EMERGENCY EPINEPHRINE AUTO-INJECTOR DEVICES Policy Code: 5024/6127/7266

Transcription

1 EMERGENCY EPINEPHRINE AUTO-INJECTOR DEVICES Policy Code: 5024/6127/7266 Anaphylaxis is a severe systemic allergic reaction from exposure to allergens that is rapid in onset and can cause death. Many severe allergies are undiagnosed, and students or others may experience their first severe allergic reaction while at school. Epinephrine auto-injector devices can be used to administer epinephrine to provide rapid, convenient first aid for persons suffering a potentially fatal reaction to anaphylaxis. This policy addresses the use of emergency epinephrine auto-injector devices administered under a non-patient specific standing order. Student-specific orders for epinephrine auto-injector devices are addressed in policy 6125, Administering Medicines to Students. Designated trained school personnel are authorized to use emergency epinephrine auto-injector devices to deliver emergency medical aid to any person suffering from an anaphylactic reaction during the school day or at a school-sponsored event on school property. The superintendent shall ensure that at least two emergency epinephrine auto-injector devices are located at each school for this purpose and are stored in secure, but unlocked and easily accessible, locations. Each school principal shall designate one or more school personnel, as part of the medical care program under G.S. 115C-375.1, to receive initial training and annual retraining from a school nurse or qualified representative of the local health department regarding the storage and emergency use of epinephrine auto-injector devices. Only such trained personnel are authorized to administer epinephrine to persons believed to be having an anaphylactic reaction. The principal shall make reasonable efforts to notify other school staff members as to which employee(s) has received this training in order to facilitate a prompt emergency response. The principal, in collaboration with appropriate school personnel, shall create an emergency action plan for the use of epinephrine auto-injector devices that complies with all state law requirements. Principals are encouraged to include in the plan school-wide employee training in recognizing symptoms of anaphylaxis. Epinephrine auto-injector devices provided by the school are not intended, and cannot be used, as the sole supply for students known to have medical conditions requiring the availability of an epinephrine auto-injector device. 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 in accordance with policy 6125, Administering Medicines to Students. Students who meet the conditions established in policy 6125 may possess and self-administer their own medication. This policy does not require emergency epinephrine auto-injector devices to be available at activities held off school grounds during or after the school day, including field trips or off-site athletic events, or during transportation to or from school, except as may be required pursuant to an individual student s IEP, Section 504 Plan, or health or emergency plan. TYRRELL COUNTY BOARD OF EDUCATION POLICY MANUAL Page 1 of 2

2 Policy Code: 5024/6127/7266 Legal References: G.S. 115C-375.1, A Cross References: Administering Medicines to Students (policy 6125) Adopted: November 3, 2014 TYRRELL COUNTY BOARD OF EDUCATION POLICY MANUAL Page 2 of 2

3 EMERGENCY EPINEPHRINE AUTO-INJECTOR DEVICES Policy Code: 5024/6127/7266-R It is the policy of Tyrrell County Public Schools to provide at least two (2) doses of autoinjectable epinephrine (hereinafter called unassigned or stock epinephrine ) in each school, to be administered by a school nurse or employee of the school board who is authorized and trained in the administration of epinephrine to any individual believed to be having an anaphylactic reaction on school premises, during the academic day. The State of North Carolina 56 G.S. 115C-375.2A 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, extra-curricular activities, etc. off campus). It does apply to persons suffering from anaphylactic reactions during the school day and at school sponsored events on school property. 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 TYRRELL COUNTY BOARD OF EDUCATION POLICY MANUAL Page 1 of 4

