title: An audit of the use of self-administered adrenaline syringes in patients with angio-oedema.
abstract: BACKGROUND
  Self-administered adrenaline syringes may be prescribed for patients at risk of life-threatening episodes of angio-oedema or anaphylaxis.
  
  
  OBJECTIVE
  To determine whether patients are able to use these syringes appropriately and adequately.
  
  
  METHODS
  Twenty-nine consecutive patients who had been prescribed self-administered adrenaline syringes for severe angio-oedema were recruited. All completed a questionnaire (unsupervised), and were asked to demonstrate how to use a dummy syringe.
  
  
  RESULTS
  Three of 29 (10%) patients had been prescribed syringes in the absence of severe angio-oedema or collapse. Seventeen of 29 (59%) patients had been prescribed two syringes, and 21 of 29 (72%) kept a syringe with them at all times. Twenty of 28 (71%) patients had had the use of a syringe demonstrated to them with the initial prescription, but two of 29 (7%) had never been shown how to use it. Only six of 26 (23%) patients had been told to telephone for an ambulance after using a syringe. Only seven of 29 (24%) patients would use a syringe for an episode of collapse, whereas eight of 28 (29%) would use one for an episode of lip swelling. Nine of 21 (43%) patients had not been warned about adverse effects, although 13 of 20 (65%) given adrenaline had had at least one adverse effect. Of the 25 patients asked to demonstrate their use of a syringe, only 14 (56%) were able to perform all steps correctly, and three (12%) were unable to perform any of the steps. Despite this, all 29 patients felt confident about giving themselves an injection, and most felt more secure having been prescribed syringes.
  
  
  CONCLUSIONS
  As self-administered adrenaline syringes are prescribed for life-threatening events, it is vital that they are given to appropriate patients with adequate written instructions and proper demonstration at the time of the initial prescription. As a result of this study we have developed a more detailed patient information leaflet, and all patients are shown how to use a syringe for a second time when attending the clinic for follow-up.
authors.affiliation: Urticaria Unit, St John's Institute of Dermatology, Guy's, King's College and St Thomas' Hospitals' Medical and Dental Schools, St Thomas' Hospital, London SE1 7EH, U.K.
authors.forename: R A
authors.initials: RA
authors.lastname: Sabroe
authors.forename: A-K
authors.initials: AK
authors.lastname: Glendinning
authors.forename: I
authors.initials: I
authors.lastname: Sabroe
authors.forename: F
authors.initials: F
authors.lastname: Lawlor
authors.forename: A
authors.initials: A
authors.lastname: Kobza Black
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000799:Angioedema / Q000188:drug therapy*; D004346:Drug Information Services / Q000592:standards; D004837:Epinephrine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008131:London; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards*; D012646:Self Administration; D013594:Syringes; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine