Anaphylaxis model policy Updated January 2011

Transcription

1 Anaphylaxis mdel plicy Updated January 2011

2 Acknwledgements The Victrian Gvernment Department f Educatin and Early Childhd Develpment acknwledges the cntributin f the Ryal Children s Hspital Department f Allergy, Kindergarten Parents Victria Inc and Anaphylaxis Australia Inc fr their cntributin t the develpment f this mdel plicy fr children s services in Victria. Revised January 2011 Published by the Victrian Gvernment Department Educatin and Early Childhd Develpment, Melburne, Victria, Australia May 2006 Cpyright State f Victria, Department f Educatin and Early Childhd Develpment, 2009 State f Victria, Department f Educatin and Early Childhd gives permissin t reprduce any part f this mdel plicy. Als published n Authrised by the Victrian Gvernment, 35 Spring St, Melburne

3 Anaphylaxis plicy 1. Plicy statement Values This children s service believes that the safety and wellbeing f children wh are at risk f anaphylaxis is a whle-f-cmmunity respnsibility. The service is cmmitted t: Purpse prviding, as far as practicable, a safe and healthy envirnment in which children at risk f anaphylaxis can participate equally in all aspects f the children s prgram and experiences raising awareness abut allergies and anaphylaxis amngst the service cmmunity and children in attendance actively invlving the parents/guardians f each child at risk f anaphylaxis in assessing risks, develping risk minimisatin strategies and management strategies fr their child ensuring each staff member and ther relevant adults have adequate knwledge f allergies, anaphylaxis and emergency prcedures facilitating cmmunicatin t ensure the safety and wellbeing f children at risk f anaphylaxis The aim f this plicy is t: 2. Scpe minimise the risk f an anaphylactic reactin ccurring while the child is in the care f the children s service ensure that staff members respnd apprpriately t an anaphylactic reactin by initiating apprpriate treatment, including cmpetently administering an adrenaline aut-injectin device raise the service cmmunity s awareness f anaphylaxis and its management thrugh educatin and plicy implementatin The Children s Services Act 1996 requires prprietrs f licensed children s services including Family Day Care (FDC) and Out f Schl Hurs Care (OSHC) t have an anaphylaxis management plicy in place. This plicy will be required whether r nt there is a child diagnsed at risk f anaphylaxis enrlled at the service. It will apply t children enrlled at the service, their parents/guardians, staff and licensee as well as t ther relevant members f the service cmmunity, such as vlunteers and visiting specialists. The Children s Services Regulatins 2009 include the matters t be included in the plicy, practices and prcedures related t anaphylaxis management and staff training. 3. Backgrund and legislatin Anaphylaxis is a severe, life-threatening allergic reactin. Up t tw per cent f the general ppulatin and up t five per cent (0-5years) f children are at risk. The mst cmmn causes in yung children are eggs, peanuts, tree nuts, cw milk, sesame, bee r ther insect stings and sme medicatins. Yung children may nt be able t express the symptms f anaphylaxis. A reactin can develp within minutes f expsure t the allergen, but with planning and training, a reactin can be treated effectively by using an adrenaline aut-injectin device. The licensee recgnises the imprtance f all staff/carers respnsible fr the child/ren at risk f anaphylaxis undertaking training that includes preventative measures t minimise the risk f an anaphylactic reactin, recgnitin f the signs and symptms f anaphylaxis and emergency treatment, including administratin f an adrenaline aut-injectin device. Page 3

