COATESVILLE POLICIES

ANAPHYLAXIS MANAGEMENT POLICY


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1. Definitions:

1.1 Anaphylaxis is a severe, rapidly progressive allergic reaction that is potentially life threatening. The most common allergens in school aged children are peanuts, eggs, tree nuts (e.g. cashews), cow’s milk, fish and shellfish, wheat, soy, sesame, latex, certain insect stings and medication.

1.2 DET – Department of Education & Training

1.3 CRTs – Casual Relief Teachers

1.4 ASCIA – Australasian Society of Clinical Immunology and Allergy http://www.allergy.org.au/

 

2. Purpose:

2.1 The key prevention of anaphylaxis in schools is knowledge of those students who have been diagnosed at risk, awareness of triggers (allergens), and prevention of exposure to these triggers.

2.2 Partnership between the school and parents is important to ensure our risk management strategies are adhered to.

2.3 To provide, as far as practicable, a safe and supportive environment in which students at risk of anaphylaxis can participate equally in all aspects of the student’s schooling.

2.4 To raise awareness about anaphylaxis and the school’s anaphylaxis management policy in the school community.

2.5 To engage with parents/carers of students at risk of anaphylaxis in assessing risks, developing risk minimisation strategies and management strategies for the student.

2.6 To ensure that each staff member has adequate knowledge about allergies, anaphylaxis and the school’s policy and procedures in responding to an anaphylactic reaction.

2.7 To comply with DET Ministerial Order 706 and associated guidelines.

 

3. Guidelines:

3.1 An individual management plan must be developed, in consultation with the student’s parents, for any student who has been diagnosed by a medical practitioner as being at risk of anaphylaxis.

3.2 Management of students with anaphylaxis is a joint responsibility of parents and the school staff.

3.3 Parents must keep the school fully informed, in writing, of current medical issues related to their child and participate in the development of the individual management plan.

3.4 The school recognises and acts on its responsibility for informing the school community of the condition and seeking co-operation from parents and students in minimising the risk to these students.

3.5 Adrenaline, given through an EpiPen®auto-injector to the muscle of the outer mid-thigh, is the most effective first aid treatment

3.6 Staff training and briefings are undertaken as required by DET regulations (Refer to DET Anaphylaxis Guidelines).

 

4. Implementation

4.1 Prevention Strategies

APPENDIX ONE Individual Anaphylaxis Management Plans

APPENDIX TWO Communication Plan Steps

APPENDIX THREE Staff Training

APPENDIX FOUR Anaphylaxis Response Plan

APPENDIX FIVE Annual Risk Management Checklist

4.2 Risk Minimisation and Prevention Strategies

4.2.1 Minimisation of the risk of anaphylaxis is everyone's responsibility: the school (including the Principal and all school staff), parents, students and the broader school community.

4.2.2 Parents must:

  • communicate their child's allergies and risk of anaphylaxis to the school upon enrolment
  • continue to communicate with school staff and provide up to date information about their child’s medical condition
  • provide the School Staff with an ASCIA Action Plan
  • participate in yearly reviews of their child’s Individual Anaphylaxis Management Plan
  • ensure that their child has an adrenaline auto-injector that is current and not expired, at all times.

4.2.3 Statistics show that peanuts and nuts are the most common trigger for an anaphylactic reaction and fatality due to food anaphylaxis. To minimise the risk of a first time reaction to peanuts and nuts, peanuts, nuts, peanut butter or other peanut or nut products are not used during in-school and out-of-school activities. School activities do not place pressure on students to try foods, whether they contain a known allergen or not.

4.2.4 More information about peanut and nut banning can be found in the ASCIA Guidelines for Prevention of Food Anaphylactic Reactions in Schools, available from the ASCIA website at: www.allergy.org.au.

4.2.5 Risk minimisation and prevention strategies should be considered for all relevant in-school and out-of-school settings which include(but are not limited to) the following:

  • during classroom activities (including class rotations, specialist and elective classes)
  • between classes and other breaks
  • at the canteen and the garden area
  • during recess and lunchtimes
  • before and after school.

4.2.6 Banning of food or other products is not used as a risk minimisation and prevention strategy. The reasons for this are as follows:

  • it can create complacency among staff and students
  • it does not eliminate the presence of hidden allergens

4.2.7 Students need to be aware of their allergens in order to self-manage.

4.2.8 It is difficult to ‘ban’ all triggers (allergens) because these are not necessarily limited to peanuts and nuts. Triggers and common allergens can also include eggs, dairy, soy, wheat, sesame, seeds, fish and shellfish.

