Special Note: Thank you! Happy Safe and Healthy Schools

Transcription

1 Special Note: The following Swain County School s EpiPen / Anaphylaxis information is accurate, however all personal information or contact information have been left blank / XXX for the privacy of the agencies and people involved. **************************** If you should need - contact Swain County s Superintendent for the Swain County s EpiPen Program Coordinator for use of such information. Thank you! Happy Safe and Healthy Schools

2 Swain County Schools (SCHS, SCMS, East Elementary, West Elementary, Pre-K) EpiPen / Anaphylaxis Policy and Procedure Manual Information Effective Date: XXXXXX XX, XXXX *************************************** Last updated: XXXXXX XX, XXXX 2

3 Disclaimer Page Swain County s EpiPen Program Coordinator has designated to hold on to this blue-green binder/information until no longer hold their working position or if the Swain County EpiPen Program Coordinator reassigns this blue-green binder/information to someone else. NOTE: This blue-green binder and ALL containing information is strict private property and belongs to Swain County School system. If you have not been designated by Swain County s EpiPen Program Coordinator to hold on to this information PLEASE RETURN this blue-green binder to Swain County s Superintendent, so it can be returned to Swain County s EpiPen Program Coordinator and reassigned: Swain County Central Office Att: Swain County s Superintendent 280 School Dr. (P.O. Box 2340) Bryson City, NC Phone (828) Fax: (828) Swain County Central Office Website: No contact information (phone numbers, address, etc ) found in this AED School Policy & Procedure Manual is to be given out unless prior approval is given each time by the owner of the contact information. NOTE: For Swain County s EpiPen Policy and Procedure Manual - Most filled-in information can be found in a blue-green binder, with the school s nurse at each school s site. ALL filled-in information can be found with the AED Program Coordinators. Non-filled in information is kept on the School s website. EpiPen(s) is kept in the AED cabinet (along with the AED) with a copy of the EpiPen Post Incident Report Form (Appendix I) 3

4 Table of Contents 1. Swain County Life Threatening Allergic Reaction and EpiPen Committee 2. Swain County Schools Anaphylaxis Policy Pathophysiology and Treatment Guideline Determinants - Federal Requirements 3. Training Procedures: Anaphylaxis Education for School wide training all staff members Anaphylaxis Training: school staff a. Pathophysiology and Treatment Procedures Trained school staff Website/quiz/skill sheet information regarding training for school staff a). List (names) of train school staff 4. EpiPen Administration Protocol: Responding to Anaphylaxis Post Event Actions Photos of where Swain County Schools have EpiPens 5. Individual Roles, Responsibility, and Guidelines Anaphylaxis Management Storage, Access and Maintenance Definitions Swain County Schools EpiPen info 6. Appendix (see below) 7. References *******Appendices on following page******* 4

5 Table of Contents continue ***************Appendices*************** Contact Phone List Appendix A EpiPen Location Appendix B School s monthly/yearly EpiPen check off sheet Appendix C SC Schools Nurses (Allergy/Anaphylaxis) Individualized Healthcare Plan (IHP) Appendix D Voluntary guidelines for managing food allergies in schools & early care CDC Appendix E Medication Authorization Form (for carrying self-injectable epi & other meds) Appendix F Food Allergy Quiz (Post Test AND Answers: Anaphylaxis) Appendix G Emergency Anaphylaxis & Epinephrine Auto-Injector Pen Training Checklist Appendix H EpiPen Post Incident Report Form Appendix I Anaphylaxis Take Home Information Appendix J 10A NCAC 27G.0209 Medication Requirements Appendix K (FARE) Food Allergy & Anaphylaxis Emergency Care Plan Appendix L Student Health Registration Form Appendix M Food Allergy Assessment Form Appendix N Bee or Insect Allergy Assessment Form Appendix O Authorization for Administration of Medication at School Appendix P Authorization for Exchange of Medical Information Appendix Q Letter - Staff Administering Emergency Medication at School Appendix R Children with a Life-Threatening Food Allergies Diet Prescription Form Appendix S Children with Special Dietary Needs Diet Prescription Form Appendix T Life-Threatening Allergy Care Plan Appendix U Emergency EpiPen Medication Administration at School Skills Checklist Appendix V Registered Nurse Checklist for Students with Life-Threatening Food Allergies Appendix X Sack Lunch Request Form Appendix Y Substitute Teacher Letter Appendix Z Classroom Letter Appendix AA School Letter to All Parents Appendix BB (WASSDA) Policy & Procedure Letter to Parents Appendix CC Information found with Primary & Alternate EpiPen Program Coordinators Appendix DD 5

6 Swain County Life Threatening Allergic Reaction and EpiPen Committee Swain County Schools EpiPen Physician, Lead Nurse, and Program Coordinators Dr. XXXXXX XXXXXX Swain County Schools EpiPen Physician via Swain County Health Department *XXXX XXXXX *Lead EpiPen Nurse Coordinator XXXXX XXXX Swain County Superintendent and Alternate EpiPen Program Coordinator XXXXX XXXXX Primary EpiPen Program Coordinator and Alternate monthly EpiPen date checker Swain County Health Department XXXXX XXX Director of Swain County Health Department 545 Center Street, Bryson City, NC Phone x 2002 Fax Swain County Schools XXXXX XXXX High School Nurse XXXXX XXXXX Middle School Nurse XXXXX XXXXX West Elementary School Nurse XXXXX XXXXX East Elementary School Nurse XXXXXX XXXX Pre-K Bright Adventure monthly EpiPen date checker 6