4 Policy Code: 5024/6127/7266 Nausea, abdominal pain, vomiting and diarrhea Burning sensation, especially face or chest Loss of consciousness 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 Building level administration shall be responsible for identifying at least two employees, in addition to the school nurse (RN), to be trained in the administration of epinephrine by autoinjector and cardiopulmonary resuscitation. Only trained personnel should administer epinephrine to an individual believed to be having an anaphylactic reaction. Training shall be conducted initially. Annual retraining will be conducted yearly from a school nurse or qualified representative from the local health department regarding the storage and emergency use of an epinephrine auto injector. Prescriptions The school nurse or other designated school personnel so trained are responsible for obtaining the auto-injectors. The appropriate school personnel shall obtain a non patient specific prescription for epinephrine auto-injectors from a physician, physicians assistant, or nurse practitioner of the local health department serving the area in which the local school administrative unit is located. 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. Based on symptoms, determine that an anaphylactic reaction is occurring. 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. Note the time. 4. 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 of epinephrine 5 to 15 minutes after the initial injection. Note the time. TYRRELL COUNTY BOARD OF EDUCATION POLICY MANUAL Page 2 of 4

5 Policy Code: 5024/6127/ 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. 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. Document the incident and complete the incident report. 15. Replace epinephrine stock medication as appropriate. 16. See Instruction for Use 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. Document the event Complete Epinephrine Reporting Form Replace epinephrine stock medication immediately 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). Epinephrine should not be maintained in a locked cabinet or behind locked doors. 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 periodically checked; 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 autoinjectors or those with discolored solution or solid particles should not be used. Discard them in a sharps container. TYRRELL COUNTY BOARD OF EDUCATION POLICY MANUAL Page 3 of 4

6 Policy Code: 5024/6127/7266 Legal References: G.S. 115C-375.1, A Cross References: Administering Medicines to Students (policy 6125) Adopted: November 3, 2014 TYRRELL COUNTY BOARD OF EDUCATION POLICY MANUAL Page 4 of 4

7 October 2014 Adopted: November 3, 2014 Tyrrell County Board of Education ANAPHYLAXIS ACTION PLAN Immediate Assessment: Are the signs or symptoms severe? (for suspected or known ingestion) Any one of: LUNG: Short of breath, wheeze, repetitive cough HEART: Pale, blue, faint, weak pulse, dizzy, confused THROAT: Tight, hoarse, trouble breathing/swallowing MOUTH: Obstructive swelling (tongue and/or lips) SKIN: Many hives over body Or combination of symptoms from different body areas: SKIN: Hives, itchy rashes, swelling (e.g., eyes, lips) GUT: Vomiting, crampy pain YES Take Immediate Actions 1. INJECT EPINEPHRINE IMMEDIATELY 2. Call Begin monitoring (see box below) 4. Give additional medications:* Inhaler (bronchodilator) if asthma *Inhalers/bronchodilators are not to be depended upon to treat a severe reaction (anaphylaxis). USE EPINEPHRINE. NO MILD SYMPTOMS ONLY: MOUTH: Itchy mouth SKIN: A few hives around mouth/face, mild itch GUT: Mild nausea/discomfort YES MILD SYMPTOMS ONLY: MOUTH: Monitor Itchy as below. mouth SKIN: Observe A few for hives severe around signs mouth/face, or symptomsif any develop, take immediate action. mild itch Contact parent/guardian. GUT: Mild nausea/discomfort Monitoring Stay with individual. Check and record respirations, pulse and BP. Alert healthcare professionals and family/parent. Tell EMS (Emergency Medical Services ) that epinephrine was given; request an ambulance with epinephrine. Note time when epinephrine was administered. A second dose of epinephrine can be given 5 minutes or more after the first if symptoms persist or recur. For a severe reaction, consider keeping the individual lying on back with legs raised. Treat individual even if family/parents cannot be reached. Continue to observe individual after symptoms have subsided, as a biphasic reaction can occur hours after the original exposure/reaction. Send [Type a copy text] of the health room encounter report to the individual s physician. (With parental permission Page 1 with students) Obtain a personal Emergency Action plan.