4 /carers and parents/guardians need t be made aware that it is nt pssible t achieve a cmpletely allergen-free envirnment in any service that is pen t the general cmmunity. /carers shuld nt have a false sense f security that an allergen has been eliminated frm the envirnment. Instead the licensee recgnises the need t adpt a range f prcedures and risk minimisatin strategies t reduce the risk f a child having an anaphylactic reactin, including strategies t minimise the presence f the allergen in the service. Legislatin Children s Services Act 1996 Children s Services Regulatins 2009 Health Act 1958 Health Recrds Act 2001 Occupatinal Health and Safety Act Definitins Allergen: A substance that can cause an allergic reactin. Allergy: An immune system respnse t smething that the bdy has identified as an allergen. Peple genetically prgrammed t make an allergic respnse will make antibdies t particular allergens. Allergic reactin: A reactin t an allergen. Cmmn signs and symptms include ne r mre f the fllwing: hives, tingling feeling arund the muth, abdminal pain, vmiting and/r diarrhea, facial swelling, cugh r wheeze, difficulty swallwing r breathing, lss f cnsciusness r cllapse (child pale r flppy), r cessatin f breathing. Ambulance cntact card: A card that the service has cmpleted, which cntains all the infrmatin that the Ambulance Service will request when phned n 000. An example f this is the card that can be btained frm the Metrplitan Ambulance Service and nce cmpleted by the service it shuld be kept by the telephne frm which the 000 phne call will be made. Anaphylaxis: A severe, rapid and ptentially fatal allergic reactin that invlves the majr bdy systems, particularly breathing r circulatin systems. Anaphylaxis medical management actin plan: a medical management plan prepared and signed by a Registered Medical Practitiner prviding the child s name and allergies, a phtgraph f the child and clear instructins n treating an anaphylactic episde. An example f this is the Australian Sciety f Clinical Immunlgy and Allergy (ASCIA) Actin Plan. Anaphylaxis management training: accredited anaphylaxis management training that has been recgnised by the Secretary f the Department f Educatin and Early Childhd Develpment and includes strategies fr anaphylaxis management, recgnitin f allergic reactins, risk minimisatin strategies, emergency treatment and practise using a trainer adrenaline autinjectin device. Current curses that are accredited and recgnised by the Secretary are: Curse in Anaphylaxis Awareness, 21827VIC First Aid Management f anaphylaxis Curse 21659VIC (Expired 31 December 2010) Curse in First Aid Management f Anaphylaxis 22099VIC (Valid frm 1 January 2011 until 31 December 2015) Adrenaline aut-injectin device: A device cntaining a single dse f adrenaline, delivered via a spring-activated needle, which is cncealed until administered. EpiPen : This is ne frm f an aut-injectin device cntaining a single dse f adrenaline, delivered via a spring-activated needle, which is cncealed until administered. Tw strengths are available, an EpiPen and an EpiPen Jr, and are prescribed accrding t the child s weight. The EpiPen Jr is recmmended fr a child weighing 10-20kg. An EpiPen is recmmended fr use when a child is in excess f 20kg. Page 4

