RCoA recommends appointment of local Anaphylaxis Leads

The NAP6 project of the Royal College of Anaesthetists identified that perioperative anaphylaxis, though generally managed promptly and competently by anaesthetists, remains a significant complication of anaesthesia and surgery. The project identified that in 2016, 10 patients died from the condition and 39 experienced cardiac arrest. Most hospitals will admit one or more such patients to their intensive care unit each year. The project identified that early care was poor, or good and poor in 54 per cent of cases, with the gaps in care often relating to the quality of advanced resuscitation and onward referral for investigation. The project also identified a need for improved communication between all clinicians and patients and their general practitioners. NAP6 has made numerous recommendations and produced standardised (editable) forms to improve and harmonise patient management, referral, investigation, communication and follow-up.

Improving the quality of care these patients receive and improving institutional and individual preparedness for these life-threatening events requires each Trust to take action. The RCoA supports the NAP6 recommendation that there should be a departmental lead for perioperative anaphylaxis in each department of anaesthesia. While the NAP6 report describes this as an individual’s role the RCoA emphasises that responsibilities of the role should be met by the department, whether by an individual or subsumed into another, broader role.
The key responsibilities that each department should achieve are:

• implementing the NAP6 recommendations and ensuring maintenance of these, especially anaphylaxis treatment packs and investigation packs
• education and simulation
• acting as a point of contact to provide support and ensure all cases are optimally managed, investigated and followed-up
• local co-ordination of a survey – likely in 2020, which will measure the impact of NAP6 and the local changes that have been made as a result.

The existence of this role does not remove the responsibility for the clinician caring for a patient to manage the aftermath of an anaphylaxis episode. Departments will find it valuable to support the new role with appropriate time and DCC/SPA allocation, and the work should be considered as justification for SPA in an appraisal. The role should not be daunting, and while there will be a significant amount of set-up work, it is likely that once established it should not be an onerous task. For consultants, this may well be in the region of 0.25 PA.

Further resources and local tools relating to NAP6 can be found here.