4.2.9 School staff members have a duty of care to take reasonable steps to protect a student in their care from risks of injury that are reasonably foreseeable. Set out below are a range of specific strategies as a minimum, that should be considered by school staff, for the purpose of developing prevention strategies for in-school and out-of-school settings.

4.3 In school settings

School staff determine which strategies set out below are appropriate; considering factors such as the age of the student, the facilities and activities available at the school, and the general school environment.

Classrooms

4.3.1 Keep a copy of the student's Individual Anaphylaxis Management Plan and how to administer an EpiPen, in the classroom. Be sure the ASCIA Action Plan is easily accessible even if the adrenaline auto-injector is kept in another location.

4.3.2 Liaise with parents about food-related activities ahead of time.

4.3.3 Use non-food treats where possible, but if food treats are used in class it is recommended that parents of students with food allergy provide a treat box with alternative treats. ‘Treat’ boxes should be clearly labelled and only handled by the student.

4.3.4 Never give food from outside sources to a student who is at risk of anaphylaxis.

4.3.5 Treats for the other students in the class should not contain the substance to which the student is allergic. It is recommended to use non-food treats where possible.

4.3.6 Products labelled 'may contain traces of nuts' should not be served to students allergic to nuts. Products labelled ‘may contain milk or egg’ should not be served to students with milk or egg allergy and so forth.

4.3.7 Be aware of the possibility of hidden allergens in food and other substances used in cooking, food technology, science and art classes (e.g. egg or milk cartons, empty peanut butter jars).

4.3.8 Ensure all cooking utensils, preparation dishes, plates, and knives and forks etc. are washed and cleaned thoroughly after preparation of food and cooking.

4.3.9 Have regular discussions with students about the importance of washing hands, eating their own food and not sharing food

4.3.10 Casual relief teachers and specialist teachers are provided with the names of any students at risk of anaphylaxis, the location of each student’s Individual Anaphylaxis Management Plan and adrenaline auto-injector, the school’s Anaphylaxis Management Policy, and each individual person’s responsibility in managing an incident e.g. seeking a trained staff member.

  • Folders containing such information are distributed to CRTs and specialist teachers.
  • Volunteers are always under the supervision of a trained member of staff.

Canteen

4.3.11 Canteen staff should be able to demonstrate satisfactory training in food allergen management and its implications on food-handling practices, including knowledge of the major food allergens triggering anaphylaxis, cross-contamination issues specific to food allergy, label reading, etc. Refer to:

4.3.12 Canteen staff, including volunteers, will be briefed about students at risk of anaphylaxis.

4.3.13 The name and photo of students at risk of anaphylaxis will be displayed in the canteen as a reminder to school staff.

4.3.14 Products labelled 'may contain traces of nuts' should not be served to students allergic to nuts.

4.3.15 The canteen will provide a range of healthy meals/products that exclude peanut or other nut products in the ingredient list or a ‘may contain...’ statement

4.3.16 Tables and surfaces will be wiped down with warm soapy water regularly.

4.3.17 A nut-free environment is provided in the canteen and out of school hours care (Camp Australia). However, the school is not ‘nut-free’. A ‘no sharing’ with the students with food allergy approach for food, utensils and food containers is used.

4.3.18 Canteen staff will be wary of contamination of other foods when preparing, handling or displaying food. For example, a tiny amount of butter or peanut butter left on a knife and used elsewhere may be enough to cause a severe reaction in someone who is at risk of anaphylaxis from cow’s milk products or peanuts.

Yard Duty

Yard duty bags carry information about students who are at risk of anaphylaxis and the yard duty bags contain a fluorescent (fluoro) alert card. An auto-injector is also attached to the yard duty bag. In an emergency, the fluorescent alert card is sent to the office and/or first aid room and immediately prioritised. The student’s auto-injector penkit is then taken immediately to the student.

4.3.19 When a student is at risk of anaphylaxis, sufficient school staff on yard duty must be trained in the administration of the adrenaline auto-injector, i.e. EpiPen®, to be able to respond quickly to an anaphylactic reaction if needed.

4.3.20 The adrenaline auto-injector and each student’s Individual Anaphylaxis Management Plan are easily accessible from the yard, and staff should be aware of their exact location (First Aid Room).Remember that an anaphylactic reaction can occur in as little as a few minutes.

