Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Int Forum Allergy Rhinol. 2015 Jun;5(6):513-6. doi: 10.1002/alr.21487. Epub 2015 Apr 6.
Anaphylaxis is the most serious potential complication from allergy treatment with subcutaneous immunotherapy (SCIT). Quality measures were developed with the goal to decrease the incidence of complications resulting from SCIT and improve the safety of care provided.
The incidence and characteristics of anaphylaxis episodes resulting from SCIT was measured between 2008 and 2012 prior to implementation of quality measures including vial verification, vial testing, and standardized training across 6 allergy delivery sites. Errors and anaphylaxis rates were then tracked prospectively over a 2-year period after implementation of these process measures.
From 2008 to 2012 there were 9 episodes of anaphylaxis or 0.02% of injections/year. Eight patients had sufficient information from which to derive meaningful data. Patient identification error led to anaphylaxis in 2 patients, dosing error in 2, and compounding error in 1 patient. In 2 patients, anaphylaxis occurred with advancement during pollen season, and in 1 patient no clear reason could be identified although she had asthma as a risk factor. After implementation of quality improvement measures the anaphylaxis rate fell to 0 of 8948 injections for years 2013 and 2014.
Errors in the mixing and administration of allergy serum comprised the majority of identifiable factors that led to anaphylaxis. Implementation of quality measures, including vial verification and vial testing, can improve safety and decrease anaphylaxis rates in the delivery of allergy immunotherapy.
过敏治疗的皮下免疫疗法（SCIT）最严重的潜在并发症是过敏反应。制定质量措施的目的是降低因 SCIT 引起的并发症发生率，提高提供的护理安全性。
在实施质量措施（包括小瓶验证、小瓶测试和 6 个过敏治疗点的标准化培训）之前，测量了 2008 年至 2012 年 SCIT 引起的过敏反应的发生率和特征。然后，在实施这些流程措施后的 2 年内，前瞻性地跟踪错误和过敏反应率。
2008 年至 2012 年期间，有 9 例过敏反应或每年 0.02%的注射，8 名患者有足够的信息来获得有意义的数据。患者识别错误导致 2 例过敏反应，剂量错误 2 例，配药错误 1 例。在 2 例患者中，过敏反应发生在花粉季节进展期间，1 例患者无明确原因，尽管她有哮喘作为危险因素。在实施质量改进措施后，2013 年和 2014 年，过敏反应率从 8948 次注射中降至 0。
在混合和管理过敏血清过程中的错误是导致过敏反应的大多数可识别因素。实施质量措施，包括小瓶验证和小瓶测试，可以提高过敏免疫治疗的安全性并降低过敏反应率。