7 Swain County Schools Anaphylaxis Policy Policy statement and purpose: The Swain County Public Schools recognizes that some students have life-threatening allergies. It is imperative that parents/guardians notify school administration regarding allergies and health issues with their children. The Swain County School District believes that the safety and wellbeing of children who are at risk of anaphylaxis is a whole community responsibility. The school is committed to: Providing a safe and healthy environment. Raising awareness about allergies and anaphylaxis among the school community and children in attendance. Ensuring each staff member and other relevant adults has adequate knowledge of allergies, anaphylaxis and emergency procedures. Facilitating communication between all staff, students, and families to ensure the wellbeing of children at risk for anaphylaxis. Upon notification and identification of a student with life-threatening allergies by a parent/guardian, and with complete documentation from a physician, the school will follow the plan of care as identified below. Scope: This policy applies when a child has an unsuspected anaphylaxis and those students who are diagnosed as being at risk for anaphylaxis and is enrolled in school. It applies to the whole school community/staff, students, parents/guardians and school volunteers while on school grounds during operation hours. Background: Anaphylaxis is a severe, life-threatening allergic reaction. Up to two percent of the general population and up to five percent of children are at risk. The most common causes in young children are eggs, peanuts, tree nuts, cow milk, bee or other insect stings, and some medications. Young children may not be able to express the symptoms of anaphylaxis. A reaction can develop within minutes of exposure to the allergen, but with planning and training, a reaction can be treated effectively by using an adrenaline auto-injector called an EpiPen. The school recognizes the importance of staff responsible for the child/ren at risk of anaphylaxis undertaking training that includes preventative measure to minimize the risk of an anaphylactic reaction, recognition of the signs and symptoms of anaphylaxis and emergency treatment, including administration of an EpiPen. Staff and parents/guardians need to be made aware that it is not possible to achieve a completely allergen-free environment in any school that is open to the general community. Staff should not have a false sense of security that an allergen has been eliminated from the environment. Instead the school recognizes the need to adopt a range of procedures and risk minimization strategies to reduce the risk of a child having an anaphylactic reaction, including strategies to minimize the presence of the allergen in the school. 7

8 Anaphylaxis Policy (Severe Allergic Reaction) It is the policy of Swain County Public Schools ((SCHS, SCMS, East Elementary, West Elementary, Pre-K Bright Adventures)) to provide at least two (2) doses of auto-injectable epinephrine (hereinafter called unassigned or stock epinephrine ) in each school, to be administered by a school nurse or employee of the school who is authorized and trained in the administration of epinephrine to any student (school community/staff, students, parents/guardians and school volunteers while on school grounds during operation hours) believed to be having an anaphylactic reaction on school premises, during the academic day. The Code of North Carolina (Statute 115C-307 (2000)) provides civil protection for employees of a school board who are appropriately trained to administer epinephrine. Policy Limitations Parents of students with known life threatening allergies and/or anaphylaxis should provide the school with written instructions from the students health care provider for handling anaphylaxis and all necessary medications for implementing the student specific order on an annual basis. This anaphylaxis policy is not intended to replace student specific orders or parent provided individual medications. This policy does not extend to activities off school grounds (including transportation to and from school, field trips, etc.) or outside of the academic day (sporting events unless the school s certified athlete trainer is available at that event), extra-curricular activities, etc.). Overview Anaphylaxis is a severe systemic allergic reaction from exposure to allergens that is rapid in onset and can cause death. Common allergens include animal dander, fish, latex, milk, shellfish, tree nuts, eggs, insect venom, medications, peanuts, soy, and wheat. A severe allergic reaction usually occurs quickly; death has been reported to occur within minutes. An anaphylactic reaction can occur up to one to two hours after exposure to the allergen. Symptoms of Anaphylaxis Shortness of breath or tightness of chest; difficulty in or absence of breathing Sneezing, wheezing or coughing Difficulty swallowing Swelling of lips, eyes, face, tongue, throat or elsewhere Low blood pressure, dizziness and/or fainting Heart beat complaints: rapid or decreased Blueness around lips, inside lips, eyelids Sweating and anxiety Itching, with or without hives; raised red rash in any area of the body Skin flushing or color becomes pale Hoarseness Sense of impending disaster or approaching death Loss of bowel or bladder control Nausea, abdominal pain, vomiting and diarrhea Burning sensation, especially face or chest Loss of consciousness 8