5 Anapen. Is anther adrenaline aut injectin device cntaining a single dse f adrenaline, recently intrduced t the Australian market. NB: The mechanism fr delivery f the adrenaline in Anapen is different t EpiPen. Adrenaline aut-injectin device training: training in the administratin f adrenaline via an autinjectin device prvided by allergy nurse educatrs r ther qualified prfessinals such as dctrs, first aid trainers, thrugh accredited training r thrugh the use f the self paced trainer CD ROM and trainer aut-injectin device. Children at risk f anaphylaxis: thse children whse allergies have been medically diagnsed and wh are at risk f anaphylaxis. Aut-injectin device kit: An insulated cntainer, fr example an insulated lunch pack cntaining a current adrenaline aut-injectin device, a cpy f the child s anaphylaxis medical management actin plan, and telephne cntact details fr the child s parents/guardians, the dctr/medical service and the persn t be ntified in the event f a reactin if the parent/guardian cannt be cntacted. If prescribed an antihistamine may be included in the kit. Aut-injectin devices are stred away frm direct heat. Intlerance: Often cnfused with allergy, intlerance is a reprducible reactin t a substance that is nt due t the immune system. N fd sharing: The practice where the child at risk f anaphylaxis eats nly that fd that is supplied r permitted by the parent/guardian, and des nt share fd with, r accept ther fd frm any ther persn. Nminated staff member: A staff member nminated t be the liaisn between parents/guardians f a child at risk f anaphylaxis and the licensee. This persn als checks the adrenaline autinjectin device is current, the aut-injectin device kit is cmplete and leads staff practise sessins after all staff have undertaken anaphylaxis management training. Cmmunicatin plan: A plan that frms part f the plicy utlining hw the service will cmmunicate with parents and staff in relatin t the plicy and hw parents and staff will be infrmed abut risk minimisatin plans and emergency prcedures when a child diagnsed at risk f anaphylaxis is enrlled in the service. Risk minimisatin: The implementatin f a range f strategies t reduce the risk f an allergic reactin including remving, as far as is practicable, the majr surces f the allergen frm the service, educating parents and children abut fd allergies and washing hands after meals. Risk minimisatin plan: A plan specific t the service that specifies each child s allergies, the ways that each child at risk f anaphylaxis culd be accidentally expsed t the allergen while in the care f the service, practical strategies t minimise thse risks, and wh is respnsible fr implementing the strategies. The risk minimisatin plan shuld be develped by families f children at risk f anaphylaxis and staff at the service and shuld be reviewed at least annually, but always upn the enrlment r diagnsis f each child wh is at risk f anaphylaxis. A sample risk minimisatin plan is utlined in Schedule 3 f this dcument. Service cmmunity: all adults wh are cnnected t the children s service. Treat bx: A cntainer prvided by the parent/guardian that cntains treats, fr example, fds which are safe fr the child at risk f anaphylaxis and used at parties when ther children are having their treats. Nn-fd rewards, fr example stickers, stamps and s n are t be encuraged fr all children as ne strategy t help reduce the risk f an allergic reactin. Page 5

6 5. Prcedures The Prprietr shall: 1. In all children s services : ensure that all staff members have cmpleted first aid and anaphylaxis management training that has been apprved by the Secretary by January 2012 then at least every 3 years(r 63 (1)(3)(4)) ensure there is an anaphylaxis management plicy in place cntaining the matters prescribed in Schedule 3 f the Children s Services Regulatins 2009 (r. 87) ensure that the plicy is prvided t a parent r guardian f each child diagnsed at risk f anaphylaxis at the service (r. 43 and r. 48 fr FDC services) ensure that all staff in all services whether r nt they have a child diagnsed at risk f anaphylaxis undertakes training in the administratin f the adrenaline aut-injectin device and cardi- pulmnary resuscitatin every 12 mnths (r. 65(1)) and fr FDC services (r. 65(2)) recrding this in the staff recrds (r. 38) and fr FDC services (r. 39). It is recmmended that practise with the trainer aut-injectin device is undertaken n a regular basis, preferably quarterly 2. In services where a child diagnsed at risk f anaphylaxis is enrlled the prprietr shall als: cnduct an assessment f the ptential fr accidental expsure t allergens while child/ren at risk f anaphylaxis are in the care f the service and develp a risk minimisatin plan fr the service in cnsultatin with staff and the families f the child/ren (Schedule 3 f the Regulatins) ensure that a ntice is displayed prminently in the main entrance f the children s service ther than a family day care service stating that a child diagnsed at risk f anaphylaxis is being cared fr r educated at the service (r. 40) ensure staff members n duty whenever a child diagnsed at risk f anaphylaxis is being cared fr r educated have cmpleted training apprved by the Secretary in the administratin f anaphylaxis management (r. 67(2) and fr FDC services r. 67(3)) and that practice f the adrenaline aut-injectin device is undertaken n a regular basis, preferably quarterly, and recrded ensure that all relief staff members in a service have cmpleted training apprved by the Secretary in the administratin f anaphylaxis management including the administratin f an adrenaline aut-injectin device, awareness f the symptms f an anaphylactic reactin, the child at risk f anaphylaxis, the child s allergies, the individual anaphylaxis medical management actin plan and the lcatin f the aut-injectin device kit ensure that n child wh has been prescribed an adrenaline aut-injectin device is permitted t attend the service, its prgrams r family day carers hme withut the device (Schedule 3 f the Regulatins) implement the cmmunicatin strategy and encurage nging cmmunicatin between parents/guardians and staff regarding the current status f the child s allergies, this plicy and its implementatin (Schedule 3 f the Regulatins) display an Australasian Sciety f Clinical Immunlgy and Allergy inc (ASCIA) generic pster called Actin Plan fr Anaphylaxis in a key lcatin at the service, fr example, in the children s rm, the staff rm r near the medicatin cabinet display an Emergency cntact card by the telephne cmply with the prcedures utlined in Schedule 1 f the mdel plicy Page 6

