Anaphylaxis Observation

POAC Funding of Anaphylaxis Observation

This POAC funding policy aligns with the Anaphylaxis HealthPathway for adults and children.

POAC Funding:

POAC funds up to four hours of observation time at a fixed rate, strictly under the below criteria.  

Submit POAC referral using clinical code 'Anaphylaxis' and claiming using the practice observation anaphylaxis code.  See POAC claiming guide for further information.

Eligibility Criteria (All must be met):

1. The patient responds within minutes to a single dose only of IM adrenaline (which may have been administered in the community, e.g. via Epipen before presenting to primary care).

2. The GP surgery or Urgent Care Clinic has the clinical expertise and resources to carry out at least four hours of observation.

3. IV access has been established in case it becomes necessary.

Exclusions (Not Funded by POAC):

POAC does not fund observation under any of the following circumstances:

• More than one dose of adrenaline is administered.

• Severe reactions with slow onset (e.g. idiopathic anaphylaxis).

• Patient has severe asthma or a significant asthmatic component.

• Ongoing absorption of allergen is suspected.

• History of biphasic reactions.

• Patient lives alone.

These patients must be referred to hospital.

Observation Requirements:

Observation is defined as regular sighting and assessment at least every 10 minutes for signs of abnormal:

• Temperature (e.g. pyrexia, flushing)

• Heart rate (e.g. tachycardia, irregularity)

• Blood pressure (e.g. hypotension)

• Airway (e.g. facial/oropharyngeal swelling)

• Respiration (e.g. rate, stridor, wheezing, pulse oximetry)

• Cutaneous symptoms (e.g. pruritus, urticaria, facial swelling)

• Gastrointestinal symptoms (e.g. nausea, vomiting, abdominal pain, diarrhoea)

• Nervous system (e.g. agitation, anxiousness, confusion)

Vital signs should be recorded at least every 30–60 minutes, depending on the patient’s condition.

Patients presenting with a severe initial phase, laryngeal oedema, or hypotension may require extended observation and should be promptly referred to the hospital.

Documentation Requirements:

Clinical documentation must include:

• Recorded observations and vital signs.

• Evidence that the patient was:

  • Provided with anaphylaxis education and a written action plan.

  • Referred for immunology or paediatric follow-up, as appropriate.

  • Given advice on ongoing safety measures per the Anaphylaxis HealthPathway (see "Prevention and Follow-Up" section).

Hospital Referral Pathways:

• Adults (≥15 years):

  • Auckland District: Request non-acute immunology assessment

  • Counties Manukau / Waitematā: Request non-acute general medicine assessment

• Children (<15 years): Request non-acute paediatric assessment

Medicine-Induced Anaphylaxis:

All cases of medicine-induced anaphylaxis must be reported to CARM (Centre for Adverse Reactions Monitoring).

Useful Resources:

• BPAC NZ – Management of Anaphylaxis in Primary Care

Policy Date: August 2022
Review Date: August 2024