9 Although anaphylactic reactions typically result in multiple symptoms, reactions may vary. A single symptom may indicate anaphylaxis. Epinephrine should be administered promptly at the first sign of anaphylaxis. It is safer to administer epinephrine than to delay treatment for anaphylaxis. Training Anaphylaxis Education for School wide training all staff members School wide training is done annually by the school nurse which will include information on signs and symptoms of allergic reactions (anaphylaxis) for all staff members in their school. This school wide training of all staff in recognizing anaphylaxis will be done within the first week of school for each building. (There will be additional training for school staff administering of EpiPens to appropriate assigned personal see below). Anaphylaxis Training: school staff School administration (principal and school nurse) shall be responsible for identifying at least two employees, in addition to the school nurse (RN or LPN), to be trained in the administration of epinephrine by autoinjector. Only trained personnel should administer epinephrine to a student believed to be having an anaphylactic reaction. Training shall be conducted in accordance with the most current edition of the North Carolina Department of State Policies on Staff Administration of Medication in Schools. Training of school staff (see page 11); The training and quiz MUST done is done annually / the skill sheet is done biannually (at the beginning of each school semester) for each trained individual. Those trained in EpiPen administration with passing the quiz of at least 80% and skill sheet of 100%. It is the responsibility of the school nurse to correct and assure learning of each individual. Names of the trained individuals will be kept on page 12. (More information regarding this training pages 10-11) Standing Orders Standing orders are written to cover multiple people as opposed to individual-specific orders, which are written for one person. Swain County Public Schools shall designate an authorized medical provider (MD, DO, PA, or NP with prescriptive authority) to prescribe non-student specific epinephrine for the school division, to be administered to any student believed to be having an anaphylactic reaction on school grounds, during the academic day. Standing orders must be renewed annually and with any change in prescriber. North Carolina Statute 115C-307 (2000) allows any teacher or school employee, when given authority by the board of education or its designee, to administer any drugs or medication prescribed by a doctor upon written request of the parents. Statute 115C allows any teacher or school employee to administer any drugs or medication prescribed by a doctor upon written request of the parents in the case of an emergency and to perform any other first aid or lifesaving techniques in which the employee has been trained in a program approved by the State Board of Education. The statute provides for immunity from liability in civil damages for any authorized act or act of omission relating to it, unless the act or omission amounts to gross negligence, wanton conduct or intentional wrongdoing. 9

10 Guideline Determinants Federal Requirements Individuals with Disabilities Education Act (IDEA), Section 504 of the Rehabilitation Act and the Americans with Disabilities Act (ADA) require schools receiving federal funding to provide reasonable accommodations and to allow for safe inclusion of these students in school programs. This required related service includes medication administration. Not all students needing medications during the school day fall under this requirement (eg. short term needs) but specific policies for administration of medication should be applied consistently with all students. Family Educational Rights and Privacy Act (FERPA) specifies when student health information may be shared and when it may not. FERPA protects the confidentiality of student health information. Student health information must be kept private except for situations where disclosure serves a compelling purpose, is required by law or when parental permission is obtained. Occupational Safety & Health Administration s (OSHA) Bloodborne Pathogen Standard (29 CFR ) prescribes safeguards to protect workers against the health hazards caused by bloodborne pathogens. The school s required Exposure Control Plan identifies the safeguards for handling blood and body fluids. These safeguards include identification and training of staff that are most at risk for exposure, utilization of Universal Precautions for all blood and body fluids, personal protective equipment (PPE) to prevent exposure, engineering controls in managing contaminated sharps, and proper disposal of regulated waste. Individualized Healthcare Plan (IHP) It is the position of the National Association of School Nurses (NASN) that the registered professional school nurse (hereinafter referred to as school nurse), in collaboration with the student, family and healthcare providers, shall meet nursing regulatory requirements and professional standards by writing an Individualized Healthcare Plan (IHP) for students whose healthcare needs affect or have the potential to affect safe and optimal school attendance and academic performance. Health conditions can be complex and unfamiliar to school staff and the children s requirement for nursing can be frequent and sometimes emergent, therefore, accurate and adequate documentation of their chronic medical conditions and individual needs is critical (Lyon, 2012, p. 288). Development of IHPs is a nursing responsibility, based on standards of care regulated by state nurse practice acts and cannot be delegated to individuals (National Council of State Boards of Nursing [NCSBN], 2005). It is the responsibility of the school nurse to implement and evaluate the IHP at least yearly and as changes in health status occur to determine the need for revision and evidence of desired student outcomes. BACKGROUND The IHP is a written document based on the nursing process. Since emerging in the 1970s, the nursing process is the cornerstone of nursing practice, using a scientific approach in the identification and solution of health problems in nursing practice (Hermann, 2005). The American Nurses Association (ANA) and NASN define the nursing process as a circular, continuous and dynamic critical-thinking process comprised of six steps and that is client-centered, interpersonal, collaborative, and universally applicable (American Nurses Association [ANA] & NASN, 2011, p. 76). Documentation of these steps for individual students who have healthcare issues results in the development of an IHP, a variation of the nursing care plan. Swain County s School Nurses (Allergy/Anaphylaxis) Individualized Healthcare Plan (IHP) can be found (appendix D) State Requirements - Nursing Statutes and Regulations, registered nurses are authorized to delegate the administration of medication to UAP in the school known as a school setting provider. The school setting provider is a person who is employed at a school that provides educational services to students age 21 or younger. The person to whom the administration of medication is delegated must successfully complete a training course in administration of medication that is approved by the board. 10

