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Parveen’s pre-reg pharmacist, Sam, is worried about not being able to help someone having an anaphylactic reaction...

“It doesn’t seem right that we give out these adrenaline injections and counsel patients on how to use them, yet we don’t get any training on how to use them ourselves,” muses Sam. “If someone had an anaphylactic reaction here in the pharmacy, or someone ran in and said their friend or relative was having a reaction nearby, I reckon they’d expect us to jump in and sort it out – but I don’t think I’d have the confidence to do that.”

Answer

Anaphylaxis is a medical emergency and Sam’s comments are apt in that many people would expect a pharmacist to be able to administer an adrenaline injection if the situation arose.

Parveen may be able to access a local training course for Sam that includes dealing with anaphylaxis using intramuscular adrenaline (e.g. as part of a flu vaccination service). Failing that, she should signpost Samuel to resources that cover this information.

A good starting point is the guidance for healthcare providers produced by the Resuscitation Council (UK) available at www.resus. org.uk/pages/reaction.pdf.

The next step would be for Sam to familiarise himself with the various adrenaline auto-injector products stocked in the pharmacy, as each differs slightly in how it is administered. Information is available in the PILs or from the manufacturers directly, and demonstration videos can be viewed at:

• www.epipen.com/aboutepipen/how-to-use-epipen 
• www.jext.co.uk/jext-videodemonstrations.aspx
• www.emerade.com/adrenaline-auto-injector 

The bigger picture

Although POMs should not be dispensed or administered without an appropriate prescription, the Human Medicines Regulations 2012 state that the restriction does not apply to certain products in a lifesaving situation. Adrenaline 1 in 1,000 injection (1mg/ml) is one such exception.

In Scotland, a scheme has been set up that encourages pharmacies to stock adrenaline injections in both adult and paediatric doses. Pharmacies that are signed up to the initiative are provided with campaign materials to raise awareness and a special sign to display in the window so it can be easily identified if someone needs to access an adrenaline injection in an emergency.

More information on this is available at www.community pharmacyscotland.org.uk/ news-policy-and-publications/ policy/anaphylaxis-campaign/ anaphylaxis-campaign.

Extend your learning

• Would you recognise the signs of anaphylaxis? Refresh your knowledge at www.nhs.uk/Conditions/Anaphylaxis/Pages/Symptoms.aspx

• Do you know which 18 POMs can be supplied or administered by anyone for the purpose of saving life in an emergency? The list is available at www.mhra.gov.uk.