7 ensure that a child s individual anaphylaxis medical management actin plan is signed by a Registered Medical Practitiner and inserted int the enrlment recrd fr each child (r. 34). This will utline the allergies and describe the prescribed medicatin fr that child and the circumstances in which the medicatin shuld be used. ensure that all staff in a service knw the lcatin f the anaphylaxis medical management plan and that a cpy is kept with the aut-injectin device Kit (Schedule 3 f the Regulatins) ensure that the staff member accmpanying children utside the service carries the anaphylaxis medicatin and a cpy f the anaphylaxis medical management actin plan with the aut-injectin device kit (r. 74(4)(d)). respnsible fr the child at risk f anaphylaxis shall: ensure a cpy f the child s anaphylaxis medical management actin plan is visible and knwn t staff in a service fllw the child s anaphylaxis medical management actin plan in the event f an allergic reactin, which may prgress t anaphylaxis in the situatin where a child wh has nt been diagnsed as allergic, but wh appears t be having an anaphylactic reactin: Call an ambulance immediately by dialling 000 Cmmence first aid measures Cntact the parent/guardian Cntact the persn t be ntified in the event f illness if the parent/guardian cannt be cntacted. practice the administratin prcedures f the adrenaline aut-injectin device using an aut-injectin device trainer and anaphylaxis scenaris n a regular basis, preferably quarterly ask all parents/guardians as part f the enrlment prcedure, prir t their child s attendance at the service, whether the child has allergies and dcument this infrmatin n the child s enrlment recrd. If the child has severe allergies, ask the parents/guardians t prvide a medical management actin plan signed by a Registered Medical Practitiner ensure that an anaphylaxis medical management actin plan signed by the child s Registered Medical Practitiner and a cmplete aut-injectin device kit (which must cntain a cpy the child s anaphylaxis medical management actin plan) is prvided by the parent/guardian fr the child while at the service ensure that the aut-injectin device kit is stred in a lcatin that is knwn t all staff, including relief staff; easily accessible t adults (nt lcked away); inaccessible t children; and away frm direct surces f heat (r. 84(3)) ensure that the aut-injectin device kit cntaining a cpy f the anaphylaxis medical management actin plan fr each child at risk f anaphylaxis is carried by a staff member r family day carer accmpanying the child when the child is remved frm the service r the hme e.g. n excursins that this child attends (r. 74(4)(d)) regularly check the adrenaline aut-injectin device expiry date. (The manufacturer will nly guarantee the effectiveness f the adrenaline aut-injectin device t the end f the nminated expiry mnth) prvide infrmatin t the service cmmunity abut resurces and supprt fr managing allergies and anaphylaxis cmply with the prcedures utlined in Schedule 1 f the mdel plicy. Page 7