11 Procedures Trained school staff should: a. Consult and collaborate with the school nurse and/or school administrator for purposes of more effectively helping the student. Staff should share only such information that will serve the student s best interests, and divulge the student s name only when necessary. b. Consult with the school nurse or school administrator before making a decision if in doubt to the reasonableness of a course of action regarding the sharing of confidential information. c. Share information verbally with other professional colleagues rather than giving them copies of notes and ensure that colleagues respect the confidential nature of the information being shared. d. Take care, when sharing information about students that the information is accurate and unbiased. e. Guard against sharing confidential information in halls, staff rooms or other public places where persons who do not need to know can overhear it. f. Not leave reports, student service records, computer files or log books where unauthorized people can have access to them. g. Keep accurate and objective records to facilitate the provision of services to students. Failure to keep records is negligence. Notes should be made as immediately as possible to the time of the event(s), and the original notes should never be changed. Any additions should be initialed, signed and dated. h. Make the student aware that confidential information is being recorded, share such information with the student and clarify the information with student, school nurse, or administrator, if needed. i. Take care that individual student records are kept in a secure location. Medication Administration: Guide for Training School Staff State administrative rules require that personnel who administer medication be trained by registered nurses, pharmacists or physicians. See Rule 10A NCAC 27G Medication requirements (Appendix K) 11

12 All school nurses should use the following procedures to train school staff The on-line training and quiz MUST done is done annually / the skill sheet is done biannually (at the beginning of each school semester) for each trained individual Training website to use: Go to: Click on: Staff Training: Food Allergies & Anaphylaxis in School What School Staff Need to Know o Then click on: School Staff Training Module (Web Training) Go through the full 30 min PowerPoint/video: Food Allergy School Staff Training Full Length Module o *Note: make sure you go through the whole PowerPoint/Video, including Food allergy management to specific school settings (#83-91, as of 12/10/14) ( (Manual) Go through the blue/green Swain County Policy and Procedure manual, *especially pages: (Quiz) Take the Food Allergy Quiz, (must pass with 80% or better): found in the EpiPen blue/green binder - Appendix G o The Food Allergy Quiz for each trained individual, taken annually and must the kept in EpiPen blue/green binder and a copy need to be given to Primary EpiPen Program Coordinator. (Skill sheet) The Nurse need to check off the skills of the school staff must go thought The Emergency Anaphylaxis and Epinephrine Auto-Injector Pen Training Checklist (Appendix H) o A copy of this completed skills sheet (of 100% pass) for each trained individual must the kept in EpiPen blue/green binder and a copy needs to be given to Primary EpiPen Program Coordinator. o This skills sheet should be done at least biannually (at the beginning of each school semester) for each trained individual, if the individual does not pass with 100% it is the responsibility of the school nurse to correct and assure learning, via going back through the PowerPoint/video and/or other means of teaching of the missed material. 12

13 The follow are the train school staff Give all info ASAP to the Primary EpiPen Program Coordinator (see Appendix A) First and last name of trained person Date passed online training & quiz (80% or better) (Biannual) Date passed skill sheet (100%) School the trained person is at / ( ) ( ) Trained person s phone number(s) Name of nurse that did the training / ( ) ( ) / ( ) ( ) / ( ) ( ) / ( ) ( ) / ( ) ( ) / ( ) ( ) / ( ) ( ) / ( ) ( ) / ( ) ( ) ALL trained persons are allowed to perform such skills ONLY within any Swain County Schools (SCHS, SCMS, East Elementary, West Elementary, Pre-K). Notes: 13

14 Pathophysiology and Treatment Signs and Symptoms of Anaphylaxis Include: Anaphylaxis can affect any part of the body and cause various symptoms. The most dangerous symptoms include breathing difficulties and a drop in blood pressure or shock, which are potentially fatal. Other signs and symptoms are hives, itching, red water eyes, runny nose, vomiting, diarrhea, stomach cramps, change of voice, coughing, wheezing, throat tightness or closing, difficulty swallowing, difficulty breathing, sense of doom, dizziness, fainting or loss of conscience, change of skin color. Medications: Epinephrine Antihistamines (Benadryl) Treatment is centered on treating the rapidly progressing effects of histamine release in the body with epinephrine. The allergen should also be removed immediately. The health offices will have standing orders written by the district s MD to administer Epi-pens in the event of unsuspected anaphylaxis and those students who we are aware of. 14

