title: A systematic review of patients', parents' and healthcare professionals' adrenaline auto-injector administration techniques.
abstract: BACKGROUND
  In order to enable fast treatment response to anaphylactic reactions, adrenaline auto-injectors (AAI) have been developed and manufactured. It has been reported in several studies that administration technique is suboptimal. The primary purpose of this study was to review the nature and extent of the deficiencies in administration technique among patients, parents/caregivers and healthcare professionals.
  
  
  METHODS
  Relevant publications were identified between 1998 and 2015 using two search methods: a keyword search in Embase, PubMed, British Nursing Index and Cumulative Index to Nursing and Allied Health Literature and a search of reference lists of relevant articles.
  
  
  RESULTS
  Twenty-three studies met the inclusion criteria. Overall, 37% of patients, 32% of parents/caregivers and 21% of healthcare professionals demonstrated correct administration technique. For studies which employed a before-and-after training study design, correct technique was achieved in 77% of patients, 79% of caregivers and 65% of healthcare professionals. The most consistently observed error was the failure to hold the device in place for the recommended time. For patients, factors associated with good technique were being aged over 18 years, trained in AAI administration by an allergist, prescribed an AAI for more than 30 months, having a history of severe anaphylaxis and membership of a support group. For parents/caregivers in addition to those mentioned, being given a training device with which to practice, improved technique.
  
  
  CONCLUSIONS
  There was wide variation in administration techniques reported. However, studies designed using before-and-after training show that even a brief demonstration and educational intervention can improve technique. Further studies are required to design and pilot acceptable and cost-effective educational materials.
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.
authors.forename: Aisha
authors.initials: A
authors.lastname: El Turki
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Smith
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.
authors.forename: Carrie
authors.initials: C
authors.lastname: Llewellyn
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.
authors.forename: Christina J
authors.initials: CJ
authors.lastname: Jones
mesh_terms: D000707:Anaphylaxis / Q000188:drug therapy*; D004837:Epinephrine / Q000008:administration & dosage* / Q000627:therapeutic use; D006282:Health Personnel / Q000592:standards; D006801:Humans; D007273:Injections, Intramuscular / Q000379:methods* / Q000592:standards*; D010290:Parents
chemical_list: D004837:Epinephrine
keywords: anaphylaxis/allergy; clinical assessment, competence; performance improvement