Epinephrine autoinjector administration diagrams differ from evidence-based greatest apply

Key takeaways:

• A affected person must be supine or sitting when an epinephrine autoinjector gadget is run per greatest apply guides.
• The affected person was standing in a number of administration diagrams.

SAN DIEGO — Standing vs. supine or sitting was the place during which an epinephrine autoinjector gadget was administered in a number of written and visible examples exhibiting administration, in keeping with a poster introduced right here.

This discovering was introduced on the 2025 American Academy of Allergy, Bronchial asthma and Immunology/World Allergy Group Joint Congress.

Deryn Thompson

“While you’re really equipping sufferers with the automated epinephrine injectors, just be sure you are demonstrating, you may have the particular person within the right place and you’ve got the right diagrams to indicate them find out how to use the pen and never assume that they’re going to search out the fitting diagram,” Deryn Thompson, PhD, MN, MACN, FANA, registered nurse and lecturer in nursing at College of South Australia, informed Healio.

On this examine, Thompson, Sacha Palmer, MN(NP), Grad CCAFHN, FANA, WCHN, and 24 post-grad allergy nurse college students recognized 16 written/visible epinephrine autoinjector gadget administration examples from well being skilled organizations (n = 7), product info websites (n = 4), affected person help teams (n = 3) and shopper drugs (n = 2) in an “ultra-rapid” gray literature overview. The purpose was to find out if these diagrammatic examples help and reveal greatest apply positioning pointers.

Notably, Thompson informed Healio this investigation got here out of the 2024 on-line Skilled Certificates of Allergy Nursing quick course she teaches on the College of South Australia. At school, Palmer highlighted a scientific case the place an ED well being skilled scolded a dad or mum for giving their baby automated epinephrine mendacity down, not standing up.

“One allergy nurse pupil mentioned, ‘nicely, with giving the EpiPens, can’t you give it standing or sitting?’ … as a result of if you take a look at the diagrams, they’ve all received the affected person standing, however our greatest apply says about having the affected person supine or sitting [since] they might have respiratory difficulties,” Thompson informed Healio.

“There was silence within the digital (on-line) classroom for a couple of minutes as we’re processing this,” Thompson mentioned. “We as clinicians and tutors realized the scholars have been right.”

Through the analysis of the written and visible examples they collected, Thompson famous that standing was the place the epinephrine autoinjector gadget was administered in a number of diagrammatic examples, one in all which was the product info diagram.

“We discovered ambiguity and conflicting info between the diagrams of find out how to administer the EpiPen with the particular person actually standing, versus the particular person being supine or sitting,” Thompson informed Healio.

The poster additionally mentioned that solely two of the 5 recognized well being skilled organizations — World Allergy Group and Chinese language College of Hong Kong, Allergy — had diagrammatic info on epinephrine autoinjector administration place of their anaphylaxis motion plans that supported greatest apply guides.

Within the motion plans from the remaining three organizations, supine place was both burdened alongside incorrect administration product info diagrams (Australasian Society of Medical Immunology and Allergy [ASCIA]; Allergy and Anaphylaxis Australia) or positioning was not burdened with no ambiguous diagrams (AAAAI), in keeping with the poster.

“As soon as alerted, ASCIA acted in a short time to amend their on-line info, however the already printed plans and diagrammatic product info adjustments take time, resulting from product regulatory adjustments,” Thompson informed Healio.

Thompson additionally highlighted that some positioned footage exhibiting find out how to use the epinephrine autoinjector had the gadget pointing on the improper website and incorrect thumb placement.

“Had been they utilizing an actual gadget and had it the other way up, it will be going by way of their thumb, and there’d be no epinephrine for the affected person,” Thompson informed Healio.

Following this overview, an essential query got here up at an allergy nurse assembly relating to how allergists and allergy nurses place themselves when exhibiting the affected person find out how to use the gadget, Thompson mentioned.

“[Palmer is] a nurse practitioner, and in her clinic, she has to return round from her desk and present the affected person,” Thompson informed Healio. “By way of this, she realized that she was really standing there as she demonstrated the pen, resulting from room set-up restraints. Some nurses concurred they’d comparable points, however all have amended this of their apply demonstrations.”

With this query and the outcomes from the gray literature overview in thoughts, Thompson encourages well being care professionals who reveal epinephrine autoinjector gadget administration to verify their diagrams on administration and anaphylaxis motion plans.

“Examine your motion plans [to make sure] they make right statements, diagrams align and there’s nothing ambiguous on there as a result of we all know that one of many greatest disappointments that sufferers quote is, ‘I’m getting conflicting info from completely different well being professionals,’” Thompson informed Healio.

“If we will all be on the identical web page, we’d have significantly better affected person outcomes,” she mentioned.

Transferring ahead, Thompson mentioned a strong literature overview on this matter must be performed.

“We really must do a deeper literature search making comparability between the diagrams and the written info throughout the main anaphylaxis useful resource websites globally,” Thompson informed Healio. “But additionally, we’ve received that subset inside academic establishments, hospitals and well being care facilities which have created their very own plans, so it’s opened our eyes to an essential concern.”

These on this yr’s Skilled Certificates in Allergy Nursing quick course in July can go to the College of South Australia web site.

For extra info:

Deryn Thompson, PhD, MN, MACN, FANA, could be reached at deryn.thompson@unisa.edu.au.