Authors (including presenting author) :
Ho Eunise(1)(2), Chan Lily (1)(2), Lai Winnie(3), Lai Mavis (4), Lam Peter(4), Poon Toby (1)(4), Yu Linda (4)
Affiliation :
(1) Resuscitation Subcommittee, Prince of Wales Hospital, NTEC (2) Department of Intensive Care Medicine, Prince of Wales Hospital, NTEC (3) Pharmacy Department, Prince of Wales Hospital, NTEC (4) Quality and Safety, Prince of Wales Hospital, NTEC
Keyword 2: :
Medication Safety
Keyword 3: :
Hospital Accreditation
Introduction :
Anaphylaxis is a time‑critical medical emergency with a rising global trend in hospital admissions. The anaphylaxis kit has been widely adopted in overseas settings such as schools, vaccination centres, clinics, and hospitals. Common triggers include foods (for example shellfish, eggs, peanuts), medications (including vaccines, antibiotics, anaesthetic agents, and contrast media), latex, and blood or blood products, though episodes may also be idiopathic. In the SHARC hospital accreditation framework, there is a specific requirement for the hospital emergency response plan for drug‑induced anaphylactic shock (Quality 3.4.7). Timely and safe administration of intramuscular adrenaline 1:1000 is the cornerstone of effective rescue. To address this need, the Prince of Wales Hospital (PWH) Resuscitation Subcommittee, Pharmacy Department, and Quality and Safety Department collaboratively developed a locally standardised anaphylaxis kit and a Guideline on Anaphylaxis Management. The kit and guideline were first implemented at PWH and subsequently adopted across the New Territories East Cluster (NTEC). The anaphylaxis kit is an “I am (IM) rescue“ tool for life‑threatening allergy, as essential as a defibrillator for patients in shockable cardiac arrest. It is now available in the emergency trolley across NTEC hospitals and clinics.
Objectives :
This presentation describes the development of the PWH anaphylaxis kit, detailing its contents and key safety features, as well as the governance process underpinning its design. It further outlines the implementation strategy and subsequent adoption of the kit across the NTEC, the training programme established to support frontline staff in its use, and the clinical experience with case illustration.
Methodology :
The implementation of the anaphylaxis kit and guideline followed a Plan–Do–Check–Act (PDCA) framework. 1. Plan There were reported wrong‑route and wrong‑dose incidents in anaphylaxis management in Hong Kong. To comply with the requirements for hospital accreditation, a system for drug-induced anaphylactic shock is to be developed. It is particularly crucial for vaccination clinics, radiology department with use of contrast agents and oncology day wards. In fact, general ward patients and other in-hospital patients could also encounter anaphylaxis. The project aims to introduce an anaphylaxis kit with built‑in safety features to enable safe, timely intramuscular adrenaline administration during rescue therapy, and to develop a guideline for anaphylaxis management. 2. Do PWH Resuscitation Subcommittee, Pharmacy Department, and Quality and Safety Department collaborated closely and developed a dedicated anaphylaxis kit with safety features. The content in the anaphylaxis kit, including needles, syringes, selected drug (adrenaline 1:1000), and their quantity, was thoroughly reviewed with reasons behind. The PWH Resuscitation Subcommittee developed the PWH Guideline on Management of Anaphylaxis, which outlines the recognition of anaphylaxis, a rescue flowchart, and the safe use of IM adrenaline. The Pharmacy Department assisted in preparing the anaphylaxis kits and established a mechanism for prompt replacement of used kits. A pilot in a medical ward confirmed the workflow. The anaphylaxis kit was placed in the emergency trolley. The guideline and the anaphylaxis kit were endorsed. Training and reinforcement of safe practices are integrated into new-resident resuscitation workshops, ward CPR drills, and intern sharing sessions. 3. Check The utilisation of the anaphylaxis kit was recorded. Clinical cases were reviewed, and the timely and safe rescue was confirmed. The user feedback on kit configuration and usability was collected. 4. Act Drug‑induced anaphylactic shock events were incorporated into adverse event reporting, which is a specific requirement in SHARC hospital accreditation. The PWH anaphylaxis management guideline was refined according to feedback and review. The standardised practice was rolled out across all hospitals and clinics in NTEC.
Result & Outcome :
The anaphylaxis kit is now widely available in emergency trolleys in clinics, vaccination sites, and hospitals within NTEC. This has introduced a systematic, standardised, and timely approach to the recognition and treatment of anaphylaxis, particularly for safe and immediate administration of intramuscular adrenaline. After full implementation of the service, no further medication incidents were reported related to the use of adrenaline in anaphylaxis. Additionally, immediate access to the anaphylaxis kit improved logistics and time for administering 1:1000 adrenaline, leading to rapid stabilisation. In conclusion, the anaphylaxis kit is a rescue for anaphylaxis. The NTEC anaphylaxis kit and guideline have incorporated safety features and demonstrated effectiveness and timeliness. Moreover, it fulfils the SHARC hospital accreditation requirement and better aligns with international practice in rapid, timely rescue for anaphylaxis.
