Health support planning: Anaphylaxis and severe allergies in education and care
Health support planning: Anaphylaxis and severe allergies in education and care
1 | Health support planning: Anaphylaxis and severe allergies in education and care | August 2018 Procedure Health support planning: Anaphylaxis and severe allergies in education and care Please note this procedure is mandatory and staff are required to adhere to the content. Summary This document is a practical direction for all staff working in education and care to plan and manage for children and young people with anaphylaxis and severe allergies. Table 1 - Document details Publication date August 2018 File number 18/07540 Related legislation Code of Practice First Aid in the Workplace 2012 Work Health and Safety Act 2012 State Records Act 1997 Disability Discrimination Act 1992 Disability Standards for Education 2005 National Disability Insurance Scheme Act 2013 Education and Early Childhood Services (Registration and Standards) Act 2011 Education Regulations 2012 Education and Care Services National Law 2010 Education and Care Services National Regulations and within those regulations in particular: Regulation 12(b)(i) Regulation 90(1)(a) Regulation 91 Regulation 92 Regulation 94(1) Regulation 95 Regulation 96 Regulation 136(1), (2) and (3) Regulation 153(1)(j) Regulation 162(c), (d) and (e) Regulation 168(2)
2 | Health support planning: Anaphylaxis and severe allergies in education and care | August 2018 Regulation 173(2)(f) Regulation 177(1)(c) Regulation 183(2)(a), (b) and (c) Related policies, procedures, guidelines, standards, frameworks Duty of Care policy Work Health and Safety policy First Aid and Infection Control Standard Direct Health Support of People with Disability (DCSI Policy) Medication management in education and care procedure Version 1.0 Replaces Anaphylaxis in education and children's services, revised edition 2012 Anaphylaxis management in education and care (2014 FAQs) Policy officer (position) Health Support Planning Policy Officer Policy officer (phone) 8226 1769 Policy sponsor (position) Director, Disability Policy and Programs Executive director responsible Executive Director, Early Years and Child Development Applies to All education and care staff Key words adrenaline, allergy, anaphylaxis, duty of care, epipen, first aid, guidelines, health support, medication, procedure, training, HSP120, HSP151, HSP154, HSP321, HSP322, HSP323 Status Approved Approved by Senior Executive Group Approval date 10 August 2018 Review date 10 August 2019
3 | Health support planning: Anaphylaxis and severe allergies in education and care | August 2018 Table 2 - Revision record Date Version Revision description Pending 1.0 New procedure developed incorporating information from the former ‘Guidelines for anaphylaxis in education and children’s services’ revised edition 2012 and ‘anaphylaxis management in education and care’ 2014 FAQs. The national law is clearly articulated. This procedure clearly explains the management of children and young people diagnosed with severe allergies and the emergency response for any person that may experience an episode of anaphylaxis while in an education and care setting.
This procedure includes guidelines for the provision and management of general use adrenaline autoinjectors at all education and care services.
4 | Health support planning: Anaphylaxis and severe allergies in education and care | August 2018 Table of Contents 1. Title ___ 5
2. Purpose ___ 5
3. Scope ___ 5
4. Procedure detail ___ 5
4.1 Legislative requirements ___ 5
4.2 Aboriginal cultural context statement ___ 6
4.3 Cultural diversity ___ 7
4.4 Allergic reactions and anaphylaxis background ___ 7
4.5 Signs and symptoms of allergic reaction including anaphylaxis ___ 8
4.6 Treatment for anaphylaxis ___ 8
4.7 Mental health and anaphylaxis ___ 10
4.8 ASCIA Action Plans, Health Care Plans and Health Support Agreement ___ 10
4.9 Adrenaline autoinjector (Epipen ___ 14
4.10 Planning and post-incident management ___ 19
4.11 Training and education ___ 21
4.12 Risk management ___ 22
Roles and responsibilities ___ 26
6. Monitoring, evaluation and review ___ 28
7. Consultation ___ 28
8. Definitions and abbreviations ___ 29
9. Supporting documents ___ 31
10. References ___ 32
Appendix . . 33
- the roles and responsibilities of education and care staff for managing the health support needs both proactively and reactively for children and young people who suffer from anaphylaxis and severe allergies
- signs and symptoms of mild to moderate allergic reactions and of anaphylaxis
- the emergency response for any person experiencing an episode of anaphylaxis while in an education or care setting
- the requirement for all government preschools and schools to maintain at least one general use adrenaline autoinjector on site
- education and training for anaphylaxis and severe allergies
- risk minimisation strategies for children and young people suffering from severe allergies and/or anaphylaxis 3. Scope This procedure applies to educators, early childhood development specialists, Principals, Directors and education support staff working in education and care.
