Background: Anaphylaxis is a time sensitive and potentially life threatening allergic reaction. Definitive treatment is intramuscular administration of epinephrine in the anterolateral thigh. Epinephrine administration has been associated with drug errors related to concentration, dosing or route. Studies suggest epinephrine injections (EI)s have a higher risk of life threatening errors. Average time to death from anaphylaxis in autopsy studies was shown to be five minutes. In our institution, anaphylaxis is commonly treated with EIs and not EAIs due to cost and availability of EAIs. Our objective was to perform a simulation study to assess delays or errors in anaphylaxis treatment. Methods: A standardized script involving a 5 year old patient with anaphylaxis to an IV medication was created by a multidisciplinary group of simulation experts. One pediatric resident and one registered nurse participated in the scenario between May-August 2018. All participants were PALS certified. The patients who received incorrect dosages or concentrations `worsened` and required PALS resuscitation. At least 3 simulation staff members observed the scenario and recorded time to epinephrine injection and errors in administration. Demographics and data for time to epinephrine administration and medication errors were collected. A thorough debriefing session following each scenario was conducted to ensure participants understood any errors.
Results: 12 simulations were conducted in our institution. The mean time to order epinephrine was 56 seconds. The mean time to administer adrenaline was 137 seconds. 83% of the orders given by residents contained errors in dosage of epinephrine, location or administration or concentration of epinephrine. The most common error was use of incorrect concentration. Conclusions: Our in-situ simulation of a standardized anaphylaxis scenario reveal delays and errors in ordering and administering epinephrine.