8 Parents/guardians f children shall: infrm staff at the children s service, either n enrlment r n diagnsis, f their child s allergies develp an anaphylaxis risk minimisatin plan with service staff prvide staff with an anaphylaxis medical management actin plan signed by the Registered Medical Practitiner giving written cnsent t use the aut-injectin device in line with this actin plan prvide staff with a cmplete aut-injectin device kit regularly check the adrenaline aut-injectin device expiry date assist staff by ffering infrmatin and answering any questins regarding their child s allergies ntify the staff f any changes t their child s allergy status and prvide a new anaphylaxis actin plan in accrdance with these changes cmmunicate all relevant infrmatin and cncerns t staff, fr example, any matter relating t the health f the child cmply with the service s plicy that n child wh has been prescribed an adrenaline aut-injectin device is permitted t attend the service r its prgrams withut that device cmply with the prcedures utlined in Schedule 1 f the mdel plicy. 6. Related dcuments Related dcuments at the service: Enrlment checklist fr children at risk f anaphylaxis (Schedule 2 f the mdel plicy) Sample Risk Minimisatin Plan (Schedule 3 f the mdel plicy) Brchure titled Anaphylaxis a life threatening reactin, available thrugh the Ryal Children s Hspital, Department f Allergy Relevant service plicies such as: Enrlment Illness and Emergency Care Nutritin Hygiene and Fd Safety Asthma Inclusin Cmmunicatin. Page 8

9 Cntact details fr resurces and supprt Australasian Sciety f Clinical Immunlgy and Allergy (ASCIA), at prvides infrmatin n allergies. Their sample Anaphylaxis Actin Plan can be dwnladed frm this site. Cntact details fr Allergists may als be prvided. Anaphylaxis Australia Inc, at is a nn-prfit supprt rganisatin fr families with fd anaphylactic children. Items such as strybks, tapes, autinjectin device trainers and s n are available fr sale frm the Prduct Catalgue n this site. Anaphylaxis Australia Inc prvides a telephne supprt line fr infrmatin and supprt t help manage anaphylaxis. Telephne Ryal Children s Hspital, Department f Allergy, at prvides infrmatin abut allergies and the services prvided by the hspital. Cntact may be made with the Department f Allergy t evaluate a child s allergies and if necessary, prvide an adrenaline aut-injectin device prescriptin, as well as t purchase aut-injectin device trainers. Telephne (03) Ryal Children s Hspital Anaphylaxis Advisry Supprt Line prvides infrmatin and supprt abut anaphylaxis t schl and licensed children s services staff and parents. Telephne r Wilma.Grant@rch.rg.au Department f Educatin and Early Childhd Develpment website at prvides infrmatin related t anaphylaxis, including frequently asked questins related t anaphylaxis training. Training Access the Department f Educatin and Early Childhd Develpment website fr infrmatin abut free training fr staff members in services where there is a child diagnsed at risk f anaphylaxis enrlled at: There are a range f prviders ffering anaphylaxis training, including Ryal Children s Hspital Department f Allergy, first aid prviders and Registered Training Organisatins. Ensure that where there is a child diagnsed at risk f anaphylaxis enrlled in the service the anaphylaxis management training undertaken is accredited. 7. Authrisatin This plicy was adpted by the [insert name f service] n [insert date]. 8. Review date This plicy shall be reviewed n [insert date f autmatic review]. Page 9

10 9. Evaluatin The licensee shall: discuss with staff their knwledge f issues fllwing staff participatin in anaphylaxis management training selectively audit enrlment checklists (e.g. annually) t ensure that dcumentatin is current and cmplete discuss this plicy and its implementatin with parents/guardians f children at risk f anaphylaxis t gauge their satisfactin with bth the plicy and its implementatin in relatin t their child respnd t cmplaints and ntify the Department within 48 hurs (r.105) review the adequacy f the respnse f the service if a child has an anaphylactic reactin and cnsider the need fr additinal training and ther crrective actin. The staff shall nminate a staff member t: cnduct anaphylaxis scenaris and supervise practise sessins in adrenaline autinjectin device administratin prcedures t determine the levels f staff cmpetence and cnfidence in lcating and using the aut-injectin device kit (Anaphylaxis resurce kits have been prvided t all licensed children s services. The kits cntain aut-injectin device trainers (EpiPen and Anapen ) and trainer CD Rms t enable staff t practise the administratin f the aut-injectin device regularly at least quarterly. The trainer aut-injectin devices shuld be stred separately frm all ther aut-injectin devices fr example in a file with anaphylaxis resurces, s that the autinjectin device trainer is nt cnfused with an actual aut-injectin device) rutinely (e.g. mnthly) review each child s aut-injectin device kit t ensure that it is cmplete and the aut-injectin device is nt expired liaise with the licensee and parents f children at risk f anaphylaxis. Parents/guardians shall: read and be familiar with the plicy identify and liaise with the nminated staff member bring relevant issues t the attentin f bth staff and licensee Page 10

