Introduction

This quality standard covers the care of adults, young people and children after emergency treatment for suspected anaphylaxis, including referral to a specialist allergy service. For more information see the food allergy and anaphylaxis topic overview.

NICE quality standards focus on aspects of health and social care that are commissioned locally. Areas of national policy, such as national training standards, are therefore not covered by this quality standard.

Why this quality standard is needed

Anaphylaxis is a severe, potentially life‑threatening generalised allergic reaction. It is characterised by rapidly developing symptoms and signs including skin changes (such as redness and itching), mucosal changes (swelling below the skin surface), swallowing and breathing difficulties (due to swollen mouth, throat or tongue), wheezing, rapid breathing rate (tachypnoea), rapid heart rate (tachycardia) and falling blood pressure (hypotension).

The incidence of anaphylaxis in the UK is increasing, with a reported increase in hospital admissions for anaphylaxis from 1 to 7 cases per 100,000 population per year between 1992 and 2012[1]. An estimated 20 deaths from anaphylaxis are reported each year in the UK.

The quality standard is expected to contribute to improvements in the following outcomes:

  • incidence of anaphylactic episodes

  • admission rate for anaphylactic episodes

  • mortality from anaphylactic episodes.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – safety, experience and effectiveness of care – for a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2015–16

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicators

1a Potential Years of Life Lost (PYLL) from causes considered amenable to healthcare

i Adults ii Children and young people

Improvement areas

Reducing mortality in children

1.6 i Infant mortality*

2 Enhancing quality of life for people with long‑term conditions

Overarching indicator

2 Health‑related quality of life for people with long‑term conditions**

Improvement areas

Ensuring people feel supported to manage their condition

2.1 Proportion of people feeling supported to manage their condition

4 Ensuring that people have a positive experience of care

Overarching indicators

4a Patient experience of primary care

i GP services

4b Patient experience of hospital care

4c Friends and family test

4d Patient experience characterised as poor or worse

i Primary care

ii Hospital care

Improvement areas

Improving people's experience of outpatient care

4.1 Patient experience of outpatient services

Improving people's experience of accident and emergency services

4.3 Patient experience of A&E services

Alignment with Public Health Outcomes Framework

* Indicator is shared

** Indicator is complementary

Indicators in italics in development

Table 2 Public health outcomes framework for England, 2013–16

Domain

Objectives and indicators

1 Improving the wider determinants of health

Objective

Improvements against wider factors that affect health and wellbeing and health inequalities

Indicators

1.3 Pupil absence

1.9 Sickness absence rate

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, whilst reducing the gap between communities

Indicators

4.1 Infant mortality*

4.3 Mortality rate from causes considered preventable**

4.11 Emergency readmissions within 30 days of discharge from hospital*

Alignment with NHS Outcomes Framework

* Indicator is shared

** Indicator is complementary

Safety and people's experience of care

Ensuring that care is safe and that people have a positive experience of care is vital in a high‑quality service. It is important to consider these factors when planning and delivering services relevant to anaphylaxis.

NICE has developed guidance and an associated quality standard on patient experience in adult NHS services (see the NICE pathway on patient experience in adult NHS services), which should be considered alongside this quality standard. They specify that people receiving care should be treated with dignity, have opportunities to discuss their preferences, and be supported to understand their options and make fully informed decisions. They also cover the provision of information to people using services. Quality statements on these aspects of patient experience are not usually included in topic‑specific quality standards. However, recommendations in the development sources for quality standards that affect patient experience and are specific to the topic are considered during quality statement development.

Coordinated services

The quality standard for anaphylaxis specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole anaphylaxis care pathway. A person‑centred, integrated approach to providing services is fundamental to delivering high‑quality care to people with anaphylaxis.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high‑quality anaphylaxis service are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating people with anaphylaxis or suspected anaphylaxis should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development source(s) on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting people with anaphylaxis. If appropriate, healthcare practitioners should ensure that family members and carers are involved in the decision‑making process about investigations, treatment and care.



[1] Turner PJ, Gowland MH, Sharma V et al. (2015) Increase in anaphylaxis-related hospitalizations but no increase in fatalities: an analysis of United Kingdom national anaphylaxis data, 1992–2012. Journal of Allergy and Clinical Immunology. 135: 956–963