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New e-training aims to avoid anaphylaxis in hospitals

National Allergy Strategy is launching the first free food allergy e-training for Australian hospital staff to combat unnecessary allergic reactions in hospitals.

Allergic diseases currently affect more than four million Australians and the prevalence of such diseases is on the rise. Life threatening food allergy rates have doubled in ten years and deaths due to allergies have risen 42 per cent over the last six years to 2019.

The National Allergy Strategy – a partnership led by the Australasian Society of Clinical Immunology and Allergy (ASCIA) and Allergy & Anaphylaxis Australia (A&AA) – believes many allergic reactions can be avoided, and the hospital setting is one place they should not be happening.

Dr Preeti Joshi, a paediatric clinical immunology/allergy specialist and Co-chair of the National Allergy Strategy, says there has been an increase in the number of reported reactions to foods in hospitals, even after an allergy was declared.

“You need to be so careful about what you give people when they declare an allergy, especially if they're unwell. And we already knew that catering services in general needed food allergy training, and this is a really important branch of that,” she says.

Joshi says that the issue came to national attention with the tragic death of Louis Tate at Frankston Hospital. Louis, a 13-year old Victorian, died in hospital in 2015 and last year a coroner ruled the hospital failed to properly record his allergies in the kitchen. A meal he was served sparked an anaphylactic episode that contributed to his death, as per the Nine papers.

“Those sorts of tragedies are rare, but near misses are not as rare as we would like,” Joshi says.

Eva Henderson from Queensland has encountered near misses at hospitals. Her four-year-old daughter Chloe has an egg allergy which was not properly managed on two separate hospital admissions.

"In Aug 2018 Chloe was medevac’d by Careflight to a hospital. She had severe croup. We didn’t have much trust in hospitals preparing foods as this was not the first time we’d had concerns about the food at the hospital where she was taken to, however this time was worse as the hospital provided a hard-boiled egg cut in half on her plate,” she told Nursing Review.

“A year ago she was admitted to the same hospital for croup also and she was served some type of battered fish fingers, and the nurse couldn’t confirm for sure there was no egg so I wouldn’t let her eat it and she was offered a sandwich. 

"Her allergy was disclosed, she had a red ankle band on, a white board with her allergy on it behind her bed and she had been admitted to the hospital before with her allergy. There is clearly something wrong with the hospital’s system. Someone will die if this continues and I am genuinely worried.”

Briony Tyquin, a paediatric nurse with a speciality in allergy nursing, says that the lack of data on the number allergic reactions in hospitals each year is an issue, but more problematic is the general lack of allergy knowledge in the community.

“I think because the word allergy is bandied around so much that people call them fad diets sometimes, or they say, 'Oh, well I've got a allergy. I can't eat it,' but they just avoiding it because they're on some diet or they've got an intolerance or something like that.

"And the general community really don't understand that food can induce anaphylaxis and, realistically, some people can die from it. So I just don't think that there's a good enough understanding out there in the Australian community generally,” she says.

“Data is a shared responsibility. The patient actually has to disclose their allergies. And clinicians ask about allergies, they need to not just ask about drug allergies, they need to ask about any allergies and then actually find out what sort of reaction the person has if they were to eat that food.”

The “All about Allergens for Hospitals” e-training, covers a range of different modules for different jobs, from kitchen manager to ward clerk and the complexity differs per the role. The trainee meets a series of learning objectives before taking a short test to assess their knowledge

“I think nurses are actually pivotal in this. I think that they have a huge amount of contact with the patient. They get to know their patients really well, and I think the patients trust the nurses,” Joshi says.

“So I think them having an idea of what it means to have a food allergy and to respect the fact that that person has got a food allergy and take it seriously, so help them to choose the right foods and then make sure they're served the correct food, and if they don't know what's in it or they access that food, just to really be the advocate for the patients so that they actually get what they need and the knowledge that they need. I think that's really important.”

Joshi herself has to deal with the fear of anaphylaxis as her own child has a severe allergy.

“I think what I would say is, you can do something potentially life-saving and learn about something potentially lifesaving in a relatively short period of time,” she says.

“So, whilst it may be something that you have to add to your list of things that you need to learn, it'll have a huge amount of impact on the lives of the people that you're managing.

"And you have to remember now that one in 10 infants has a food allergy in Australia, one in 20 children and one in 50 adults. That's a lot of people, so you are going to come across someone, if not every day, at least every week, if you're working in a hospital, who has a food allergy.”

The 'All about Allergens for Hospitals' training resources can be found here.

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