In addition to this procedure, some children and young people may require support from the Access Assistant Program (AAP) or Registered Nurse (RN) Delegation of Care Program where they have invasive or complex healthcare needs, uncertain or changing health. The Access Assistant Program Flowchart or RN Delegation of Care Service Provider Toolkit support education and care staff to determine when additional supports are required. This procedure applies from the time a child or young person is enrolled until they leave the education or care service.
4. Procedure detail 4.1 Legislative requirements Education and care staff have a duty of care and safe work obligations (see Duty of Care Policy).
The education and care service and its staff have a duty of care to take reasonable steps to be informed as to whether a child or young person has a health condition and to take reasonable precautions during the period of care. The specific steps taken to minimise risk depend on the health condition, age and stage of development of the child or young person, triggers and the circumstances of the environment.
Pursuant to Regulation 136(1) and (2) of the Education and Care Services National Regulations 2014 education and care settings are required to have at least one staff member who is in attendance at a site and is immediately available in an emergency who holds a current approved first aid qualification, together with at least one staff member who is in attendance at a site and is immediately available in an emergency who has completed a current approved anaphylaxis management training course. It is sufficient to satisfy requirements where the same person holds both qualifications.
The Department for Education has an expectation that all staff have up to date first aid training.
6 | Health support planning: Anaphylaxis and severe allergies in education and care | August 2018 In accordance with the Department for Education School Transport Policy there is no requirement for drivers of departmentally owned and operated buses to be trained in first aid procedures and would therefore not be required to administer emergency response medications. Drivers of departmental owned buses must use discretion in an emergency situation, but on no account leave children unsupervised in such a situation.
All staff working with a child or young person who is known to be at risk of anaphylaxis should complete the approved anaphylaxis management training course in conjunction with practical training using an adrenaline autoinjector training device.
The Australasian Society of Clinical Immunology and Allergy (ASCIA) offer a free e-training course on anaphylaxis management in education and care services. Education and care staff should complete this course every three years and have regular practical training using an adrenaline autoinjector training device.
The Director or Principal must ensure appropriate support to enable all children and young people to participate in and benefit from their educational experience, as per requirements of the Disability Discrimination Act 1992 (DDA) and Disability Standards for Education 2005 (DSE). This includes the allocation of staff who are appropriately trained and able to provide the required level of support and supervision. For example, a child or young person cannot be excluded from an education or care service because they require health support assistance and staff are uncomfortable or unqualified to provide assistance.
4.2 Aboriginal cultural context statement The Department for Education acknowledge and give thanks to the members of the Women’s and Children’s Health Network Aboriginal Focus Group for their time and commitment to developing this generic Aboriginal cultural context statement for the health support planning procedures. Note: The term ‘Aboriginal’ is used to refer to people who identify as Aboriginal, Torres Strait Islanders, or both Aboriginal and Torres Strait Islander. This is done because the people indigenous to South Australia are Aboriginal and we respect that many Aboriginal people prefer the term ‘Aboriginal’.
We also acknowledge and respect that many Aboriginal South Australians prefer to be known by their specific language group(s).
Australian Aboriginal culture is the oldest living culture in the world, yet Aboriginal people currently experience the poorest health and education outcomes when compared to non-Aboriginal Australians. [The National Aboriginal and Torres Strait Islander Social Survey 2014-2015 shows poor education and literacy are linked to poor health status.] The cumulative effects of forced removal of Aboriginal children, poverty, exposure to violence, historical and transgenerational trauma, the ongoing effects of past and present systemic racism, culturally unsafe and discriminatory services are all major contributors to the disparities in Aboriginal education outcomes.
To achieve the best Aboriginal education outcomes, education and care services have a responsibility to provide a culturally safe environment allowing Aboriginal children and families to draw strength in their identity, community and culture. Aboriginal children are born into strong kinship structures where roles and responsibilities are integral and woven into the social fabric of Aboriginal societies. The primary caregiver for Aboriginal children is not always the parent. Education and care staff should consider engaging members of the extended family in the absence of parents and legal guardians where appropriate.
Education and care staff can secure positive long term education and wellbeing outcomes for our Aboriginal children and young people by making well informed decisions in consultation with families, based on cultural considerations.
7 | Health support planning: Anaphylaxis and severe allergies in education and care | August 2018 Health support agreements must be developed in partnership with parents. The opportunity to identify cultural needs is paramount. Education and care staff should be aware that parents may request the input of Aboriginal Community Education Officers (ACEOs) or Aboriginal Health Workers (AHW) in the development of their child’s Health Support Agreements. The use of an Aboriginal languages interpreter or translator should also be considered. 4.3 Cultural diversity Cultural diversity refers to the differences between human communities based on differences in their ideologies, values, beliefs, norms, customs, meanings and ways of life.
These differences are expressed and exemplified in social practices, attitudes and values, family interactions and expectations, values concerning education, ways of defining and treating health (physical and mental), business and management behaviours and practices, political practices and interpersonal relations.
