Managing Food Allergies in the School Setting

Transcription

1 Managing Food Allergies in the School Setting Amy Hampton, MSN, BSN, RN 2017 Kansas School Nurse Conference Kansas School Nurse Advisory Council in conjunction with the CDC sent 3 representatives from Kansas to Orlando, Florida for the Meeting the Needs of Food Allergic Children at School workshop and the annual FARE conference This presentation has been derived from presentations given at the workshop Learning Objectives o Explain how the development and implementation of FAMPP priorities can improve the daily management and emergency care needs of students with food allergies. o Identify practical strategies and recommendations for creating a safer and more inclusive school environment. o Describe strategies on how to create and implement a school-wide food allergy policy. 1

2 Food Allergy is on the Rise o 50% increase in food allergy between 1997 and 2011 o 40% of children with food allergies have already experienced a severe or life-threatening reaction o One in three children with food allergies have multiple food allergies Food Allergies Challenging to Manage o Past reactions do not predict future reactions o Eight foods are responsible for 90% of food allergy reactions in the US o ANY food has the potential to cause and allergic reaction o Only top 8 allergens required on label Food Allergy Symptoms in Children o Mucous Membrane Symptoms: red watery eyes or swollen lips, tongue, eyes o Skin Symptoms: itchiness, flushing, rash or hives o Gastrointestinal Symptoms: nausea, pain, cramping, vomiting, diarrhea, or acid reflux o Upper Respiratory Symptoms: nasal congestion, sneezing, hoarse voice, trouble swallowing, dry staccato cough, or numbness around mouth o Lower Respiratory Symptoms: deep cough, wheezing, shortness of breath or difficulty breathing, chest tightness o Cardiovascular Symptoms: pale or blue skin color, weak pulse, dizziness or fainting, confusion or shock, hypotension, or loss of consciousness o Mental or Emotional Symptoms: sense of impending doom, irritability, change in alertness, mood change, or confusion 2

3 Food Allergy Symptoms in Children Children with food allergies might communicate their symptoms in the following ways: o It feels like something is poking my tongue o My tongue (or mouth) is tingling (or burning) o My tongue (or mouth) itches o My tongue feels like there is hair on it o My mouth feels funny o There s a frog in my throat; there s something stuck in my throat o My tongue feels full (or heavy) o My lips feel tight o It feels like there are bugs in there (to describe itchy ears) o It (my throat) feels thick o It feels like a bump is on the back of my tongue (throat) Fatal Food Allergy Reactions Risk Factors: o Delayed administration of epinephrine o Reliance on oral antihistamines alone to treat symptoms o Consuming alcohol and the food allergen at the same time Groups at Higher Risk: o Adolescents and young adults o Children with known food allergy o Children with prior history of anaphylaxis o Children with asthma, particularly those with poorly controlled asthma Food Allergies at School o 79% of allergic reactions at school happen inside the classroom o One in six children with food allergies will have a reaction at school o 25% of severe reactions at school happen to individuals with no previous diagnosis of a food allergy 3

4 Why are We Here? Duty of Schools o Schools have a responsibility for the health and safety of ALL children under our care o Need to address Individual as well as Stock Epinephrine orders o Fatalities can result for delaying administration of epinephrine or not providing appropriate emergency care Need to have a plan in place CDC s Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs Recommend that ALL schools develop and implement a comprehensive plan for managing food allergies, called a Food Allergy Management and Prevention Plan (FAMPP) 4

5 Food Allergy Management and Prevention Plan Per CDC guidelines, FAMPP Priority Areas: 1. Ensure the daily management of food allergies in individual children 2. Prepare for food allergy emergencies 3. Provide professional development on food allergies for staff members 4. Educate children and family members about food allergies 5. Create and maintain a healthy and safe educational environment National Legislation School Access to Emergency Epinephrine Act Kansas Legislation 5

6 Where to Start. o Prior to developing any plan: Important to get input/info from parents, physician, as well as staff members/administration who may have vested interest and responsibility (Team approach) o Review relevant state/local laws or policies Stock epinephrine, District policies, HIPPA concerns o Work collaboratively reasonable accommodations need to be considered Parents may be passionate, but remember, it is their child s life that is at stake Often times parents feel isolated or labeled as that parent Working together is a win-win for all! Individualized Healthcare Plans o A child with a serious food allergy should have a written management plan in place with medications ordered o All food allergies can be serious however need to identify if food allergy or food intolerance o Doctor s orders, specific symptoms, identified foods o Lack of parent s providing medication/expectations with stock epinephrine o Plan should address student s individual needs o Classroom activities including snacks o Cafeteria / lunch time o Medication orders o Field trips o After school activities Food Allergy Research & Education (FARE) 6

