was done jointly by two researchers (IB and PN) and independently by a third researcher (AA).…”

Pitfalls in the use of epinephrine for anaphylaxis: patient and provider opportunities for improvement

“…Salter et al . used simulated patients to assess pharmacists’ ability to assist patients in management of anaphylaxis and found only 17% were able to correctly demonstrate the use of an EAI.…”

Managing vaccine‐associated anaphylaxis in the pharmacy

“…This highlights a need for continued education provision by pharmacists to patients prescribed an auto‐injector device. A recent study that used simulated patients to approach pharmacists and ask for assistance on how to use their auto‐injector, identified that only 47 of 271 (17.3%) of Australian pharmacists could correctly demonstrate how to use an adrenaline auto‐injector …”

“…A recent study that used simulated patients to approach pharmacists and ask for assistance on how to use their auto-injector, identified that only 47 of 271 (17.3%) of Australian pharmacists could correctly demonstrate how to use an adrenaline auto-injector. 27 Literature reports that when health practitioners are stressed, utilising tools that can reduce reliance on memory and dose calculations reduces medication error rates and improves health outcomes for patients. 28 Following a series of adrenaline dosing errors, a US hospital replaced adrenaline ampoules and associated needles and syringes with prefilled adrenaline auto-injectors in emergency carts for use by doctors in the event of anaphylaxis.…”

“…© 2015 Society of Hospital Pharmacists of Australia.Journal of Pharmacy Practice and Research (2015) 45,[24][25][26][27][28][29][30] …”