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Using Video Technology to Improve Epinephrine Auto-Injector Use
Abstracts AB211
J ALLERGY CLIN IMMUNOL VOLUME 135, NUMBER 2
Using Video Technology to Improve Epinephrine Auto-Injector Use Ashish Asawa, MD1, Aasia I. Ghazi, MD2, Rana S. Bonds, MD, FAAAAI1; 1University of Texas Medical Branch, Galveston, TX, 2Allergy and Asthma Specialists, Plano, TX. RATIONALE: Incorrect use of epinephrine auto-injectors is well documented in the literature. We hypothesized that providing personalized instructional videos that patients can access via email would improve selfadministration technique. METHODS: 102 patients aged 12 and above who were previously prescribed epinephrine auto-injectors were recruited and randomized to receive an instructional video versus no video in this IRB-approved study. All participants received standard of care instruction. Active arm participants were given a video of themselves demonstrating proper self-administration of the auto-injector. They received a bi-weekly email-viewing reminder. At three and six month follow-up, participants demonstrated use of the autoinjector. A blinded investigator evaluated their technique. RESULTS: Number of missed steps decreased significantly from baseline to three months in both groups (t-test, p<0.0001). The percentage of patients with perfect self-administration increased from 16% to 43% at three months (Fisher’s, p<0.0001) with no difference between active and control arms. At three months, participants who viewed their video two or more times demonstrated correct use more frequently than participants viewing the video less than twice (Fisher’s p50.03). CONCLUSIONS: There was significant improvement in epinephrine self-administration technique at three months in both study arms. Receiving the video did not increase likelihood of perfect technique; however, viewing the video multiple times was associated with correct auto-injector technique. We suspect the study made participants accountable for proper medication use, and motivated subjects in both arms to prepare for follow-up assessments. In practice, we suggest that patients should be made accountable by requiring them to demonstrate epinephrine auto-injection technique at each appointment.
681
Parent / Child Perceptions of Children's Readiness to SelfInject Epinephrine Caitlin Shneider1, Evan Wiley, BA1, Brianna Lewis, MA1, Melissa Rubes, MA1, Eyal Shemesh, MD1, Rachel Annunziato, PhD1,2, Scott H. Sicherer, MD1; 1Icahn School of Medicine at Mount Sinai, New York, NY, 2Fordham University, Bronx, NY. RATIONALE: To decide upon a food-allergic child’s autonomy, the parent and child must be comfortable with the child self-injecting epinephrine; however, little is known about the consistency of parentchild assessment of this responsibility. METHODS: Children with food allergies ages 8-18 years and their parents attending a food allergy referral center independently completed surveys containing the query: ‘‘Can you (your child) use an epinephrine auto-injector on your (his/her) own if needed’’ (‘‘Never’’, ‘‘Sometimes’’, ‘‘Most of the time,’’ ‘‘Always’’ or ‘‘Don’t know’’). We predefined a child (ages 8-11 years) and an ‘‘adolescent’’ (ages 12-18 years) age group. RESULTS: There were 413 parent-child pairs (273 children, 140 adolescents). Overall, 38% of parents and 22% of children reported ‘‘don’t know’’; those responses were excluded from the correlational analyses. In the child age group, parents and children’s perception about the child’s ability to self-inject generally aligned well with each other (Kappa5.79), but there was substantial disagreement between adolescents and parents (Kappa 5 .48). 69% of adolescents perceived that they can self-inject ‘‘most of the time’’ or ‘‘always’’, whereas only 53% of parents thought so. Even in instances in which an auto-injector was previously used (34.9% of the sample), many parents reported that they ‘‘don’t know’’ if their child (33.7%) or adolescent (32.8%) can self-inject, and agreement between parents and adolescents remained low (Kappa5.44). CONCLUSIONS: Parents and adolescents disagree about whether the adolescent can self-inject epinephrine. This lack of agreement may lead to confusion in decisions related to granting autonomy to the food-allergic adolescent.
682
School Staff Food Allergy (FA) Education Increases Epinephrine Coverage and Recognition of Allergic Reactions Atoosa Kourosh, MD, MPH1,2, C. M. Davis3; 1Texas Children’s Hospital, Houston, TX, 2Baylor College of Medicine, Houston, TX, 3Immunology, Allergy and Rheumatology, Department of Pediatrics, Baylor College of Medicine/Texas Children’s Hospital, TX. RATIONALE: Because 5-8% of children have FA, 16-18% experience reactions and 28% of fatalities secondary to anaphylaxis occur in school, improving recognition and treatment of school FA reactions is essential. We hypothesized that expanding FA training to entire school staff would increase school epinephrine device (Epi) coverage (#Epi/#FA students) and prevent food related allergic reactions. METHODS: A school nurse survey in spring 2013 identified 12 target schools selected for high FA prevalence rates (>6 FA children/school) in the Houston Independent School District. The remaining 68 district schools served as controls. Target school staff received FA training through school nurse didactic sessions. The number of Epi/FA child and food reactions/school for both groups were measured by survey in the spring of 2013 and 2014. Mann Whitney U test was used for analysis. RESULTS: Mean Epi/FA child in 2013 was 61%(0-100%) and 59%(0100%) for target and control schools, respectively.(p5NS) In 2014, Epi/FA child increased to 76%(0-100%)and 71%(0-100%)for target and controls, respectively. (p50.258, p50.05). Recorded FA reaction rates decreased for controls from 36% to 11% but increased for target schools from 7.3% to 10% in 2014. Total FA reactions/school decreased from 2013 to 2014. (p50.003). CONCLUSIONS: Increasing epinephrine coverage for FA children after training reflects awareness of anaphylaxis preparedness. While the rise in allergic reactions/FA children in target schools would seem to indicate increased exposure, it may be due to heightened awareness and recognition with systematic treatment of food related allergic reactions. Further study will determine the effect of staff education on the incidence of reactions.