11 Schedule 1 Risk minimisatin plan The fllwing prcedures shuld be develped in cnsultatin with the parent r guardian and implemented t help prtect the child diagnsed at risk f anaphylaxis frm accidental expsure t fd allergens: In relatin t the child at risk: This child shuld nly eat fd that has been specifically prepared fr him/her Where the service is preparing fd fr the child, ensure that it has been prepared accrding t the parent s instructins Sme parents will chse t prvide all fd fr their child All fd fr this child shuld be checked and apprved by the child s parent/guardian and be in accrdance with the risk minimisatin plan Bttles, ther drinks and lunch bxes, including any treats, prvided by the parents/guardians fr this child shuld be clearly labelled with the child s name There shuld be n trading r sharing f fd, fd utensils and cntainers with this child In sme circumstances it may be apprpriate that a highly allergic child des nt sit at the same table when thers cnsume fd r drink cntaining r ptentially cntaining the allergen. Hwever, children with allergies shuld nt be separated frm all children and shuld be scially included in all activities Parents/guardians shuld prvide a safe treat bx fr their child Where this child is very yung, prvide his/her wn high chair t minimise the risk f crss-cntaminatin When the child diagnsed at risk f anaphylaxis is allergic t milk, ensure nn-allergic babies are held when they drink frmula/milk Increase supervisin f this child n special ccasins such as excursins, incursins r family days In relatin t ther practices at the service/family day carer s hme: Ensure tables, high chairs and bench tps are washed dwn after eating Ensure hand washing fr all children befre and after eating and, if the requirement is included in a particular child s anaphylaxis medical management actin plan, n arrival at the children s service Restrict use f fd and fd cntainers, bxes and packaging in crafts, cking and science experiments, depending n the allergies f particular children shuld discuss the use f fds in activities with the parent/guardian f a child at risk f anaphylaxis and these fds shuld be cnsistent with the risk minimisatin plan All children need t be clsely supervised at meal and snack times and cnsume fd in specified areas. T minimise risk children shuld nt wander arund the centre with fd shuld use nn-fd rewards, fr example stickers, fr all children The risk minimisatin plan will infrm the children s service s fd purchases and menu planning Page 11

12 Fd preparatin persnnel (staff and vlunteers) shuld be instructed abut measures necessary t prevent crss cntaminatin between fds during the handling, preparatin and serving f fd such as careful cleaning f fd preparatin areas and utensils Where fd is brught frm hme t the service, all parents/guardians will be asked nt t send fd cntaining specified allergens r ingredients as determined in the risk minimisatin plan. Page 12