15 EpiPen Administration Protocol: Responding to Anaphylaxis If student-specific orders are on file they should be followed for students with known life threatening allergies and/or anaphylaxis. For suspected anaphylaxis without specific orders: 1. Identify when procedure is indicated. Based on symptoms, determine that an anaphylactic reaction is occurring. If signs and symptoms of anaphylaxis instruct someone to call 911. **If no one else is around - administer epinephrine to the student first. 2. Act quickly. It is safer to give epinephrine than to delay treatment. This is a life and death decision. 3. Determine the proper dose and administer epinephrine. A child weighing between pounds will be given EpiPen Jr. A child weighing over 60 pounds will be given EpiPen. Inject the EpiPen into fatty OUTER THIGH (through one layer of clothing is fine). HOLD FOR 10 SECONDS, firmly pushed against the thigh at 90 angle (perpendicular) to the thigh the whole time. *Note the time 4. If not already done so, direct someone to call 911 and request medical assistance. Advise the 911 operator that anaphylaxis is suspected and that epinephrine has been given. 5. Stay with the person until emergency medical services (EMS) arrives. 6. Monitor their airway and breathing. 7. Reassure and calm person as needed. 8. Call School Nurse/Front Office school personnel and advise of situation. 9. Direct someone to call parent/guardian 10. If symptoms continue and EMS is not on the scene, administer a second dose if necessary of epinephrine 5-20 minutes after the initial injection. *Note the time. 11. Administer CPR if needed. 12. EMS to transport individual to the emergency room. Document individual s name, date, and time the epinephrine was administered on the used epinephrine auto-injector and give to EMS to accompany individual to the emergency room. A copy of the student s emergency record should be sent with EMS. 13. Even if symptoms subside, 911 must still respond and individual must be evaluated by a physician. A delayed or secondary reaction may occur. 14. Monitor blood pressure. Elevate legs if the blood pressure is low. 15. Cover with blankets if necessary to keep warm; don t allow blankets to interfere with handling or observation. 16. Document the incident and complete the EpiPen Post Incident Report Form. (know where this documentation is kept) 17. Send Anaphylaxis take home information (know where this documentation is kept) 18. Call school nurse to have epinephrine stock medication replace immediately. Place the USED EpiPen in appropriate approved sharps container. 19. Notify school Physician. ** The general standing order must be renewed each school year by the School Physician and Director of Swain County Health Office. Director of Swain County Health Office Date School Physician Date 15

16 Perform Five Rights: 1. Right person ask student s full name and compare with EpiPen label. 2. Right drug check EpiPen label for correct student. 3. Right amount check both directions and EpiPen label. 4. Right time review criteria. 5. Right method of administration follow procedure. EPIPEN (EPINEPHRINE) AUTO-INJECTOR DIRECTIONS Remove the EpiPen Auto-Injector from the plastic carrying case. 2. Pull off the blue safety release cap. 3. Swing and firmly push orange tip against mid-outer thigh. 4. Hold for approximately 10 seconds. 5. Remove and massage the area for 10 seconds. 3. & 4. * (The needle in the EpiPen or Auvi-Q are only ½ of an inch for EpiPen Jr. dose and 5/8th of an inch for EpiPen). So it is best to ONLY have one layer of clothing to go through with using an EpiPen) AUVI-QTM (EPINEPHRINE INJECTION, USP) DIRECTIONS 1. Remove the outer case of Auvi-Q. This will automatically activate the voice instructions. 2. Pull off red safety guard. 3. Place black end against mid-outer thigh. 4. Press firmly and hold for 5 seconds. 5. Remove from thigh & 4. Optional Video demonstration: Epineprhine auto-injector demonstration kit (EpiPen or Auvi-Q training device) Epi Pen web video: Auvi-Q web video: Auvi-Q demo is also available as a Smartphone Ap. 16

17 Post Event Actions Once epinephrine is administered, local Emergency Medical Services (911) shall be activated and the student transported to the emergency room for follow care. In some reactions, the symptoms go away, only to return one to three hours later. This is called a biphasic reaction. Often these second-phase symptoms occur in the respiratory tract and may be more severe than the first-phase symptoms. Therefore, follow up care with a health care provider is necessary. The student will not be allowed to remain at school or return to school on the day epinephrine is administered. Be sure to: Call parents/legal guardian and send anaphylaxis take home information (Appendix J) Document the event by completing the EpiPen Post Incident Report Form. (know where this documentation is kept) (Appendix I) Call lead Nurse Coordinator to replace epinephrine stock medication immediately (Appendix A) o *Marcia Winchester West Elementary School Nurse and *Lead EpiPen Nurse Coordinator ************************************************************* *** The EpiPen Post Incident Report Form that is to be complete ASAP after an incident is kept behind the daily/monthly AED and monthly EpiPen check sheet attached to the clipboard at EACH Swain County School. (As well as in the blue-green binder (Appendix I) Vertical view AED check list EpiPen check list EpiPen Post Incident Report Form Horizontal view AED check list EpiPen check list EpiPen Post Incident Report Form 17

18 Where Swain County Schools have EpiPens Swain High School - Adult ONLY EpiPens Swain Middle School - Adult & Ped EpiPens Swain East Elementary - Adult & Ped EpiPens Swain West Elementary - Adult & Ped EpiPens Swain Pre-Kindergarten (Bright Adventures) - Adult ONLY EpiPens 18

19 Swain County High School EpiPen Locations There are TWO (2) Adult ONLY EpiPen locations at SCHS: Adult ONLY EpiPen #1 - Main office of the high school on the left wall behind the desk. Adult ONLY EpiPen #2 - Located with the Certified Athletic Trainer. 19

20 Swain County Middle School EpiPen Locations There is ONE (1) Adult & Ped EpiPen location at SCMS: Adult & Ped EpiPen #1 - Main office of the Middle school on the front wall as you walk in. 20

21 Swain County EAST Elementary EpiPen Location There is ONE (1) Adult & Ped EpiPen location at Swain East Elementary: Adult & Ped EpiPen #1 - Main office of EAST Elementary on the front wall as you walk in. 21

22 Swain County WEST Elementary AED Locator There is ONE (1) Adult & Ped EpiPen location at Swain West Elementary: Adult & Ped EpiPen #1 - Main office of WEST Elementary on the front wall as you walk in. 22