683
Barriers to Treatment with Epinephrine for Anaphylaxis By School Nurses Ashika Odhav, MD1, Christina E. Ciaccio, MD, FAAAAI1, Marc Serota, MD2, Paul J. Dowling, MD, FAAAAI1; 1Children’s Mercy Hospital, Kansas City, MO, 2University of Colorado Denver, Denver, CO. RATIONALE: Approximately 150-200 fatalities per year occur from anaphylaxis related to food allergies. School nurses have significant barriers associated with administering epinephrine to a student in anaphylaxis including availability of stock epinephrine, expired prescriptions, first episode with previously unknown allergies, state regulations, and legal ramifications. Our survey identifies existing barriers to receiving life-saving epinephrine at school, and to evaluate the need for stock epinephrine. METHODS: In 2012, an anonymous online survey was distributed via an e-mail newsletter to the National Association of School Nurses. Excel was used to generate descriptive statistics. RESULTS: 2,439 school nurses completed the survey. For students with known allergies, 25.3% of students have no epinephrine and 24.6% had two unexpired autoinjectors at school. 16.7% of school nurses replied that they would not give an expired epinephrine. 41.3% would not give a different child’s epinephrine if there was nothing else available. 3.6% would not use a non-patient specific stock epinephrine autoinjector if it were available. In each situation, the majority had the concern for legal repercussions. 43.3% already have stock epinephrine available of which 90.8% felt it improved the overall safety of their students, and 8.6% were not sure. 25.8% had used their stock epinephrine at least once and 10.9% used it more than once. CONCLUSIONS: Significant barriers currently exist which may prevent school nurses from treating episodes of anaphylaxis with life-saving epinephrine. Stock epinephrine available in schools may improve the likelihood that children will receive effective treatment in a timely manner.
MONDAY
680
J ALLERGY CLIN IMMUNOL VOLUME 135, NUMBER 2
Using Video Technology to Improve Epinephrine Auto-Injector Use Ashish Asawa, MD1, Aasia I. Ghazi, MD2, Rana S. Bonds, MD, FAAAAI1; 1University of Texas Medical Branch, Galveston, TX, 2Allergy and Asthma Specialists, Plano, TX. RATIONALE: Incorrect use of epinephrine auto-injectors is well documented in the literature. We hypothesized that providing personalized instructional videos that patients can access via email would improve selfadministration technique. METHODS: 102 patients aged 12 and above who were previously prescribed epinephrine auto-injectors were recruited and randomized to receive an instructional video versus no video in this IRB-approved study. All participants received standard of care instruction. Active arm participants were given a video of themselves demonstrating proper self-administration of the auto-injector. They received a bi-weekly email-viewing reminder. At three and six month follow-up, participants demonstrated use of the autoinjector. A blinded investigator evaluated their technique. RESULTS: Number of missed steps decreased significantly from baseline to three months in both groups (t-test, p<0.0001). The percentage of patients with perfect self-administration increased from 16% to 43% at three months (Fisher’s, p<0.0001) with no difference between active and control arms. At three months, participants who viewed their video two or more times demonstrated correct use more frequently than participants viewing the video less than twice (Fisher’s p50.03). CONCLUSIONS: There was significant improvement in epinephrine self-administration technique at three months in both study arms. Receiving the video did not increase likelihood of perfect technique; however, viewing the video multiple times was associated with correct auto-injector technique. We suspect the study made participants accountable for proper medication use, and motivated subjects in both arms to prepare for follow-up assessments. In practice, we suggest that patients should be made accountable by requiring them to demonstrate epinephrine auto-injection technique at each appointment.