Education and care services have a responsibility to provide a culturally safe environment through fostering awareness of cultural diversity and implementing culturally inclusive practices. To support the development of culturally valid health support planning in education and care settings, consideration must be given to the political, cultural, spiritual, emotional, environmental, structural, economic and biological factors impacting on the wellbeing of all children and young people. The development of health support agreements must be completed in consultation with parents and legal guardians; with an assurance that parents and legal guardians understand the content and the underlying values of the Australian context as well as have the opportunity to discuss their cultural perspective and needs.
The Department for Education English as an Additional Language or Dialect (EALD) program supports children and young people, and their families, from culturally and linguistically diverse backgrounds, and provides access to interpreter services and Community Liaison Officers (CLOs). Family members and friends should not be used as interpreters. The Preschool Bilingual program may be able to assist preschools to access interpreter services to support children and their families from culturally and linguistically diverse backgrounds. 4.4 Allergic reactions and anaphylaxis background An allergic reaction occurs when the immune system reacts to substances in the environment that are harmless to most people; known as ‘allergens’ and found in foods, insects, pollen, mould, dust mites and some medications.
Most allergic reactions are mild and do not involve the airways or circulation.
Anaphylaxis is a potentially life threatening, severe allergic reaction and should always be treated as a medical emergency. Not all people with allergies are at risk of anaphylaxis. Anaphylaxis involves the obstruction of oxygen (air) to the airway and lungs and/or the heart, brain and blood vessels. Research shows an increase of 10% per year in hospital admissions for food-induced anaphylaxis between 1997 and 20131 , with the majority of food-induced anaphylaxis admissions occurring in children aged less than 5, and fatalities as a result occurring between 8 and 35 years of age. Sting-induced anaphylaxis hospital admissions peak between 5 and 9 years of age, with no fatalities within this age group.2 1 http://allergenbureau.net/food-related-anaphylaxis-fatalities-rise-australi a/ 2 https://www.ncbi.nlm.nih.gov/pubmed/19117599
- 8 | Health support planning: Anaphylaxis and severe allergies in education and care | August 2018 4.5 Signs and symptoms of allergic reaction including anaphylaxis The first symptoms of an allergic reaction are often skin rash or facial swelling, however this is not always the case. Early symptoms to food-based reactions may also include abdominal pain and/or vomiting. Mild to moderate allergic reactions (hives/swelling) may not always occur before anaphylaxis (severe allergic reaction). Anaphylaxis may present with symptoms of breathing difficulty, cough or wheeze. If the same child or young person has asthma then it can be difficult to determine if this is anaphylaxis or asthma. SIGNS OF A MILD TO MODERATE ALLERGIC REACTION AND ANAPHYLAXIS Mild to moderate allergic reaction Anaphylaxis (Severe allergic reaction)
- Tingling mouth
- Swelling of lips, face, eyes
- Hives or welts
- Abdominal pain, vomiting (these are signs of anaphylaxis when the trigger is insect venom)
- Difficult/noisy breathing
- Swelling of tongue
- Swelling/tightness in throat.
- Difficulty talking and/or hoarse voice
- Wheeze or persistent cough
- Persistent dizziness or collapse
- Pale and floppy appearance (young children) If in doubt give adrenaline autoinjector Always give adrenaline autoinjector FIRST and then asthma reliever puffer if someone with known asthma and allergy to food, insects or medication has SUDDEN BREATHING DIFFICULTY even if there are no skin symptoms.
- 4.6 Treatment for anaphylaxis All education and care staff are required to provide first aid measures following any relevant ASCIA action plan or health support agreement and contacting emergency services. 4.6.1 First aid treatment for an allergic reaction including anaphylaxis
- Lay person flat. Do not allow them to stand or walk. If breathing is more difficult lying down allow them to sit. If unconscious place in recovery position
- Ensure the child or young person is no longer exposed to the allergen or trigger
- Administer adrenaline autoinjector into the muscle of the outer thigh (when using an EpiPen® hold in place for 3 seconds after the injection)
- Phone ambulance 000
- Phone family/emergency contact
- Further adrenaline doses may be given if no response after 5 minutes, if another adrenaline autoinjector is available
- Commence cardiopulmonary resuscitation (CPR) at any time if person is unresponsive and not breathing normally
- 9 | Health support planning: Anaphylaxis and severe allergies in education and care | August 2018
- In all cases of anaphylaxis the care for the child or young person must be transferred to the ambulance officer for admitting to hospital for at least 4 hours of observation
- The used adrenaline autoinjector should be handed to the ambulance officer, and they should be advised of the time of administration 4.6.2 Who can provide first aid for anaphylaxis by administration of an adrenaline autoinjector?