23 Swain County Pre-Kindergarten (Bright Adventures) Adult ONLY EpiPen Location There is ONE (1) AED located at Swain County Pre-Kindergarten (Bright Adventures): Adult ONLY EpiPen #1 - Main Entrance of Pre-Kindergarten (Bright Adventures) building, on the RIGHT wall, (approximately) 15 feet from the front door. 23

24 Individual Roles, Responsibility, and Guidelines Anaphylaxis Management Procedure The following procedures will be implemented when a student is found to have life threatening allergies. Role of School Nurse Identify students at risk. The school nurse will initiate the Individual Health Care Plan (Appendix D) (IHCP) with parent/guardian and establish a multi-disciplinary team in order to reduce exposure to allergens and establish procedures to treat exposure to allergens and allergic reactions. The school nurse will provide a form for parents/guardians which contains: an Allergy Action Plan and Medication Authorization forms to be completed by parent and health care provider. (see Appendix L ) The school nurse will meet with members of the multi-disciplinary team to assist them in preparing for their responsibilities. The school nurse will provide basic education concerning life-threatening allergies including prevention and management of exposure to allergens. The Individual Health Care Plan will include the Allergy Action Plan. IHCP will be signed by parent and nurse. A copy of IHCP will be given to all relevant school staff. The Allergy Action Plan and Medication Authorizations must be updated yearly and as needed for changes. The school nurse will provide blank Action Plans and Medication Authorizations to parents upon request. The location of the medications will be noted on the IHCP. IHCP will have emergency protocol for exposure. If epinephrine is administered student will be sent via ambulance to the hospital. If Benadryl is administered, student will be sent home to be monitored by parent/guardian. School wide training is done annually by the school nurse which will include information on signs and symptoms of allergic reactions (anaphylaxis) for all staff members in their school. This school wide training of all staff in recognizing anaphylaxis will be done the first week of school for each building. (There will be additional training for administering of EpiPens to appropriate assigned personal see below). In addition to school wide training school nurses will train at least 2-3 staff members in Epi-pen administration (see page 11); The training and quiz MUST done is done annually / the skill sheet is done biannually (at the beginning of each school semester) for each trained individual. Those trained in Epi-pen administration with passing the quiz of at least 80% and skill sheet of 100%. It is the responsibility of the school nurse to correct and assure learning of each individual. Names of the trained individuals will be kept on page 12. School nurse or appropriate assigned personal is responsible to check and sign the monthly EpiPen check sheet for outdated EpiPens each month; and is to immediately notify the appropriate assigned personal within 60 days of EpiPen(s) expiring. Communicate with all staff members. Including bus drivers. Open line of communication between staff and parents especially with the Swain County Health Office. Collaborate with Dietary Staff and provide necessary documentation regarding students and food allergies. In the school setting-allow self directed students as assessed by the school nurse to carry life saving medication with prior approval by the medical provider, and according to health practice and procedures, as long as duplicate lifesaving medication is also maintained in the health office in the event that the selfcarrying student misplaces their medicines. (Appendix F) For Physical Education classes / recess / etc staff members will have a charged/working cell phone, knowledge of anaphylaxis, and the school s procedures and plan of action. The Health Office will initiate this for safety until the nurse can get out to the playground. Each Nursing office will have a land-line phone and charged/working cell phone while recess and outside Physical Education classes are occurring; as well as the staff that this affects. 24

25 Role of the EpiPen Lead Nurse All of the above responsibility of a nurse still applies, with a few additional responsibilities below: Replacement epinephrine stock medication for all Swain County schools immediately after use or when expiration is due (annually) Consult and collaborate with the school nurses and/or school administrators for purposes of more effective education for students, faculty, staff, and training of school wide training and for the school staff. Assure training of all school nurses is followed according to this policy (page 10-11) for training of staff. Set up meet(s) as necessary with school nurse and school administrators to inform them of any changes in the state law. Consult with Swain County Health Department and School EpiPen physician regarding necessary means and state law regarding Anaphylaxis/EpiPen(s). Keep the Primary and Alternate EpiPen Program Coordinator(s) informed of any changes and information. Parent / Guardian Responsibility The parent/guardian will obtain the forms from the school nurse (Appendix L). The parent/guardian will ensure all forms are completed by the student's health care provider and returned to the school nurse. The parent/guardian are responsible to provide their child s EpiPen and provide all necessary medications to the school nurse and replace used and expired medications. The parent/guardian will provide school nurse with current and complete contact information. The parent/guardian will inform the bus driver and bus monitors of the student's allergy. The parent/guardian, health care provider, and nurse will determine if student can self-medicate and selfcarry medication. The parent/guardian will provide safe snacks for special occasions. The parent/guardian will consider providing the child with a medic alert bracelet or chain for identification. Annual Meeting for Individual Health Care Plan The multidisciplinary team will meet yearly, as close to the opening of the school year as possible. The multidisciplinary team will include, but is not limited to, the school nurse, parent/guardian, classroom and specials teachers, principal, food services director, representative of the school bus company, and the student, if age appropriate. Other individuals may be invited per the request of the parent/guardian. The school nurse will review the IHCP with the team. The school nurse will provide all relevant information and training to any individuals unable to attend the IHCP meeting. The school nurse will immediately share any changes to the IHCP with the team. Cafeteria Guidelines IHCPs and Allergy Action Plans for all life-threatening allergic students will kept in the cafeteria/kitchen. An allergen free table will be maintained in the cafeteria. Custodial and food service staff will be trained in cleaning tables in between meals with disinfectant. Food Services will provide a monthly menu so parents/guardians and students can select appropriate foods. Ensure that foods are stored in separate containers Minimize cross contamination of foods A list of students with food allergies will be given to the necessary cafeteria personal from the school nurse within two weeks of the start of school and updated as necessary. Students will be supervised during eating Students will be reminded of no food sharing There is a peanut free zone (table(s)) for students with such allergies to sit. 25

