METHODS: Retrospective chart review of nursing records for assigned and unassigned epinephrine administrations (EA) in a large urban school district for the 2015-2016 and 2016-2017 school years.
RESULTS: Thirty-one EA were recorded in AISD elementary, middle, and high schools. Unassigned epinephrine accounted for 68% of epinephrine use. Twenty-two percent of EA occurred in persons with no history of allergy. Fifty-eight percent of EA occurred in students with known allergy who did not have assigned epinephrine. Sixty-eight percent of EA was in students aged 12-19. Adolescents also represented the largest group with a history of allergy but no assigned epinephrine. Food was the trigger for nearly 50% of reactions requiring epinephrine.
CONCLUSIONS: In the first two years of a stock epinephrine program, unassigned epinephrine was used more frequently than assigned epinephrine. Unassigned epinephrine was utilized in students with no history of allergy and those with a history of allergy but without assigned epinephrine. Adolescents, a group known to be at high-risk for fatal food anaphylaxis, comprised the largest group without assigned epinephrine despite a known allergy. This data highlights areas for improvement in the management of patients with food allergy and the importance of having unassigned epinephrine available in schools.