View Abstract

A3639 - Improving Epinephrine Possession in Children Receiving Omalizumab: A Quality Improvement Project
Author Block: S. P. Shah1, A. M. Fitzpatrick2, J. A. Shih3; 1Pediatric Pulmonology, Atlanta, GA, United States, 2Emory Univ, Atlanta, GA, United States, 3Pediatric Allergy/Immunology, Atlanta, GA, United States.
Rationale: Omalizumab is indicated for moderate to severe allergic asthma and chronic idiopathic urticaria uncontrolled by inhaled corticosteroids and H1 antihistamines, respectively. Anaphylaxis is a rare but potentially fatal adverse effect associated with omalizumab treatment, occurring in 0.1-0.2% of patients. The timing of anaphylaxis is somewhat unpredictable, with occurrences reported after the first dose and beyond 1 year after treatment initiation. Deaths from anaphylaxis are largely preventable if epinephrine is administered in a timely manner.
Objective: This project aimed to increase possession of self-administered epinephrine pens among children receiving omalizumab. The primary outcome was the proportion of children with an epinephrine pen in their purse or pocket at the time of the omalizumab injection visit.
Methods: Children 6 years and older presenting to a pediatric allergy clinic at Children’s Health Care of Atlanta (CHOA) were included in this quality improvement project, guided by Plan, Do, Study, Act methodology. Initially, a random audit was performed to assess the proportion of patients possessing an epinephrine pen at their injection visit. Telephone calls were then made up to 7 days before the next visit, reminding families to bring their epinephrine pens to their next appointment. Outcome data were collected in 3 cycles (3 weeks/cycle) from March through June 2017. Prior to proceeding to the next cycle, modifications were implemented to facilitate epinephrine pen possession.
Results: In the audit period, 11% of patients possessed an epinephrine pen at the time of the omalizumab injection. In cycle 1, after all telephone calls were made (up to 7 days prior to the visit), this proportion increased to 56%. In cycle 2, possession increased to 71% after telephone calls were made 2 days prior to each patient’s visit. In cycle 3, telephone calls were made both 7 days and 2 days prior to each patient’s appointment. By the end of the monitoring period in cycle 3, epinephrine pen possession rates increased to 80% overall.
Conclusions: These results from a 3-cycle quality improvement project demonstrate that epinephrine pen possession can be increased by telephone call reminders prior to omalizumab injection visits. Future cycles are needed to address the long-term feasibility of the intervention in the clinical setting and whether the observations are sustained both in the clinic as well as the school and home environment. More comprehensive assessment of the tolerability and barriers of epinephrine pen possession in families is also warranted.