Key points of what you should expect in hospital
On arrival at the hospital the patient:
- Will be assessed by hospital staff
- Not be left alone
- Lie flat and not stand or walk. If sitting in a chair, legs should be outstretched resting on another chair, not hanging down. If the patient is a baby or child being held by an adult, they must be held in a horizontal, not an upright position. Legs must not be hanging down
- Stay at the hospital for a minimum of 4 hours after the last dose of adrenaline
Before leaving hospital you should get:
- Information about what could have caused the severe allergic reaction and how to avoid it.
- An ASCIA Action Plan if you don’t have a current one or it needs updating.
- Advice to see your general practitioner (GP) in the following day or two and information on how to make an appointment with an allergy specialist
- Advice about wearing special jewellery (necklace or bracelet) that says you have an allergy
- An adrenaline device or a prescription for this medicine if there is a risk of having anaphylaxis again. If you are given a prescription, it is very important that you go to a pharmacy to get the adrenaline device as soon as possible, preferably on the way home from hospital
- Training on how to give the adrenaline device you have been prescribed. This should be done prior to discharge from hospital by medical or nursing staff. This may also be done at the pharmacy when you are getting your two adrenaline devices
Clinical Care Standard
Please note that the Clinical Care Standard has not been updated since new adrenaline devices have entered the Australian market.
The Clinical Care Standard outlines the care that you should get from paramedics, nurses, and doctors in a healthcare setting if you experience or are at risk of anaphylaxis. The standard is made up of 6 statements that explain the importance of recognising and treating anaphylaxis quickly, treating it the right way and providing the patient with the right information before they are discharged.
The information below details the six Quality Statements and what each of them means for someone who is at risk of anaphylaxis.
1) Prompt recognition of anaphylaxis
What the standard says:
A patient with acute-onset clinical deterioration with signs or symptoms of an allergic response is rapidly assessed for anaphylaxis, especially in the presence of an allergic trigger or a history of allergy.
What this means for you:
If you have symptoms that could mean you are having an allergic reaction; you will be assessed to see if you are experiencing anaphylaxis.
If you have an allergy or have had anaphylaxis before, it’s important to let your nurse or doctor know.
2) Immediate injection of intramuscular adrenaline
What the standard says:
A patient with anaphylaxis, or suspected anaphylaxis, is administered adrenaline intramuscularly without delay, before any other treatment including asthma medicines. Corticosteroids and antihistamines are not first-line treatment for anaphylaxis.
What this means for you:
If a nurse or doctor believes you are experiencing anaphylaxis, they will immediately give you adrenaline.
If you recognise the signs of anaphylaxis yourself, use your adrenaline device (if prescribed) without delay and call for help immediately. If you’re not sure, it’s safer to use your adrenaline device than to wait for symptoms to get worse.
The adrenaline should work within 5 minutes. If you don’t start to feel better after 5 minutes, use a second adrenaline device, if you have one.
Always follow the instructions on your ASCIA Action Plan if you have one.
3) Correct patient positioning
What the standard says:
A patient experiencing anaphylaxis is laid flat or allowed to sit with legs extended if breathing is difficult. An infant is held or laid horizontally. The patient is not allowed to stand or walk during, or immediately after, the event until they are assessed as safe to do so, even if they appear to have recovered.
What this means for you:
When you are experiencing anaphylaxis, you will be advised to lie flat. If breathing is difficult, you may sit with your legs outstretched. If you feel faint, your legs may be elevated. If you’re pregnant, you should lie on your left side to ensure continued blood circulation to your body. An infant should be held horizontally across your body. Do not hold an infant upright or over your shoulder.
If you have had adrenaline, do not stand or walk anywhere, even to the bathroom, ambulance or emergency department, until a nurse or doctor has said it’s safe for you to do so. This is usually a minimum of one hour after one dose of adrenaline or 4 hours if more than one dose is given.
4) Access to a personal adrenaline device in all healthcare settings
What the standard says:
A patient who has an adrenaline device has access to it for self-administration during all healthcare encounters. This includes patients keeping their adrenaline device safely at their bedside during a hospital admission.