- Adrenaline autoinjectors have been designed for use by anyone in an emergency, including people who are not medically trained, such as a friend, teacher, childcare worker, parent, passer-by, or the individual with anaphylaxis themselves (if they are capable and old enough). Instructions are shown on the label of each device and on the ASCIA action plan for anaphylaxis. 4.6.3 Using an adrenaline autoinjector (eg EpiPen®, EpiPen®Jr)
- Give the injection in to the child or young person’s outer mid-thigh (intra-muscular). You can do this through clothing taking care to avoid seams and pockets.
- There is no need to swab the skin
- When using an EpiPen® hold the autoinjector in place for 3 seconds after the injection
- Do not rub or massage the injection site
- An Epipen® has an orange needle shield; after use the needle is retracted back into the device, no needle is exposed 4.6.4 Self-administration of an adrenaline autoinjector If a child or young person self-administers their own adrenaline autoinjector:
- A staff member must supervise and monitor the child or young person at all times
- Follow instruction in section 4.6.1 ‘First aid treatment for an allergic reaction including anaphylaxis’ The decision as to whether a child or young person can carry their own and/or selfadminister an adrenaline autoinjector in an education or care service can be made by using the carrying and/or self-administration of medication decision making tool, in consultation with the child or young person and parent or legal guardian. The Principal or Director (or nominated delegate) will determine if a child or young person is capable of assuming the responsibilities of carrying, self-administered and/or disposal of nominated medication(s); and will determine if notification, supervision and documentation of the medication administration is required. Some children and young people may choose to self-administer as they recognise the early stages of an anaphylaxis reaction but will most likely require assistance if their condition deteriorates.
Staff cannot expect children and young people experiencing anaphylaxis to selfadminister adrenaline via an adrenaline autoinjector. Individuals experiencing anaphylaxis can become confused and the risk of error in administration is high. In these circumstances education and care staff need to be prepared to administer the adrenaline autoinjector.
10 | Health support planning: Anaphylaxis and severe allergies in education and care | August 2018 4.6.5 Potential for a delayed response to an emergency Anaphylaxis management can be more difficult in remote and rural sites where ambulance bases are many kilometres away, or are operated by volunteer services.
Under these circumstances parents or legal guardians may choose to provide a second adrenaline autoinjector that travels between home and the site, in addition to the adrenaline autoinjector that remains at the education or care service. 4.7 Mental health and anaphylaxis Children and young people who have anaphylaxis, and their parents and legal guardians, may be anxious about their allergies3 .
In a small number of cases anxiety may become debilitating, preventing the child or young person from engaging in daily activities at home, school, or socially (ie a child or young person with an insect sting allergy might completely avoid the outdoors; or where there is a severe food allergy might follow an overly restrictive diet or avoid friends’ homes for fear of encountering an allergen; a young child with anaphylaxis might refuse to stay at school without a parent for fear of having a reaction there).
Where there are recurrent episodes of anxiety related to anaphylaxis or severe allergies a health support agreement should be developed (or updated) to reflect strategies to reduce and manage the anxiety.
It is important to return the child or young person quickly to class activities to distract the focus from remaining symptoms and prevent reinforcement of avoidant behaviours that may exacerbate anxiety. Calling parents or legal guardians to remove the child or young person from the education or care service may promote school avoidance.
High levels of anxiety may often be seen in parents and legal guardians of children and young people with severe allergies, particularly those with nut allergies 4 . Prescribing adrenaline autoinjectors has been associated with a reduction in anxiety for parents and legal guardians. Stress and anxiety for children and young people with severe allergies, and their parents or legal guardians, can significantly increase when there is a change in lifestyle such as starting (or changing) education or care service.There are four main causes of stress and anxiety relating to anaphylaxis for parents and legal guardians5 :
- the potential seriousness of anaphylaxis (life-threatening)
- the inconvenience and changes in lifestyle (difficulty with shopping, reading labels, constantly having to explain the allergy)
- feeling isolated and that others don’t understand
- letting go (trusting the child or young person and others to deal with the allergy) Regular and ongoing communication with parents and legal guardians is important to reassure them of the strategies in place to manage the child or young person’s allergies, with an emphasis on the ability of the education or care service to ensure a safe environment. 4.8 ASCIA Action Plans, Health Care Plans and Health Support Agreement The Australasian Society of Clinical Immunology and Allergy (ASCIA) have developed Action Plans to provide instructions for first aid treatment of anaphylaxis to be delivered by people without any 3 https://www.hindawi.com/journals/ja/2012/316296/ 4 http://onlinelibrary.wiley.com/doi/10.1034/j.1399-3038.2003.00072.x/abstrac t;jsessionid=685123D861FB4C0826013399132E77A4.f02t02 5 http://www.aaia.ca/en/living_with_anaphylaxis_handling_the_stress.htm
- 11 | Health support planning: Anaphylaxis and severe allergies in education and care | August 2018 special medical training. ASCIA action plans must be completed by the treating health professional. There are two types of Action Plans for Anaphylaxis and a third Action Plan for Allergic Reactions.