26 Teacher / Classroom Guidelines Classroom teachers, specials teachers, all staff, and paraprofessionals will attend annual EpiPen and lifethreatening allergy training provided by the school nurse at the beginning of the school year. Parents of all students in a classroom (in grades pre-k through 12) with a life threatening allergic child will be notified via phone call and letter (Appendix J) of the presence and nature of the life-threatening allergy Student s IHCP and Allergy Action Plan will be kept in an accessible and prominent format for substitute teachers. Obtain confidential health history lists from nurse pertaining to all important health issues. An allergy free desk and/or table will be designated within all classrooms with a life-threatening allergic child, and will be cleaned by custodians daily. The hand-washing techniques are taught to students for before and after eating. Additional training for the students within the classroom will be provided as appropriate. It is preferable and advisable that no food is allowed in the classroom and that special occasions are celebrated without food. Only foods that do not contain the known allergen will be allowed into the classroom. If there is a question about any food being served in the classroom, the parent/guardian will provide a snack for the life-threatening allergic student. Students will not be permitted to share food. The teacher will immediately send the life-threatening allergic child to the school nurse s office with an adult if exposure is suspected. If no adult is available to accompany the child to the school nurse s office or a reaction has begun, the nurse will be called to the student s location. Peanuts may not be used in any projects in classrooms. Teachers will also collaborate with parents to create a safe environment at school Teachers can specify a range of foods that parents/guardians may send for snack or parties and note particular foods and ingredients that should not be sent. Will make sure that they have a charged/working cell phone while on any playgrounds. Teachers will make sure that when they call in an emergency they will specify what playground they are calling in from (information posted on the Emergency Action plan (EAP) on green paper. When having to be out and have a sub, it is the primary teacher s responsibility to provide the substitute teacher the letter regarding Anaphylaxis/EpiPen(s). (Appendix Z) Maintenance Regular inspection of play areas to eliminate bees/wasps etc. Eliminate shrubs/plants that draw bees at doorways into buildings. Field Trip Protocol This anaphylaxis policy is not intended to replace student specific orders or parent provided individual medications. *Students with unknown allergies: This policy does not extend to activities off school grounds (including transportation to and from school, field trips, etc.) or outside of the academic day (sporting events unless the school s certified athlete trainer is available at that event), extra-curricular activities, etc.). Teachers will notify the school nurse at least 2 weeks in advance of a field trip. At least two adults attending the field trip have been trained in Epi-pen administration and life-threatening allergies. School nurse will ensure that Epi-pen for students with known allergies that have their own personal EpiPen(s) *(along with other medication student s need) are taken on field trips. *Epi-pen(s) for students with unknown allergies is not covered and is not extended to such activities off school grounds. A functioning cell-phone will be brought on field trips to call emergency medical services if exposure to allergen is suspected or student experiences an allergic reaction. 26

27 Bus Policy This anaphylaxis policy is not intended to replace student specific orders or parent provided individual medications. *Students with unknown allergies: This policy does not extend to activities off school grounds (including transportation to and from school, field trips, etc.) or outside of the academic day (sporting events unless the school s certified athlete trainer is available at that event), extra-curricular activities, etc.). Food and beverages are prohibited on school buses. Students are not permitted to share or trade food while on bus. School bus driver and monitor shall enforce this policy. School bus drivers and monitors will attend anaphylaxis training annually along with All staff training provided by school nurse. School bus drivers should be equipped with functioning cell phone or other device for communication in the event of a suspected exposure or allergic reaction. The parent/guardian of known student allergy that are self-carry will provide their child with their Epi-pen to be kept in student s bag with instructions for use and emergency contact information. Ensure safety on the bus. Collaborate as needed with each Health Office. Storage, Access and Maintenance Epinephrine should be stored in a safe, unlocked and accessible location, in a dark place at room temperature (between degrees F); with the exception of the EpiPen carried by the certified athletic trainer. Epinephrine should not be maintained in a locked cabinet or behind locked doors during regular business hours. Staff should be made aware of the storage location in each school. It should be protected from exposure to heat, cold or freezing temperatures. Exposure to sunlight will hasten deterioration of epinephrine more rapidly than exposure to room temperatures. The expiration date of epinephrine solutions should be checked monthly; the drug should be replaced if it is approaching the expiration date. The contents should periodically be inspected through the clear window of the auto-injector. The solution should be clear; if it is discolored or contains solid particles, replace the unit. Each school should maintain documentation that stock epinephrine has been checked on a monthly basis to ensure proper storage, expiration date, and medication stability. The school division shall maintain a sufficient number of extra doses of epinephrine for replacement of used or expired school stock on the day it is used or discarded. Expired auto-injectors or those with discolored solution or solid particles should not be used. Discard them in an approved sharps container. 27