What this means for you:
If you have a personal adrenaline device and know how to use it, you should:
- Keep your adrenaline device close by while you’re being treated in a health service, hospital, ambulance, or clinic. For example, if you’re admitted to hospital, keep it at your bedside for you or staff to use if necessary.
- Tell your healthcare team that you have an adrenaline device and arrange with them to keep it near you during your care.
- Keep the adrenaline device with your ASCIA Action Plan for Anaphylaxis in an unlocked location that you can easily reach.
If you believe you are having an allergic reaction and experience symptoms such as breathing difficulties, faintness, swelling of your tongue or tightness in your throat while in a healthcare service, lie down (or sit with your legs outstretched if breathing is difficult), use your adrenaline device as soon as possible and alert a staff member immediately. If a staff member is not close by, you can use your call button which is by your hospital bed if you can safely reach it. It is important that you do not stand up and walk to get help.
5) Observation time following anaphylaxis
What the standard says:
A patient treated for anaphylaxis remains under clinical observation for at least 4 hours after their last dose of adrenaline, or overnight as appropriate, according to the Australasian Society of Clinical Immunology and Allergy Acute Management of Anaphylaxis guidelines. Observation timeframes are determined based on assessment and risk appraisal after initial treatment.
What this means for you:
When you have been treated for anaphylaxis with adrenaline you will be kept under clinical observation for at least 4 hours after the last injection of adrenaline.
In some cases, you may need to be admitted overnight for observation after having anaphylaxis.
6) Discharge management and documentation
What the standard says:
Before a patient leaves a healthcare facility after having anaphylaxis, they are advised about the suspected allergen, allergen avoidance strategies and post-discharge care. The discharge care plan is tailored to the allergen and includes details of the suspected allergen, the appropriate ASCIA Action Plan, and the need for prompt follow-up with a general practitioner and clinical immunology/allergy specialist review. Where there is a risk of re-exposure, the patient is prescribed a personal adrenaline device and is trained in its use. Details of the allergen, the anaphylactic reaction and discharge care arrangements are documented in the patient’s healthcare record.
What this means for you:
Before you leave hospital, your nurse or doctor will speak to you about how you can manage your allergy and reduce your future risk of anaphylaxis in the community. They will also make sure you know what to do to stay safe when you go home.
Before you are discharged from a hospital or healthcare service, it is important you receive:
- Information about your allergic trigger (allergen) and how to avoid it
- An ASCIA Action Plan that includes information about:
- how to recognise the signs of an allergic reaction, including anaphylaxis
- correct positioning of the patient
- how to use the adrenaline device, if prescribed
- calling an ambulance by dialing triple zero (000)
- further adrenaline if no improvement after 5 minutes
- Training by medical or nursing staff on how to use the adrenaline device you have been prescribed
- Advice to make an appointment and see your general practitioner (GP)
- Information on how to arrange an appointment with a clinical immunology/allergy specialist. If this is your first anaphylaxis emergency, the specialist will help to confirm the cause of your anaphylaxis and advise you about how to manage your allergy. If you already have a regular specialist, arrange to see them for follow-up.
- Advice about wearing special jewellery to identify that you have an allergy.
If you’re at risk of re-exposure to the allergen trigger, you will also be given a personal adrenaline device or a prescription for this medicine. If you’re given a prescription, go to a pharmacy to get the adrenaline device as soon as possible, preferably on your way home from the hospital. The adrenaline device should always be kept with you or your carer.
More resources
Five key steps to stay safe if you have allergies and are at risk of anaphylaxis
For further information on best practice in recognising and treating anaphylaxis in healthcare settings see the Acute Anaphylaxis Clinical Care Standard. It outlines what you should expect while you are in hospital, including what you need before you go home.
Preparing for an emergency
Learn more about preparing for a severe allergic reaction (anaphylaxis) and what to expect if you or a loved one experiences anaphylaxis.