13 Schedule 2 Enrlment Check list fr Children at Risk f Anaphylaxis A risk minimisatin plan is cmpleted in cnsultatin with the parent/guardian, which includes strategies t address the particular needs f each child at risk f anaphylaxis, and this plan is implemented. Parents/guardians f a child diagnsed at risk f anaphylaxis have been prvided a cpy f the service s Anaphylaxis management plicy. All parents/guardians are made aware f the Anaphylaxis management plicy. Anaphylaxis medical management actin plan fr the child is signed by the child s Registered Medical Practitiner and is visible t all staff. A cpy f the anaphylaxis medical management actin plan is included in the child s aut-injectin device kit. Adrenaline aut-injectin device (within expiry date) is available fr use at any time the child is in the care f the service. Adrenaline aut-injectin device is stred in an insulated cntainer (aut-injectin device Kit), in a lcatin easily accessible t adults (nt lcked away), inaccessible t children and away frm direct surces f heat. All staff, including relief staff, are aware f each aut-injectin device kit lcatin and the lcatin f the anaphylaxis medical management actin plan. wh are respnsible fr the child/ren diagnsed at risk f anaphylaxis undertake accredited anaphylaxis management training, which includes strategies fr anaphylaxis management, risk minimisatin, recgnitin f allergic reactins, emergency treatment and practise with an aut-injectin device trainer, and is reinfrced at quarterly intervals and recrded annually. The service s emergency actin plan fr the management f anaphylaxis is in place and all staff understand the plan. A treat bx is available fr special ccasins (if relevant) and is clearly marked as belnging t the child at risk f anaphylaxis. Parent/guardian s current cntact details are available. Infrmatin regarding any ther medicatins r medical cnditins (fr example asthma) is available t staff. If fd is prepared at the service, measures are in place t prevent cntaminatin f the fd given t the child at risk f anaphylaxis. Page 13

14 Schedule 3 Sample Risk Minimisatin Plan fr Anaphylaxis The fllwing suggestins may be cnsidered when develping r reviewing a child s risk minimisatin plan in cnsultatin with the parent/guardian. Hw well has the children s service planned fr meeting the needs f children with allergies wh are at risk f anaphylaxis? 1. Wh are the children? 2. What are they allergic t? 3. Des everyne recgnise the at risk children? List names and rm lcatins f each f the at risk children List all f the knwn allergens fr each f the at risk children List ptential surces f expsure t each knwn allergen and strategies t minimise the risk f expsure. This will include requesting that certain fds/items nt be brught t the service List the strategies fr ensuring that all staff, including relief staff and cks, recgnise each f the at risk children Cnfirm where each child s Actin Plan (including the child s phtgraph) will be displayed D families and staff knw hw the service manages the risk f anaphylaxis? Recrd when each family f an at risk child is prvided a cpy f the service s Anaphylaxis management plicy. Recrd when each family member prvides a cmplete aut-injectin device kit. Test that all staff, including relief staff, knw where the aut-injectin device kit is kept fr each at risk child. Regular checks f the expiry date f each adrenaline aut-injectin device are undertaken by a nminated staff member and the families f each at risk child. Service writes t all families requesting that specific prcedures be fllwed t minimise the risk f expsure t a knwn allergen. This may include requesting the fllwing are nt sent t the service: Fd cntaining the majr surces f allergens, r fds where transfer frm ne child t anther is likely, fr example peanut, nut prducts, whle egg, chclate, sesame. Fd packaging f risk fds (see knwn allergens at pint 2), fr example cereal bxes, egg cartns and s n. A new written request is sent t families if the fd allergens change. Ensure all families are aware f the plicy that n child wh has been prescribed an adrenaline aut-injectin device is permitted t attend the service withut that device. The service displays the ASCIA generic pster, an actin plan fr anaphylaxis, in a key lcatin and lcates a cmpleted emergency cntact card by the telephne/s. The aut-injectin device kit including a cpy f the anaphylaxis medical management actin plan is carried by a staff member when a child is remved frm the service eg excursins. Page 14