- ASCIA general action plan for anaphylaxis (‘orange plan’) o Does not contain any personal information; for management of an anaphylaxis incident using the general use EpiPen®
- ASCIA personal action plan for anaphylaxis (‘red plan’) o Contains personal information and a photo for individuals that have been prescribed a personal use EpiPen®
- ASCIA action plan for allergic reactions (‘green plan’) o Contains personal information and a photo for individuals with medically confirmed allergies but have not been prescribed and EpiPen® There may also be circumstances where a non-specific health care plan is developed in consultation with the child or young person, parent or legal guardian and treating health professional that may include management for anaphylaxis where an ASCIA action plan is not in place. This may include where a child or young person has multiple diagnoses that are incorporated into a single health care plan.
A health support agreement with a safety and risk management plan may be developed in consultation with the parent or legal guardian to identify and document risk minimisation strategies, management and treatment for the child or young person in the event of an allergic reaction or anaphylaxis in the context of the education or care setting. 4.8.1 ASCIA General Action Plan for Anaphylaxis (‘orange plan’) The general version (orange plan) does not contain personal information and must be stored in the education or care service with the general use adrenaline autoinjector and used as an instruction guide.
4.8.2 ASCIA Personal Action Plan for Anaphylaxis (‘red plan’) The personal anaphylaxis version (red plan) is for a person who has been prescribed an adrenaline (epinephrine) autoinjector. This plan includes personal information, an area for a photo and a review date. The red plan may include a description, including the name, dose and administration instruction, of other medication (if prescribed) under the ‘action for mild to moderate allergic reaction’ section. This must be completed by the treating health professional and can be used as a medication agreement provided all relevant information is included and legible (ie dose, strength, form, route).
4.8.3 ASCIA Action Plan for Allergic Reactions (‘green plan’) The allergic reaction version (green plan) is for a person with medically confirmed allergies where an adrenaline autoinjector has not been prescribed. This green plan includes personal information, an area for a photo and a review date. The green plan is developed for a person with a confirmed food, insect or medication allergy who is thought to be at risk of anaphylaxis. However, as it is not possible to be certain that the person will not have a severe reaction; the green plan provides guidance on how to manage anaphylaxis if it occurs.
The green plan may include a description, including the name, dose and administration instruction, of other medication (if prescribed) under the ‘action for mild to moderate allergic reaction’ section. This must be completed by the treating health professional and
12 | Health support planning: Anaphylaxis and severe allergies in education and care | August 2018 may be used as a medication agreement provided all relevant information is included and legible (ie dose, strength, form, route). 4.8.4 Non-specific Health Care Plan In some circumstances a non-specific health care plan may be developed by the treating health professional or specialised nurse practitioner in consultation with parents or legal guardians, where a child or young person has a severe allergic reaction but has alternative management strategies for an anaphylaxis incident or has comorbidities.
This may include where a child or young person has multiple diagnoses that are incorporated in a single care plan.
In these circumstances this must be clearly and regularly communicated to education and care staff to ensure appropriate management of the child or young person in the event of a severe allergic reaction. Where a child or young person has invasive or complex healthcare needs, uncertain health or changing health they may be eligible for and supported by the Access Assistant Program (AAP). The Access Assistant Program Flowchart supports education and care staff to determine when to contact the AAP to talk to a Referral Coordinator. 4.8.5 Individual first aid plan In some circumstances an individual first aid plan may be developed by the treating health professional in consultation with the parents or legal guardian where a child or young person requires a first aid response that is not the standard first aid response for their health condition.
Where the first aid response for the child or young person is the standard first aid response for management of anaphylaxis and severe allergies an individual first aid plan is not required. 4.8.6 Medication management Administration of medication in an education and care setting must be done following the medication management in education and care procedure. Administration of any medication requires a medication agreement with the exception of emergency medication (adrenaline autoinjector and asthma reliever inhaler).
Where the ASCIA action plan includes the prescription of other medication under the ‘action for mild to moderate allergic reaction’ section a separate medication agreement is not required provided all relevant information is included and legible (ie dose, strength, form, route).
It is the responsibility of the parent or legal guardian to provide the education or care service with prescribed medication. This must be in-date, in the original pharmacy dispensed package, and include name, date of birth and dose information. 4.8.7 Health Support Agreement Where a child or young person has been identified to be at risk of allergic reaction and/or anaphylaxis (this could be with or without a medical diagnosis; and with or without an ASCIA action plan or a non-specific health care plan) the education or care service may complete a health support agreement in consultation with the parent or legal guardian., including the completion of the safety and risk management plan to ensure the identification and documentation of site specific risk minimisation strategies, and individualised management and treatment for the child or young person in the event of an allergic reaction or anaphylaxis.