681
Parent / Child Perceptions of Children's Readiness to SelfInject Epinephrine Caitlin Shneider1, Evan Wiley, BA1, Brianna Lewis, MA1, Melissa Rubes, MA1, Eyal Shemesh, MD1, Rachel Annunziato, PhD1,2, Scott H. Sicherer, MD1; 1Icahn School of Medicine at Mount Sinai, New York, NY, 2Fordham University, Bronx, NY. RATIONALE: To decide upon a food-allergic child’s autonomy, the parent and child must be comfortable with the child self-injecting epinephrine; however, little is known about the consistency of parentchild assessment of this responsibility. METHODS: Children with food allergies ages 8-18 years and their parents attending a food allergy referral center independently completed surveys containing the query: ‘‘Can you (your child) use an epinephrine auto-injector on your (his/her) own if needed’’ (‘‘Never’’, ‘‘Sometimes’’, ‘‘Most of the time,’’ ‘‘Always’’ or ‘‘Don’t know’’). We predefined a child (ages 8-11 years) and an ‘‘adolescent’’ (ages 12-18 years) age group. RESULTS: There were 413 parent-child pairs (273 children, 140 adolescents). Overall, 38% of parents and 22% of children reported ‘‘don’t know’’; those responses were excluded from the correlational analyses. In the child age group, parents and children’s perception about the child’s ability to self-inject generally aligned well with each other (Kappa5.79), but there was substantial disagreement between adolescents and parents (Kappa 5 .48). 69% of adolescents perceived that they can self-inject ‘‘most of the time’’ or ‘‘always’’, whereas only 53% of parents thought so. Even in instances in which an auto-injector was previously used (34.9% of the sample), many parents reported that they ‘‘don’t know’’ if their child (33.7%) or adolescent (32.8%) can self-inject, and agreement between parents and adolescents remained low (Kappa5.44). CONCLUSIONS: Parents and adolescents disagree about whether the adolescent can self-inject epinephrine. This lack of agreement may lead to confusion in decisions related to granting autonomy to the food-allergic adolescent.
682
School Staff Food Allergy (FA) Education Increases Epinephrine Coverage and Recognition of Allergic Reactions Atoosa Kourosh, MD, MPH1,2, C. M. Davis3; 1Texas Children’s Hospital, Houston, TX, 2Baylor College of Medicine, Houston, TX, 3Immunology, Allergy and Rheumatology, Department of Pediatrics, Baylor College of Medicine/Texas Children’s Hospital, TX. RATIONALE: Because 5-8% of children have FA, 16-18% experience reactions and 28% of fatalities secondary to anaphylaxis occur in school, improving recognition and treatment of school FA reactions is essential. We hypothesized that expanding FA training to entire school staff would increase school epinephrine device (Epi) coverage (#Epi/#FA students) and prevent food related allergic reactions. METHODS: A school nurse survey in spring 2013 identified 12 target schools selected for high FA prevalence rates (>6 FA children/school) in the Houston Independent School District. The remaining 68 district schools served as controls. Target school staff received FA training through school nurse didactic sessions. The number of Epi/FA child and food reactions/school for both groups were measured by survey in the spring of 2013 and 2014. Mann Whitney U test was used for analysis. RESULTS: Mean Epi/FA child in 2013 was 61%(0-100%) and 59%(0100%) for target and control schools, respectively.(p5NS) In 2014, Epi/FA child increased to 76%(0-100%)and 71%(0-100%)for target and controls, respectively. (p50.258, p50.05). Recorded FA reaction rates decreased for controls from 36% to 11% but increased for target schools from 7.3% to 10% in 2014. Total FA reactions/school decreased from 2013 to 2014. (p50.003). CONCLUSIONS: Increasing epinephrine coverage for FA children after training reflects awareness of anaphylaxis preparedness. While the rise in allergic reactions/FA children in target schools would seem to indicate increased exposure, it may be due to heightened awareness and recognition with systematic treatment of food related allergic reactions. Further study will determine the effect of staff education on the incidence of reactions.
683
Barriers to Treatment with Epinephrine for Anaphylaxis By School Nurses Ashika Odhav, MD1, Christina E. Ciaccio, MD, FAAAAI1, Marc Serota, MD2, Paul J. Dowling, MD, FAAAAI1; 1Children’s Mercy Hospital, Kansas City, MO, 2University of Colorado Denver, Denver, CO. RATIONALE: Approximately 150-200 fatalities per year occur from anaphylaxis related to food allergies. School nurses have significant barriers associated with administering epinephrine to a student in anaphylaxis including availability of stock epinephrine, expired prescriptions, first episode with previously unknown allergies, state regulations, and legal ramifications. Our survey identifies existing barriers to receiving life-saving epinephrine at school, and to evaluate the need for stock epinephrine. METHODS: In 2012, an anonymous online survey was distributed via an e-mail newsletter to the National Association of School Nurses. Excel was used to generate descriptive statistics. RESULTS: 2,439 school nurses completed the survey. For students with known allergies, 25.3% of students have no epinephrine and 24.6% had two unexpired autoinjectors at school. 16.7% of school nurses replied that they would not give an expired epinephrine. 41.3% would not give a different child’s epinephrine if there was nothing else available. 3.6% would not use a non-patient specific stock epinephrine autoinjector if it were available. In each situation, the majority had the concern for legal repercussions. 43.3% already have stock epinephrine available of which 90.8% felt it improved the overall safety of their students, and 8.6% were not sure. 25.8% had used their stock epinephrine at least once and 10.9% used it more than once. CONCLUSIONS: Significant barriers currently exist which may prevent school nurses from treating episodes of anaphylaxis with life-saving epinephrine. Stock epinephrine available in schools may improve the likelihood that children will receive effective treatment in a timely manner.
MONDAY
680