15 D all staff knw hw the children s service aims t minimise the risk f a child being expsed t an allergen? Think abut times when the child culd ptentially be expsed t allergens and develp apprpriate strategies, including wh is respnsible fr implementing them (See fllwing sectin fr pssible expsure scenaris and strategies). Menus are planned in cnjunctin with parents/guardians f at risk children: Fd fr the at risk child is prepared accrding t their parents /guardians instructins t avid the inclusin f fd allergens As far as practical the fd n the menu fr all children shuld nt cntain ingredients such as milk, egg and peanut/nut r sesame prducts t which the child is at risk The at risk child shuld nt be given fd if the label fr the fd states that the fd may cntain traces f a knwn allergen. Hygiene prcedures and practices are used t minimise the risk f cntaminatin f surfaces, fd utensils and cntainers by fd allergens. Cnsider the safest place fr the at risk child t be served and cnsume fd, while ensuring they are scially included in all activities, and ensure this lcatin is used by the child. Service develps prcedures fr ensuring that each at risk child nly cnsumes fd prepared specifically fr him/her. NO FOOD is intrduced t a baby if the parent/guardian has nt previusly given this fd t the baby. Ensure each child enrlled at the service washes his/her hands befre and after eating and n arrival if required as part f a particular child s medical management plan. Teaching strategies are used t raise awareness f all children abut anaphylaxis and n fd sharing with the at risk child/ren and the reasns fr this. Bttles, ther drinks and lunch bxes prvided by the family f the at risk child shuld be clearly labelled with the child s name. A safe treat bx is prvided by the family f each at risk child and used by the service t prvide treats t the at risk child, as apprpriate. D relevant peple knw what actin t take if a child has an anaphylactic reactin? Knw what each child s anaphylaxis medical management actin plan says and implement it. Knw wh will administer the aut-injectin device and stay with the child; wh will telephne the ambulance and the parents; wh will ensure the supervisin f the ther children; wh will let the ambulance fficers int the service and take them t the child. All staff with respnsibilities fr at risk children have undertaken anaphylaxis management training and undertake regular practise sessins fr the administratin f the aut-injectin device. Hw effective is the service s risk minimisatin plan? Review the risk minimisatin plan with families f at risk children at least annually, but always upn enrlment f each at risk child and after any incident r accidental expsure. Page 15

16 Pssible expsure scenaris and strategies Scenari Strategy Wh Fd is prvided by the children s service and a fd allergen is unable t be remved frm the service s menu (fr example milk) Menus are planned in cnjunctin with parents f at risk child/ren and fd is prepared accrding t parents instructins. Alternatively the parent prvides all f the fd fr the at risk child. Ensure separate strage f fds cntaining allergen Ck and staff bserve fd handling, preparatin and serving practices t minimise the risk f crss cntaminatin. This includes hygiene f surfaces in kitchen and children s eating area, fd utensils and cntainers. There is a system in place t ensure the at risk child is served nly the fd prepared fr him/her. An at risk child is served and cnsumes their fd at a place cnsidered t pse a lw risk f cntaminatin frm allergens frm anther child s fd. This place is nt separate frm all children and allws scial inclusin at mealtimes. Children are regularly reminded f the imprtance f n fd sharing with the at risk child. Children are supervised during eating. Ck, Primary Nminee, Parent Prprietr & Ck, Ck & Ck, Party r celebratin Give plenty f ntice t families abut the event. Prprietr/Primary Nminee/Qualified Prtectin frm insect sting allergies Latex allergies Cking with children Ensure a safe treat bx is prvided fr the at risk child. Ensure the at risk child nly has the fd apprved by his/her parent/guardian. Specify a range f fds that families may send fr the party and nte particular fds and ingredients that shuld nt be sent. Specify play areas that are lwest risk t the at risk child and encurage him/her and peers t play in the area. Decrease the number f plants that attract bees. Ensure the at risk child wears shes at all times utdrs. Quickly manage any instance f insect infestatin. It may be apprpriate t request exclusin f the at risk child during the perid required t eradicate the insects. Avid the use f party ballns r cntact with latex glves. Ensure parents/ guardians f the at risk child are advised well in advance and included in the planning prcess. Parents may prefer t prvide the ingredients themselves. Parent/ Prprietr /Primary Nminee Prprietr Prprietr Page 16