The health support agreement should clearly identify cultural, spiritual and language needs and where a child or young person’s anaphylaxis is severe.
- annually (at the start of each year)
- when the ASCIA action plan or non-specific health care plan has been reviewed and updated
- as soon as practicable after an episode of anaphylaxis at the education or care service to ensure all risk minimisation strategies have been identified and documented
- prior to the child or young person participating in an offsite activity ie camps or excursion, or at onsite special events ie class parties, cultural days, fetes, sports or swimming events, incursions (where the safety and risk management plan has not addressed risk minimisation strategies for offsite activities an offsite safety and risk management plan should be developed).
4.8.8 One Plan This section only applies where a child or young person has a One Child One Plan (referred to as One Plan). Where a child or young person has health support needs this must be referenced in the child or young person’s One Plan. Health needs are recorded under the Notes/Agreed Actions screen. Under the Type field select Medical from the drop down box. Health support needs may be recorded in the Support screen to document specific support requirements, the focus for support, frequency and intensity of the support. This will enable education and care staff to monitor and provide health support needs for the child or young person through the One Plan.4.8.9 Where severe allergies are identified but there is no ASCIA Action Plan or Health Care Plan In some circumstances parents or legal guardians may indicate a child or young person has severe allergies, however there is no ASCIA action plan or non-specific health care plan in place. In this instance the education or care service should:
- encourage the parent or legal guardian to seek advice from a health professional to obtain an ASCIA action plan for the management and treatment of the allergies and anaphylaxis
- develop a health support agreement and safety and risk management plan in consultation with the parent or legal guardian
- advise the parent or legal guardian of the standard first aid response for managing allergic reactions and/or anaphylaxis in an education or care service 4.8.10 Who can complete the ASCIA Action Plan, Non-specific Health Care Plan and Health Support Agreement ASCIA action plans and non-specific health care plans can only be completed by a treating health professional or specialised Nurse Practitioner. ASCIA action plans and health care plans cannot be completed by a parent or legal guardian or by education and care staff.
Health support agreements are completed by the education or care service in consultation with the parent or legal guardian, and child or young person (where appropriate).
14 | Health support planning: Anaphylaxis and severe allergies in education and care | August 2018 Where the health support agreement is being completed for an Aboriginal child or young person this should be developed in consultation with the primary caregiver, who is not always the parent. Extended family members and Aboriginal Community Education Officers (ACEOs) or Aboriginal Health Workers (AHW) may also assist in the development of the health support agreement to ensure they are developed in a culturally appropriate and meaningful way.
The development of health support agreements must be completed with an assurance that the content is understood and culturally valid. Children and families from culturally and linguistically diverse backgrounds may require additional support persons and access to interpreter services and Community Liaison Officers (CLOs). 4.8.11 Copies and locations of care plans and support agreements Original copies of the ASCIA action plans can be photocopied or scanned, preferably in colour as they are colour coded.
Copies of the child or young person’s personal (red) action plan must be located with their adrenaline autoinjector and easily accessible.
Additional copies of the personal (red) and allergic reaction (green) action plans should be kept in various locations around the education or care service so they are easily accessible by education and care staff in an emergency situation. Locations may include the child or young person’s classroom, canteen, sick bay, school office and yard duty bag. A general (orange) action plan must be stored with the general use adrenaline autoinjector.
The number and location of care plan and support agreement copies will be determined by the Principal or Director of the education or care service based on a risk assessment with consideration of timeliness of access in an emergency situation. A document control for care plans and support agreements form may be completed to identify the number and location of all copies of the care and support plans. When a care plan or support agreement is reviewed and updated all forms in all locations must be replaced.
4.8.12 Review of ASCIA Action Plans and Health Care Plans The personal (red) and allergic reaction (green) action plans include the date of next review.
Action Plans do not need to be updated each year. If there are no changes in the diagnosis or management, the medical information on the Action Plan or non-specific health care plan may not require updating, however the photo should be updated each time so the child or young person can be easily identified. Action Plans are often updated and replaced when the child or young person is reassessed by their treating health professional and/or when their condition changes. Where a review date has expired the action plan remains valid until an updated form is received. A review date is NOT an expiry or end date.
4.9 Adrenaline autoinjector (Epipen®) Adrenaline autoinjectors are automatic injectors that contain a single pre-measured dose of adrenaline which cannot be reused. They are designed to be used by anyone in an emergency, including people who are not medically trained. Instructions are shown on the label of each autoinjector and on the ASCIA action plan for anaphylaxis. Adrenaline works within minutes to reduce throat swelling, open up the airways and maintain blood pressure in people experiencing a severe allergic reaction. Withholding or delaying adrenaline may result in deterioration and potentially death of someone experiencing anaphylaxis.