8 Tyrrell County Schools Report of Epinephrine Administration Policy Code: 5024/6127/7266 F Adopted: November 3, 2014 Student Demographics and Health History 1. School District: Name of School: 2. Age: Type of Person: Student Staff Visitor Gender: M F Ethnicity: Spanish/Hispanic/Latino: Yes No 3. Race: American Indian/Alaskan Native African American Asian Native Hawaiian/other Pacific Islander White Other 4. History of allergy: Yes No Unknown If known, specify type of allergy: If yes, was allergy action plan available? Yes No Unknown History of anaphylaxis: Yes No Unknown Previous epinephrine use: Yes No Unknown Diagnosis/History of asthma: Yes No Unknown School Plans and Medical Orders 5. Individual Health Care Plan (IHCP) in place? Yes No Unknown 6. Written school district policy on management of life-threatening allergies in place? Yes No Unknown 7. Does the student have a student specific order for epinephrine? Yes No Unknown 8. Expiration date of epinephrine Unknown Epinephrine Administration Incident Reporting 9. Date/Time of occurrence: Vital signs: Pulse Respiration 10. If known, specify trigger that precipitated this allergic episode: Food Insect Sting Exercise Medication Latex Other Unknown If food was a trigger, please specify which food Please check: Ingested Touched Inhaled Other specify 11. Did reaction begin prior to school? Yes No Unknown 12. Location where symptoms developed: Classroom Cafeteria Health Office Playground Bus Other specify 13. How did exposure occur? 1

9 Tyrrell County Schools Report of Epinephrine Administration 14. Symptoms: (Check all that apply) Respiratory GI Skin Cardiac/Vascular Other Cough Abdominal discomfort Angioedema Chest discomfort Diaphoresis Difficulty breathing Diarrhea Flushing Cyanosis Irritability Hoarse voice Difficulty swallowing General Pruritus Dizziness Loss of consciousness Nasal congestion/rhinorrhea Oral Pruritus General rash Faint/Weak pulse Metallic taste Swollen (throat, tongue) Nausea Hives Headache Red eyes Shortness of Breath Vomiting Lip swelling Hypotension Sneezing Stridor Localized rash Tachycardia Uterine cramping Tightness (chest, throat) Pale Wheezing 15. Location where epinephrine administered: Health Office Other specify 16. Location of epinephrine storage: Health Office Other specify 17. Epinephrine administered by: RN Self Other If epinephrine was self-administered by a student at school or a school-sponsored function, was the student formally trained? Yes If known, date of training No Did the student follow school protocols to notify school personnel and activate EMS? Yes No NA If epinephrine was administered by other, please specify Was this person formally trained? Yes Date of training No Don t know 18. Time elapsed between onset of symptoms and communication of symptoms: minutes 19. Time elapsed between communication of symptoms and administration of epinephrine: minutes Parent notified of epinephrine administration: (time) 20. Was a second epi-pen dose required? Yes No Unknown If yes, was that dose administered at the school prior to arrival of EMS? Yes No Unknown Approximate time between the first and second dose Biphasic reaction: Yes No Don t know 2

10 Tyrrell County Schools Report of Epinephrine Administration Disposition 21. EMS notified at: (time) Transferred to ER: Yes No Unknown If yes, transferred via ambulance Parent/Guardian Other Discharged after hours Parent: At school Will come to school Will meet student at hospital Other: 22. Hospitalized: Yes If yes, discharged after days No Name of hospital: 23. Student/Staff/Visitor outcome: If first occurrence of allergic reaction: a. Was the individual prescribed an Epi Pen in the ER? Yes No Don t know b. If yes, who provided Epi Pen training? ER PCP School Nurse Other Don t know c. Did the ER refer the individual to PCP and/or allergist for follow-up? Yes No Don t know School Follow-up 24. Did a debriefing meeting occur? Yes No Did family notify prescribing MD? Yes No Unknown 25. Recommendation for changes: Protocol change Policy change Educational change Information sharing None 26. Comments (include names of school staff, parent, others who attend debriefing): 27. Form completed by: Date: (Please print) Title: Phone number: ( ) - Ext.: School District: School address: 3