Policy: Anaphylaxis PURPOSE. Rationale. Procedure

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1 Policy: Rev Oct 14 PURPOSE (PCCC) is committed to the safety, wellbeing and inclusion of all children enrolled in its services. PCCC will ensure all staff involved in the delivery of services to children will be trained in assessing, minimising and managing risk of anaphylaxis and emergency procedures Rationale is a severe allergic reaction which is potentially life threatening. Most cases of anaphylaxis occur after a person with a severe allergy is exposed to the allergen to which they are allergic, usually a food, insect sting or medication. Although mild, moderate and even severe allergic reactions to foods, stings and bites are common in children, deaths are rare. The majority of food allergic and anaphylactic reactions occur in pre-school age children therefore PCCC has a responsibility to ensure that every reasonable precaution is taken to protect all children being cared for by the service. Egg, peanut and milk are the most common food allergies, peanuts and tree nuts are the most likely foods to cause fatal anaphylaxis, is very unlikely to occur from food odours or skin contact to foods (even highly allergenic foods such as peanuts), but casual skin contact may provoke local urticarial reactions (hives) at the site of contact. Simple hygiene measures such as hand washing and bench-top cleaning are considered appropriate to mitigate the risk. While adverse reactions to medications are common, allergic reactions to medications are rare, and most often occur in hospitals. This policy has been written with reference to The Australian Society of Clinical Immunology and Allergy (ASCIA) has published a paper titled ASCIA guidelines for prevention of anaphylaxis in schools pre-schools and childcare: 2012 update. The ASCIA paper provides background information on anaphylaxis, allergies and risk minimisation strategies. This policy should be read in conjunction with the Dealing with Medical Conditions Policy. Procedure Staff members should universally protect and assume all persons are at potential risk of anaphylaxis. Educators will be required to attend training on how to recognize and respond to a mild, moderate or severe allergic reaction including training in the use of adrenaline autoinjection devices Educators will provide age appropriate information on the risk minimisation strategies applicable to a child with severe allergies and their peers (e.g handwashing after eating, not sharing food etc) In the situation where a child who has not been diagnosed as allergic, but who appears to be having an anaphylaxis reaction, staff shall: Page 1 of 4

2 1. Call an ambulance immediately by dialling Commence first aid treatment 3. Contact the parent/guardian Risk minimisation measures Enrolment procedure shall identify children at risk of anaphylaxis prior to the child s attendance at the service. o Child s enrolment form documents any allergies. o Families are to inform the Operations Director/educators on diagnosis of their child s allergies o Parents must provide a written Action Plan for completed by a doctor if their child suffers from severe allergies and has been prescribed an adrenaline auto-injection device. This should be attached to the enrolment form. (Refer to Appendices 1 and 2). Note that if a child has not been prescribed an adrenaline auto-injection device an action plan is still required however in this situation the Action Plan for Allergies may be a more appropriate proforma to use (Refer to Appendices of Dealing with Medical Conditions Policy). o Where an adrenaline auto-injection device (EpiPen/Anapen) has been prescribed the parent must provide a complete in-date device to each of the centres where the child is enrolled. o Parents have a responsibility to notify the Operations Director/educators of any changes to their child s Action Plan. o A specific risk minimisation plan will be developed by PCCC in consultation with the Parents. A sign will be displayed at the entrance of the education and care service premises to alert all parents/ guardians who access the service that a child at risk of anaphylaxis is in attendance. All Educators must able to identify children at risk of anaphylaxis. (Including relievers, students and volunteers). Educators must able to identify where the EpiPen/Anapen kit and action plan is located for each at risk child. Educators must ensure that each EpiPen/Anapen at PCCC is within its expiry date. PCCC will keep a register of EpiPen/Anapen training which includes the last date that each educator was trained in the use of EpiPen/Anapen. Educators will practice regularly using adrenaline autoinjector training devices (with no needle and no adrenaline) medication is accessible to educators when children are inside, outside or on excursions. To minimise risks to children who are diagnosed as being at risk of anaphylaxis due to food allergies: o All food consumed by the child with allergies is closely monitored. o Food containers are clearly and accurately labelled with the child s name. o The sharing of food, cutlery, bowls cups etc does not occur. o Children diagnosed at risk of anaphylaxis are offered only allowed foods. o Tables and chairs are washed down after eating Page 2 of 4

3 o Materials used in art and craft are managed to avoid access to allergens e.g.: No egg cartons. o It may be appropriate that a child with a severe allergy does not sit at a table where the food to which they are allergic is being served, preferably without isolating the child. o Parents of all children will be asked not to send food containing highly allergenic foods such as egg and nut products if there is a child at risk of anaphylaxis to these foods enrolled at the service (This is due to the higher risk of person-to-person contact in young children). Nut products are considered to be those that contain nuts as an ingredient i.e includes nut spreads on sandwiches, however this does not include foods that warn may contain traces of nuts and therefore these are acceptable. o NB due to the dietary importance of cows milk and other dairy products ASCIA do not recommend that these products be removed from the service instead ASCIA recommend that milk allergic children be closely supervised when their peers are consuming dairy. To minimise risks to children who are diagnosed as being at risk of anaphylaxis from insect stings/bites: o The at risk child should wear appropriate clothing and shoes when outside. o The clothing of a child who is anaphylactic to tick bites should be brushed down before coming indoors to prevent tick bites. o Educators should specify play areas that are lowest risk and encourage the at risk child and their peers to play in this area. o Reasonable measures should be taken to decrease number of plants that attract stinging insects or ticks, and bee/wasp nests etc shall be removed. o Educators are aware of bees near water sources and in grassed or garden areas. o Educate all children to avoid drinking from open drink containers (particularly those that contain sweet drinks) Related Policies: Dealing with Medical Conditions Enrolment and Orientation Safe Food Handling References: The Australian Society of Clinical Immunology and Allergy (ASCIA) Page 3 of 4