15 | Health support planning: Anaphylaxis and severe allergies in education and care | August 2018 In all cases when an adrenaline autoinjector is administered an ambulance must be called and care for the child, young person or adult must be transferred to the ambulance officer for admission to hospital for observation and monitoring. If in doubt give adrenaline autoinjector It is better to use the adrenaline autoinjector even if in hindsight the reaction is not anaphylaxis. The potential risks of NOT giving adrenaline far outweigh the potential risks of giving adrenaline. ASCIA advises that no serious harm is likely to occur from mistakenly administering adrenaline to a child or young person who is not experiencing anaphylaxis.
- 4.9.1 Provision of general use adrenaline autoinjector(s) for education and care services One clearly labelled, ‘general use’ adrenaline autoinjector that has not been prescribed to a particular child or young pers006Fn must be available at each preschool and school.
- Preschools must have one general use 0.15mg adrenaline autoinjector (eg EpiPen®Jr)
- Schools must have one general use 0.3mg adrenaline autoinjector (eg EpiPen®) Where a school has campuses across multiple physical locations and staff are unable to access the general use adrenaline autoinjector across campuses the Principal or Director may purchase additional devices.
Adrenaline autoinjectors for general use are available for purchase at any pharmacy without a prescription. When purchasing an adrenaline autoinjector it is important to ensure the date on the device has at least 12 months before expiry. Adrenaline autoinjectors are funded by the education or care service. Adrenaline autoinjectors must be replaced as soon as practicable after use, when the integrity of the medication is compromised, or prior to expiry. The anaphylaxis risk assessment can be completed by education and care services to assist in planning and measuring the implementation and use of general use adrenaline autoinjectors.
4.9.2 Prescribing an adrenaline autoinjector to children and young people with a known risk of anaphylaxis The child or young person’s treating health professional will prescribe the adrenaline autoinjector within the context of a comprehensive anaphylaxis management plan. The decision to prescribe an adrenaline autoinjector for any child or young person is a medical decision which occurs during a consultation between the treating health professional, parent or legal guardian and child or young person.
Two adrenaline autoinjectors are usually prescribed to a child or young person where they have a high risk of anaphylaxis and these are subsidised under the Pharmaceutical Benefits Scheme (PBS).
At least one adrenaline autoinjector should be kept within close proximity of the child or young person. Not all children or young people with a diagnosed allergy will be prescribed an adrenaline autoinjector. Additional adrenaline autoinjectors can be purchased without prescription from a pharmacy at full cost.
4.9.3 Adrenaline autoinjector dose recommendations Adrenaline autoinjectors currently available in Australia include the EpiPen® and EpiPen®Jr.
- 16 | Health support planning: Anaphylaxis and severe allergies in education and care | August 2018 EpiPen®Jr
- Green label device
- Contains 0.15mg of adrenaline
- Usually prescribed/administered for children aged 1 to 5 years of age (10kg-20kg)
- However, if only a yellow label EpiPen® is available this should be used in preference to not using one at all. EpiPen®
- Yellow label device
- Contains 0.3mg of adrenaline
- Usually prescribed/administered for children over 5 years of age, young people and adults (20kg+)
- However, if only a green label EpiPen®Jr is available this should be used in preference to not using one at all.
4.9.4 Storing adrenaline autoinjectors All adrenaline autoinjectors must be kept out of reach of small children but quickly accessible and not locked in a cupboard or classroom (during recess or lunch). In some cases exposure to an allergen can lead to anaphylaxis within 5 minutes. An ASCIA action plan for anaphylaxis must be kept with the adrenaline autoinjector. Adrenaline autoinjectors are light and heat sensitive and must be stored in a cool dark place at room temperature (between 15 and 25 degrees Celsius). Where there is a fluctuation outside of these temperatures the adrenaline autoinjector may be stored in an insulated wallet with an ice brick; however not in contact with the ice brick as this may damage the autoinjector mechanism.
Adrenaline autoinjectors must not be stored in a refrigerator or freezer as this may affect the autoinjector mechanism. Education and care services need to conduct emergency response training exercises to time how long it takes to obtain an adrenaline autoinjector (from raising the alarm to administration) across various locations; this should include consideration of access and availability of adrenaline autoinjectors on excursions and camps. All emergency response training should include a review of all aspects of the response; including review of current action plans, care plans and/or support agreements for effectiveness and review of storage location of adrenaline autoinjectors to ensure timely access.
Areas requiring further planning or improvements should be identified and actioned. Points for consideration about adrenaline autoinjector storage: Front office/first aid area: In the classroom: Is this the place staff will most likely go to or contact in an emergency? Are staff always available in this area?
Strategy for consideration: teachers to carry a mobile phone and contact the front office in the event of an anaphylaxis emergency so the adrenaline autoinjector can immediately be taken to the location of the emergency Is the adrenaline autoinjector stored in a classroom or locker that is not accessible during breaks? (It should not be stored in a locked location) Will the staff on duty (who may be temporary) know the location of the adrenaline autoinjector? Will staff know where the adrenaline autoinjector is stored in the room? Are adrenaline autoinjectors available on excursions and school camps?