7 Consider the 3 A s in your Plan o Awareness Know the triggers o Information from parents / physician o Eating arrangements table location o Training for teachers / staff o Avoidance o Classroom activities / snacks o Cafeteria procedures o Action give Epinephrine o Emergency Action Plan o if you see this, do this o Storage / location of medication o Calling 911 follow up Classroom Considerations o A school policy that NO food is provided to students with written consent from the parent o For each instance not a blanket form for the year o Avoid using food for rewards or parties o Desktops should be cleaned especially prior to any eating o Procedure in place / custodial use of wipes? o Classrooms often used by outside groups o Allergy Free Classroom? o In-Service / Trainings (general) o Avoidance / signs and symptoms o Address bullying / isolation issues o No sharing of food o Hand-washing procedures Cafeteria / Lunch Time Considerations o Allergy Free Tables vs Peanut Only table? o Consider use of Placemats (eliminates isolation issues) o Cafeteria staff should be trained / aware of food allergies o No cross contamination o Include Nutrition Services when developing policy o Custodial staff training for cleaning of tables - facilities 7

8 Medication Considerations o Medication should be in an UNLOCKED, but secure location o Cabinet should be clearly labeled Epinephrine Inside o Location of medication needs to be considered o Access at all times during school / school events / stored in classroom / self-carry? o CPR required? (Kansas does not require) o Disposal policy o Send with Paramedics? o Sharps container Risk Management Issues Field Trips o Plan for off-site / after school activities o Consider including Athletic Department and Transportation o Medication Plan o Who will keep medication, what about stock-epinephrine? o Food / eating plan o Access to Emergency Services o Staff training recognition of symptoms, how to administer epinephrine Staff Training o Training should include: o For students with KNOWN allergies (Individual Epi) as well as those who have NO HISTORY of allergies (Stock Epi) o Dosage concerns o What if given when not truly needed o Staff fears (epi is dangerous, liability concerns) o Documentation of training o Test emergency plan (like a fire drill) 8

9 Training Guidelines o NASN, FARE, CDC, EpiPen4Schools have excellent guidelines / training material o Address who is trained and how often o Training modules should be developed o Documentation should be part of the training o Medication / storage requirements o Accessible classroom storage? o Number per building Regular vs Junior o Signs and Symptoms known vs unknown o Emergency Procedures o Communication issues radios / classroom phones? o Follow up / evaluation procedure Stock Epinephrine Considerations o Board Policy District Policy Development o Physician s Standing Orders should be standardized Consider school physician / consultant, workers comp doctor, local allergist, public health department o Obtain epinephrine auto-injectors Mylan has a free program for schools o Protocols for administration Training guidelines o After school activities o Parental notification? o Documentation / Data Collection / Evaluation of procedures Policy Development o NSBA Policy Resource: National School Boards Association (2011). Safe at school and ready to learn. A comprehensive policy guide for protecting students with life-threatening food allergies. 9

10 10 Essential Components of a Food Allergy Policy 1. Identification of students with food allergies and provision of school health services 2. Individual written management plans 3. Medication protocols, including storage, access, and administration 4. Health school environments 5. Communication and confidentiality 6. Emergency response 7. Professional development and training for school personnel 8. Awareness education for students 9. Awareness education and resources for parents/caregivers 10.Monitoring and evaluation Key Summary Points o A collaborative training approach is needed with parents, physicians and school staff to identify and monitor students with food allergies, established health care plans, and emergency care plans o Establish written emergency protocols to prepare for and respond to food allergy emergencies o Implement practices that minimize exposure to allergens Questions?? 10

11 Contact Information Amy Hampton, MSN, BSN, RN District Support Nurse Wichita Public Schools References Centers for Disease Control and Prevention (CDC). Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs. Washington, DC: US Department of Health and Human Services; Gupta RS, Springston, MR, WarrierBS, Rajesh K, PongracicJ, HollJL. The prevalence, severity, and distribution of childhood food allergy in the United States. J Pediatr.2011; 128.doi: /peds Jackson, K., Howie, L, Akinbami, L. Trends in Allergic Conditions Among Children: United States, National Center for Health Statistics Data Brief Retrieved from National School Boards Association (2011). Safe at school and ready to learn. A comprehensive policy guide for protecting students with life-threatening food allergies. U.S. Food and Drug Administration (FDA). Food Allergies: What You Need to Know. U.S. Department of Health & Human Services; Accessed July 2,