28 Definitions: Allergen: A substance that can cause an allergic reaction. Allergy: An immune system response to something that the body has identified as an allergen. People genetically programmed to make an allergic response will make antibodies to particular allergens. Allergic reaction: A reaction to an allergen. Common signs and symptoms include one or more of the following: hives, tingling feeling around the mouth, abdominal pain, vomiting and/or diarrhea, facial swelling, cough or wheeze, difficulty swallowing or breathing, loss of consciousness or collapse (child pale or floppy), or cessation of breathing. Anaphylaxis: A severe, rapid and potentially fatal allergic reaction that involves the major body systems, particularly breathing or circulation systems. Anaphylaxis action plan: A medical management plan prepared and signed by a doctor providing the child s name and allergies, with clear instructions on treating an anaphylactic episode. A sample form will be included at the end of this policy. Anaphylaxis management training: Training provided at the Swain County School District yearly by the registered nurses in each building. Training includes but is not limited to return demonstration, power point presentation sent to each staff member for review, confidential health history summary for staff in each building including a section for students with epipens. Children at risk of anaphylaxis: Those children whose allergies have been medically diagnosed and who are at risk of anaphylaxis. Delegation: The act of transferring to a competent individual the authority to perform a selected nursing task in a selected situation. The nurse retains accountability for the delegation. (National Council of State Boards of Nursing 2005) The National Association of School Nurses further defines delegation in the school setting as a complex process in which the authority to perform a selected nursing task in transferred to a competent individual (UAP) in a specific situation. Dispense: the preparation and delivery of a prescription drug by a pharmacist, physician, dentist, podiatrist, or other person licensed or registered to distribute prescription medication in a suitable container appropriately labeled for subsequent administration to, or use by, a student. EpiPen: A device containing a single dose of adrenaline, delivered via a spring-activated needle, which is concealed until administered. EpiPen kit: An insulated container, for example an insulated lunch pack. The kit should contain a current EpiPen, a copy of the child s anaphylaxis action plan, and telephone contact details for the child s parents/guardians, the doctor/medical service and the person to be notified in the event of a reaction if the parents/guardians cannot be contacted. Individualized Healthcare Plan (IHP): This document is a nursing care plan that has studentcentered goals and objectives, and describes the nursing interventions designed to meet the student s short and long-term goals. It should be o Written for each student with a healthcare need that affects or has the potential to affect the student s safe and optimal school attendance and academic performance. o Developed by the school nurse in collaboration with the student, family, educators, and healthcare providers. o Based on and developed using the nursing process. 28

29 Definitions continue Intolerance: Often confused with allergy, intolerance is a reproducible reaction to a substance that is not due to the immune system. (i.e. lactose intolerance) No food sharing: The practice where the child at risk of anaphylaxis eats only that food that is supplied or permitted by the parents/guardians, and does not share food with, or accept other food from any other person. Nominated staff member: The nurse in each building is responsible for obtaining EpiPen s and keeping them current. Risk minimization: A practice of reducing risks to a child at risk of anaphylaxis by removing, as far as is practicable, major sources of the allergen from the school and developing strategies to help reduce risk of an anaphylactic reaction. Emergency Care plan: A plan specific to the school that specifies each child s allergies, the ways that each child at risk of anaphylaxis could be accidentally exposed to the allergen while in the care of the school, practical strategies to minimize those risks, and who is responsible for implementing the strategies. The risk minimization plan should be developed by families of children at risk of anaphylaxis and staff at the school and should be reviewed at least annually, but always upon the enrollment or diagnosis of each child who is at risk of anaphylaxis. 29

30 Swain County Schools EpiPen info Where: Swain County HIGH School EpiPen info Main High School office 1) (Adult) EpiPen Exp: XXXX XXXX Lot# XXXXX 2) (Adult) EpiPen Exp: XXXX XXXX Lot# XXXXX 3) N/A (No (pediatric) EpiPen Jr at this location) 4) N/A (No (pediatric) EpiPen Jr at this location) With Certified Athletic Trainer (ATC/LAT) 1) (Adult) EpiPen Exp: XXXX XXXX Lot# XXXXX 2) N/A N/A N/A 3) N/A (No (pediatric) EpiPen Jr at this location) 4) N/A (No (pediatric) EpiPen Jr at this location) Note(s): Where: Swain County MIDDLE School EpiPen info Middle School main office 1) (Adult) EpiPen Exp: XXXX XXXX Lot# XXXXX 2) (Adult) EpiPen Exp: XXXX XXXX Lot# XXXXX 3) (Pediatric) EpiPen Jr Exp: XXXX XXXX Lot# XXXXX 4) (Pediatric) EpiPen Jr Exp: XXXX XXXX Lot# XXXXX Note(s): Where: Swain County EAST Elementary School EpiPen info EAST Elementary School main office 1) (Adult) EpiPen Exp: XXXX XXXX Lot# XXXX 2) (Adult) EpiPen Exp: XXXX XXXX Lot# XXXX 3) (Pediatric) EpiPen Jr Exp: XXXX XXXX Lot# XXXX 4) (Pediatric) EpiPen Jr Exp: XXXX XXXX Lot# XXXX Note(s): 30