- Where a child or young person has a personal adrenaline autoinjector these must have a pharmacy label and be stored in the original container that is clearly labelled with the child or young person’s name.
- The education or care service’s general use adrenaline autoinjector must be stored within the original labelled container and clearly labelled as ‘general use’. Training devices:
- Adrenaline autoinjector training devices must never be stored in the same location as personal use or general use adrenaline autoinjectors to avoid the risk of confusion.
- All adrenaline autoinjector training devices must be clearly labelled ‘training device only’. 4.9.5 Disposal of adrenaline autoinjectors (used, expired or damaged) An EpiPen® is designed for the needle to automatically retract back into the device when administered, preventing the risk of needle stick injury.
The used adrenaline autoinjector should be handed to the ambulance officer. Expired or damaged adrenaline autoinjectors should be returned to the pharmacy when replacing the device. 4.9.6 Expired or damaged adrenaline autoinjectors The shelf life of an adrenaline autoinjector is around 1-2 years from the date of manufacture. Devices must be replaced prior to the expiry date. It is important to check the expiry date on the device, rather than the box. Education and care services are encouraged to register with the EpiClub® reminder program when an EpiPen® is purchased. This free service sends a reminder via SMS, email or post, when the EpiPen® is nearing expiry.
Where the adrenaline autoinjector is for a child or young person’s personal use, and it is noted by the education and care staff that the expiry date is nearing, the parent or legal guardian should be notified as soon as practicable. It is the responsibility of the parent or legal guardian to ensure that at all times medications are in date, and in the original container with a pharmacy label that includes name, dose and administration instructions. The ASCIA website notes that a recently expired adrenaline autoinjector should be used in preference to not using one at all; however the education or care service must ensure that a regular review is undertaken and general use adrenaline autoinjectors close to expiry date are replaced.
The EpiPen® contains a clear window near the tip where the adrenaline can be checked. This should be checked regularly. Adrenaline is a clear liquid (refer Image A). Where the adrenaline is cloudy or discoloured (refer Image B) or there is evidence of sediment the general use device should be replaced or the parent or legal guardian notified for personal use devices. Image A Image B
18 | Health support planning: Anaphylaxis and severe allergies in education and care | August 2018 4.9.7 Regular review of adrenaline autoinjectors Education and care services should have a nominated staff member to undertake a regular review of all adrenaline autoinjectors.
This includes all general use devices, and personal use devices that are held by the education or care service. The review requires a visual inspection of each adrenaline autoinjector to check the expiry date and the integrity of the adrenaline. This should be completed on the review of adrenaline autoinjectors checklist.
4.9.8 Using a child or young person’s personal use adrenaline autoinjector for another person If the education or care service has a general use adrenaline autoinjector this should always be used in the first instance. If the general use adrenaline autoinjector is not available and it is an emergency, the priority and overarching duty of care is to assist the person having the reaction as it may be life-threatening. In this instance another child or young person’s personal use adrenaline autoinjector may be used.
In the event of this education and care staff must ensure the child or young person whose adrenaline autoinjector has been used is not exposed to any risks until a replacement device is available.
This may include supervision inside if the allergen is environmental or insect related; or if food related, restrict food options to ensure exposure is minimised. If a child or young person’s personal use adrenaline autoinjector has been used on another person the education or care service must, as soon as practicable, purchase a replacement adrenaline autoinjector from a pharmacy at the education or care service expense; and the parent or legal guardian notified.
4.9.9 Medication management and legislation for adrenaline autoinjectors In all cases education and care services must ensure that medication is not administered to a child or young person unless the administration is authorised and the medication is administered in accordance with Regulation 95 and 96 of the Education and Care Services National Regulations 2014 and the Department for Education medication management in education and care procedure. The requirement for an authorisation does not apply in cases where the emergency relates to anaphylaxis or asthma (see Regulation 94(1)). Where an adrenaline autoinjector is administered in an emergency without an authorisation, the education or care staff must notify the parent or legal guardian, call the ambulance and transfer duty of care of the child or young person to the ambulance officer.
Where an ASCIA action plan includes a description of other medication under the ‘action for mild to moderate allergic reaction’ section, completed by the treating health professional, this can be used as a medication agreement. 4.9.10 If a parent or legal guardian has not provided an adrenaline autoinjector Enrolment or attendance cannot be refused because an adrenaline autoinjector is not provided where a child or young person has a known risk of anaphylaxis. Parents or legal guardians are ultimately responsible for their child or young person’s wellbeing and have a duty of care to provide information to the education or care service about their child or young person’s health care needs together with the appropriate documentation, equipment and medication.
The parent or legal guardian should be encouraged to provide a personal adrenaline autoinjector for their child or young person.