PC1244: Access to Self-injectable Epinephrine Following Discharge from the Pediatric Emergency Department in Patients Presenting with Anaphylaxis

Purpose/Objectives: Self-injectable epinephrine has life-saving potential in children presenting in anaphylaxis. Up to 14.7% of patients with anaphylaxis develop biphasic reactions; thus, intramuscular epinephrine should be readily accessible following discharge from the Emergency Department. Our goal was to examine and improve the accessibility of obtaining injectable epinephrine pens following discharge from the Pediatric Emergency Department (PED) for patients evaluated for anaphylaxis.

Design/Methods: A single-institution chart review was conducted for patients under 25 years-old who presented to the PED for allergic reactions and/or anaphylaxis based on ICD-10 codes from April 1, 2019 to December 31, 2021. The primary outcome was time of patient discharge, while secondary outcomes included outpatient pharmacy hours and distance from the PED to the outpatient pharmacy. Data collected included age, gender, presence of biphasic reactions, time of discharge from the PED, discharge medications, and location and hours of outpatient pharmacy. Patients who did not meet World Allergy Organization criteria for anaphylaxis or who were admitted were excluded.

Results: 72 patients met the criteria for anaphylaxis and 31 patients presented with an allergic reaction without anaphylaxis. Details of the hospital course and discharge are provided in Table 1. 58 (81%) of patients with anaphylaxis and 21 (65%) of patients with allergic reaction without anaphylaxis were discharged between the hours of 7pm and 7am (Figure 1). In the anaphylaxis group, 36 (65%) of injectable epinephrine prescriptions were sent to pharmacies that were closed at the time of the patient’s discharge. 10 (37%) pharmacies were closed at the time of discharge from the PED in the allergic reaction without anaphylaxis group.

To address this risk to patient safety of developing biphasic reactions after PED discharge, we initiated a program in collaboration with our institutional pharmacy team to provide patients with a self-injectable epinephrine pen for outpatient use. Patients with anaphylaxis being discharged from the PED between the hours of 7pm and 7am will now be given self-injectable epinephrine for home administration.

Conclusion/Discussion: A majority of self-injectable epinephrine pens were prescribed from the PED to an outpatient pharmacy that was closed at the patient’s time of discharge. We developed a program to dispense self-injectable epinephrine pens to patients with anaphylaxis who are being discharged from the PED after hours to ensure patient access to epinephrine in the event of a biphasic reaction.