4.3.21 The student’s medical information and medication can be retrieved quickly if a reaction occurs in the yard. Yard duty staff carry fluoro alert cards in yard-duty bags. All staff on yard duty are made aware of the School’s Emergency Response Procedures.

The staff member sends the fluoro alert card to the office and/or staffroom for immediate attention in the event of an anaphylactic reaction.

4.3.22 Yard duty staff must also be able to identify, by face, those students at risk of anaphylaxis

4.3.23 Students with anaphylactic responses to insects should be encouraged to stay away from water or flowering plants.

4.3.24 Lawns and clover are to be kept mowed and outdoor bins covered.

4.3.25 Students should keep drinks and food covered while outdoors.

Special events (e.g. sporting events, incursions, class parties, etc.)

4.3.26 School staff should avoid using food in activities or games, including as rewards.

4.3.27 For special occasions, school staff should consult parents in advance to either develop an alternative food menu or request the parents to send a meal for the student.

4.3.28 Parents of other students should be informed in advance about foods that may cause allergic reactions in students at risk of anaphylaxis and request that they avoid providing students with treats whilst they are at school or at a special school event.

4.3.29 Party balloons should not be used if any student is allergic to latex.

4.4 Out-of-school settings

The class teacher will bring the student’s auto-injector pento the event. If another teacher is supervising the student, the class teacher will be responsible for briefing the supervising teacher and delivering the auto-injector pento the supervising teacher. If the child is not provided with an auto-injector pen then they will not be able to attend sport or excursions.

Planning for appropriate supervision of students at risk of anaphylaxis at all times will ensure:

  • there are sufficient school staff attending the excursion who have been trained
  • there is an appropriate level of supervision of anaphylactic students throughout the trip, particularly at times when they are taking mediation and eating food
  • there will be capacity for adequate supervision of any affected student(s) requiring medical treatment, and that adequate supervision of other students will be available
  • staff/student ratios should be maintained during the trip, including in the event of an emergency where the students may need to be separated.

Special events: excursions/sporting carnivals

4.4.1 School staff supervising the special event must be trained in the administration of an adrenaline auto-injector and be able to respond quickly to an anaphylactic reaction if required.

4.4.2 A school staff member or team of school staff trained in the recognition of anaphylaxis and the administration of the adrenaline auto-injector must accompany any student at risk of anaphylaxis at special events.

4.4.3 School staff should avoid using food in activities or games, including as rewards.

4.4.4 The adrenaline auto-injector and a copy of the Individual Anaphylaxis Management Plan for each student at risk of anaphylaxis should be easily accessible and school staff must be aware of their exact location.

4.4.5 For each special event a risk assessment should be undertaken for each individual student attending who is at risk of anaphylaxis. The risks may vary according to the number of anaphylactic students attending, the nature of the event, size of venue, distance from medical assistance, the structure of event and corresponding staff-student ratio.

4.4.6 All school staff members present during the event need to be aware of the identity of any students attending who are at risk of anaphylaxis and be able to identify them by face.

4.4.7 The school should consult parents of anaphylactic students in advance to discuss issues that may arise; to develop an alternative food menu; or request the parents provide a meal (if required).

4.4.8 Parents may wish to accompany their child on excursions. This should be discussed with parents as another strategy for supporting the student who is at risk of anaphylaxis.

4.4.9 Prior to special events, school staff should consult with the student's parents and medical practitioner (if necessary) to review the student’s Individual Anaphylaxis Management Plan to ensure that it is up to date and relevant to the particular excursion activity.

Camps and remote settings

4.4.10 Prior to engaging a camp owner/operator’s services the school will make enquiries as to whether it can provide food that is safe for anaphylactic students. If a camp owner/operator cannot provide this confirmation to the school, then the school will consider using an alternative service provider.

4.4.11 The camp cook should be able to demonstrate satisfactory training in food allergen management and its implications on food-handling practices, including knowledge of the major food allergens triggering anaphylaxis, cross-contamination issues specific to food allergy, label reading, etc.

4.4.12 The school will not sign any written disclaimer or statement from a camp owner/operator that indicates that the owner/operator is unable to provide food which is safe for students at risk of anaphylaxis. Schools have a duty of care to protect students in their care from reasonably foreseeable injury and this duty cannot be delegated to any third party.

4.4.13 The school will conduct a risk assessment and develop a risk management strategy for students at risk of anaphylaxis. This should be developed in consultation with parents of students at risk of anaphylaxis and camp owners/operators prior to the camp dates.