4 Appendices Appendix 1: Action Plan for : For use with EpiPen Adrenaline Autoinjectors ANAPHYLAXSIS APPENDIX 1.pdf Appendix 2: Action Plan for : For use with Anapen Adrenaline Autoinjectors ANAPHYLAXSIS APPENDIX 2.pdf Page 4 of 4

5 Name: Date of birth: 1 Photo Confirmed allergens: Asthma Yes No Family/emergency contact name(s): Work Ph: Home Ph: Mobile Ph: Plan prepared by: Dr: Signed: Date: How to give EpiPen Form fist around EpiPen and PULL OFF BLUE SAFETY RELEASE. PLACE ORANGE END against outer mid-thigh (with or without clothing). PUSH DOWN HARD until a click is heard or felt and hold in place for 10 seconds. REMOVE EpiPen. Massage injection site for 10 seconds. Instructions are also on the device label and at: ASCIA This plan was developed by ASCIA PLAN FOR MILD TO MODERATE ALLERGIC RE Swelling of lips, face, eyes Hives or welts Tingling mouth Abdominal pain, vomiting (these are signs of a severe allergic reaction to insects) For insect allergy, flick out sting if visible. Do not remove ticks. Stay with person and call for help Locate EpiPen or EpiPen Jr Give other medications (if prescribed)... Dose:... Phone family/emergency contact 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 (young children) For use with EpiPen Adrenaline Autoinjectors Mild to moderate allergic reactions may or may not precede anaphylaxis Watch for any one of the following signs of anaphylaxis ANAPHYLAXIS (SEVERE ALLERGIC RE) 1 Lay person flat. Do not allow them to stand or walk. If breathing is difficult allow them to sit. 2 Give EpiPen or EpiPen Jr 3 Phone ambulance* 000 (AU), 111 (NZ), 112 (mobile) 4 Phone family/emergency contact 5 Further adrenaline doses may be given if no response after 5 minutes (if another adrenaline autoinjector is available) If in doubt, give adrenaline autoinjector Commence CPR at any time if person is unresponsive and not breathing normally. If uncertain whether it is asthma or anaphylaxis, give adrenaline autoinjector FIRST, then asthma reliever. EpiPen is generally prescribed for adults and children over 5 years. EpiPen Jr is generally prescribed for children aged 1-5 years. *Medical observation in hospital for at least 4 hours is recommended after anaphylaxis. Additional information Note: This is a medical document that can only be completed and signed by the patient's treating medical doctor and cannot be altered without their permission.

6 Name: Date of birth: Photo Confirmed allergens: Asthma Yes No Family/emergency contact name(s): Work Ph: Home Ph: Mobile Ph: Plan prepared by: Dr: Signed: Date: How to give Anapen PULL OFF BLACK NEEDLE SHIELD. PULL OFF GREY SAFETY CAP from red button. PLACE NEEDLE END FIRMLY against outer mid-thigh at 90º angle (with or without clothing). PRESS RED BUTTON so it clicks and hold for 10 seconds. REMOVE Anapen and DO NOT touch needle. Massage injection site for 10 seconds. Instructions are also on the device label and at: ASCIA This plan was developed by ASCIA PLAN FOR For use with Anapen Adrenaline Autoinjectors MILD TO MODERATE ALLERGIC RE Swelling of lips, face, eyes Hives or welts Tingling mouth Abdominal pain, vomiting (these are signs of a severe allergic reaction to insects) For insect allergy, flick out sting if visible. Do not remove ticks. Stay with person and call for help Locate Anapen 300 or Anapen 150 Give other medications (if prescribed)... Dose:... Phone family/emergency contact Mild to moderate allergic reactions may or may not precede anaphylaxis Watch for any one of the following signs of anaphylaxis ANAPHYLAXIS (SEVERE ALLERGIC RE) 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 (young children) 1 Lay person flat. Do not allow them to stand or walk. If breathing is difficult allow them to sit. 2 Give Anapen 300 or Anapen Phone ambulance* 000 (AU), 111 (NZ), 112 (mobile) 4 Phone family/emergency contact 5 Further adrenaline doses may be given if no response after 5 minutes (if another adrenaline autoinjector is available) If in doubt, give adrenaline autoinjector Commence CPR at any time if person is unresponsive and not breathing normally. If uncertain whether it is asthma or anaphylaxis, give adrenaline autoinjector FIRST, then asthma reliever. Anapen 300 is generally prescribed for adults and children over 5 years. Anapen 150 is generally prescribed for children aged 1-5 years. *Medical observation in hospital for at least 4 hours is recommended after anaphylaxis. Additional information Note: This is a medical document that can only be completed and signed by the patient's treating medical doctor and cannot be altered without their permission.

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