Policy Manual sample

MDT Home Health Care Agency, Inc. 5 ANAPHYLAXIS TREATMENT GUIDELINES PURPOSE: Anaphylaxis is an acute, life-threatening immunologic reaction which consists of the following signs and symptoms, either alone or in combination: diffuse erythema, pruritis, urticaria, angioedema, bronchospasm, laryngeal edema, hyperistalsis, hypotension or cardiac arrhythmias. Anaphylaxis occurs rapidly after exposure to the cause, usually reaching the peak severity within 5 to 30 minutes. These symptoms result from the rapid release of the inflammatory mediators from mast cells and basophils in response to the offending antigen. Clinical features may appear alone or in combination and include upper airway obstruction due to angioedema (swelling of larynx and tongue, presenting in tightness of the throat); bronchospasm presented as wheezing or chest tightness; hypotension secondary to increased permeability and shift of intracellular fluids to extracellular spaces; vasoconstriction-compensatory reaction to the hypotension; nausea, vomiting, diarrhea, abdominal pain, flushing, urticaria and pruritis. The most common drugs which cause anaphylactic reactions are NSAID’S, aspirin, penicillins, cephalosporins, insulin, sulfonamides, blood products, vaccines and enzymes such as trypsin, chymopapain and streptokinase. However, anaphylaxis can occur to many other drugs, foods and other substances as well. The following guidelines will be followed: 1) Physician’s orders for treatment of anaphylaxis will be obtained prior to dispensing medications for potential anaphylactic situations as coordinated with the infusion company. 2) Anaphylaxis kits will be dispensed by the infusion company who will obtain physician orders. The nurse will ensure all orders are obtained as needed prior to the initiation of the infusion. 3) It is not required that anaphylaxis kits be dispensed for every medication administered in the home setting. The need to provide the kit will be based on the potential of the drug to produce anaphylaxis and the patient’s history of allergies. The nurse may request an order for an anaphylactic kit in the home if, in the nurse’s judgment this would ensure the safety of the patient. 4) Obtain standing orders from the physician for anaphylaxis treatment as coordinated with the infusion company (see attached form and recommended protocol). 5) Follow procedures noted in the “First Dose” policy. PERSONNEL RESPONSIBLE: RN EQUIPMENT: • Anaphylactic kit (should include Epinephrine 1:1000 ampules, Benadryl 50mg/ml vials or tubex, NACL 0.9% 500 ml, unfiltered IV administration set, IV start kit and catheters)