4.4.14 School staff will consult with parents of students at risk of anaphylaxis and the camp owner/operator to ensure that appropriate risk minimisation and prevention strategies and processes are in place to address an anaphylactic reaction should it occur. If these procedures are deemed to be inadequate, further discussions, planning and implementation will need to be undertaken.

4.4.15 If the school has concerns about whether the food provided on a camp will be safe for students at risk of anaphylaxis, it will also consider alternative means for providing food for those students.

4.4.16 Use of substances containing allergens will be avoided where possible.

4.4.17 Camps should avoid stocking peanut or tree nut products, including nut spreads. Products that ‘may contain’ traces of nuts may be served, but not to students who are known to be allergic to nuts.

4.4.18 The student's adrenaline auto-injector, Individual Anaphylaxis Management Plan, including the ASCIA Action Plan for Anaphylaxis and a mobile phone must be taken on camp. If mobile phone access is not available, an alternative method of communication in an emergency must be considered, e.g. a satellite phone.

4.4.19 Prior to the camp taking place school staff will consult with the student's parents to review the students Individual Anaphylaxis Management Plan to ensure that it is up to date and relevant to the circumstances of the particular camp.

4.4.20 School staff participating in the camp should be clear about their roles and responsibilities in the event of an anaphylactic reaction. Check the emergency response procedures that the camp provider has in place. Ensure that these are sufficient in the event of an anaphylactic reaction and ensure all school staff participating in the camp are clear about their roles and responsibilities.

4.4.21 Contact local emergency services and hospitals prior to the camp. Advise full medical conditions of students at risk, location of camp and location of any off camp activities. Ensure contact details of emergency services are distributed to all school staff as part of the emergency response procedures developed for the camp.

4.4.22 The school will take an adrenaline auto-injector for general use on a school camp, even if there is no student at risk of anaphylaxis, as a backup device in the event of an emergency.

4.4.23 The school has adrenaline auto-injectors for general use to be kept in the first aid kit and including this as part of the Emergency Response Procedures.

4.4.24 The adrenaline auto-injector should remain close to the student and school staff must be aware of its location at all times.

4.4.25 The adrenaline auto-injector should be carried in the school first aid kit.

4.4.26 Students with anaphylactic responses to insects should always wear closed shoes and long-sleeved garments when outdoors and should be encouraged to stay away from water or flowering plants.

4.4.27 Cooking and art and craft games should not involve the use of known allergens.

4.4.28 Consider the potential exposure to allergens when consuming food on buses and in cabins.

4.5 Storage of adrenaline auto-injectors

4.5.1 Adrenaline auto-injectors for individual students, or for general use, will be stored in the first aid room and be able to be accessed quickly.

4.5.2 Adrenaline auto-injectors are stored in an unlocked and easily accessible place (away from direct light and heat but not in a refrigerator or freezer).

4.5.3 Each adrenaline auto-injector is clearly labelled with the student's name and stored with a copy of the student's ASCIA Action Plan.

4.5.4 Adrenaline auto-injectors for general use (junior and adult dosage) are clearly labelled and distinguishable from those for students at risk of anaphylaxis.

4.5.5 Trainer adrenaline auto-injectors (which do not contain adrenaline or a needle) are not stored in the same location due to the risk of confusion.

4.6 Regular Review of adrenaline auto-injectors

4.6.1 Adrenaline auto-injectors are to be:

  • stored correctly and be able to be accessed quickly, because in some cases, exposure to an allergen can lead to an anaphylactic reaction in as little as five minutes
  • stored in an unlocked, easily accessible place away from direct light and heat
  • not stored in the refrigerator or freezer
  • signed in and out when taken from its usual place, e.g. for camps or excursions.

4.6.2 Each student's adrenaline auto-injector is distinguishable from other students' adrenaline auto-injectors and medications. Adrenaline auto-injectors for general use are also clearly distinguishable from students’ adrenaline auto-injectors.

4.6.3 All school staff know where adrenaline auto-injectors are located.

4.6.4 A copy of the student's ASCIA Action Plan is kept with their adrenaline auto-injector.

4.6.5 Depending on the speed of past reactions, it may be appropriate to have a student’s adrenaline auto-injector in class or in a yard-duty bag.

4.6.6 The school will purchase six adult and one junior adrenaline auto-injectors for general use as a back up to those already supplied by parents

4.6.7 A listing of the number of students enrolled at the school, who have been diagnosed as being at risk of anaphylaxis will be retained in the First Aid room

4.6.8 The expiry date of adrenaline auto-injectors will be checked regularly by the school nurse to ensure they are ready for use.