For Further Medical Safety Guidance and Advice Please Also Refer to the Schools Portal

** For further Medical Safety Guidance and Advice please also refer to the Schools’ Portal – Reference library /health and safety/medication and medical devices. This updated advice has been compiled using information from NHS Choices and the Anaphylaxis Campaign

Contents

Introduction

Common triggers of Anaphylaxis

Signs and symptoms

Medication and storage

Administering medication

General advice on administering Intramuscular Adrenalin

Training and insurance for staff

Individual Health Care Plans (IHCPs)

Notifying the Local Authority of pupils with Anaphylaxis

Day-to-day measures

Storage of and access to medication

Further information

Internet links

Introduction

Anaphylaxis can affect both children and adults. It is a severe and potentially life-threateningallergic reaction at the extreme end of the allergicspectrum. Anaphylaxis may occur within minutes ofexposure to the allergen, although sometimes it cantake hours. It can be life-threatening if not treatedquickly with adrenalin.Any allergic reaction, including anaphylaxis, occurswhen the body’s immune system reacts inappropriately in response to the presence of a substance that itperceives as a threat. Anaphylaxis can be accompanied by shock (knownas anaphylactic shock): this is the most extreme formof an allergic reaction.

Common triggers of Anaphylaxis

Schools should give consideration not only toprovided food but also to activities undertaken in school that may inadvertently introduce allergens to affected pupils or staff, such as feeding animals and birds, first aid treatment – use of latex gloves etc.

Common triggers are:

• peanuts and tree nuts – peanut allergy and treenut allergy frequently cause severereactions andfor that reason have received widespread publicity. Some small animal and wild bird foods also contain potential allergens so you could buy separate ingredients and mix your own;
• other foods (e.g. dairy products, egg, fish, shellfish, sesameand soya);
• insect stings – most commonly wasps and bees;
• latex allergy;
• medications (e.g. allergy to penicillin);
• birthday and end-of-term treats - have a ‘swap box’ in the classroom thatis supplied with ‘safe’ food by the pupil’sparents. The pupil can then swap their treatfor something safe. Older pupils may chooseto simply go without;
• contaminated materials - (e.g. cereal boxes, egg cartons). If there is a pupil with severe allergies in yourclass do not use containers or boxes that mayhave been in contact with their particularallergen during lessons (e.g. craft or technology);
• snacks in tuck shops and vending machines–avoid selling packets of nuts and seeds asa snack. This is because the allergen canbe easily carried on the hands of the personeating them and contaminate work surfaces,computers, books etc. While this type of cross-contamination reactionis not likely to be life threatening, it can be seriousenough to cause disruption to the school andincrease anxiety in the pupil,their parents and school staff;
• Trees – conkers.A few pupils with allergies report that theybreak out in a localised skin rash when theyhandle conkers. We are not aware of anysevere reactions.

On rare occasions there may be no obvious trigger. Allergies are increasingly common and it is likely thatthere will be pupils in your school with allergies and somemay be at risk of anaphylaxis.

Signs and symptoms

Anaphylaxis has a whole range of symptoms. Even when mild symptoms are present, the child should be watched carefully. They may be heralding the start of a more serious reaction.Anyof the following may be present, although most pupilswith anaphylaxis would not necessarily experienceall of these:

• generalised flushing of the skin anywhere on the body;
• nettle rash or hives anywhere on the body;
• difficulty in swallowing or speaking;
• swelling of throat and mouth;
• alterations in heart rate;
• severe asthma symptoms;
• abdominal pain, nausea and vomiting;
• sense of impending doom;
• sudden feeling of weakness (due to a dropin blood pressure);
• collapse and unconsciousness.

Medication and storage

Diagnosis is usually made by the child’s GP or Consultant. Sometimes skin tests can further confirm the diagnosis. Treatment is urgent and essential to prevent progression of a severe anaphylactic reaction. Two main types of medication are available for treatment of a severe allergic reaction:

• Antihistamines (Piriton/Zirtec)
• Preloaded Adrenalin injection ( such as Epi-pen or Anapen)

EPI-PEN ADRENALINE AUTO-INJECTOR

ANAPEN AUTO-INJECTOR

Schools should ask parents to provide two ‘pens’ for each affected pupil. The reasons for this are in case one may misfire or fail to operate properly, or a second dose may be required whilst awaiting medical assistance.

Where possible,instructions for administration of medication from the pupil’s GP and/or the school health service must be followed. These advisedarrangements should be included on the pupil’s Individual Treatment Plan (see Appendix A). A suitable container (lidded plastic box) should be used and clearly marked on the outside with the pupil’s name,a green cross indicating its medical content, and possibly a photograph of the pupil.

The box should contain the adrenalin injectors; it could also include antihistamines, reliever inhaler (for asthma symptoms), thepupil’s Individual Treatment Plan, emergency contact telephone numbers, gloves, sharps box and anything else prescribed by the pupil’s doctor. The storage container should also contain a record of the medication being held within it, the date and time the medication was administered, the dose given, and the signature of the individual who administered the medication. This should be completed each and every time the medication stored in the box is administered.

Administering medication

Any staff who volunteer to administer medication must be given suitable training. This training must be undertaken by health professionals, e.g. the school health service or the pupil’s General Practitioner. The training should cover the identification of symptoms, the administration of the medication and details of the emergency treatment plan for the individual pupil concerned. Occasionally, parents will offer to train staff in the school and although this may seem a reasonable option, it should be avoided. Where children have conditions that may require rapid intervention, allstaff should be able to recognise the onset of the condition and take appropriate action.

If the pupil diagnosed with having anaphylaxis is displaying any of thefollowing symptoms, then these are signs of aserious allergic reaction and adrenalin shouldbe given without delay:

• difficulty in breathing or swallowing;
• weakness or floppiness;
• steady deterioration;
• collapse or unconsciousness.

General advice on administering Intramuscular Adrenalin

Adrenalin“pens” should be administered into the upper outer aspect of the thigh.

Both Epi-pen and Anapen injectors are pre-measured and contain a single dose. After use, the injector should bemade safe by placing in a rigid sharps container and thenhanded to the paramedic or ambulance crew tobe taken with the pupil to the hospital, both for theirinformation and safe disposal.

Once the injection is given, signs of improvementshould be seen fairly rapidly. If there is noimprovement or symptoms are getting worse, asecond injection, if available, may be administered. If adrenaline has been given, an ambulancemust be called and the pupil taken to hospital.

Relapse of a severe allergic reaction is possible after apparent recovery. Medical attention must be sought in every case.

Training and insurance for staff

School staff have a professional duty to safeguard the health and safety of pupils. This does not, however, imply a duty upon them to administer medication. Staff may voluntarily undertake this duty and must receive the training enabling them to do so. They will be fully supported by the Local Authority, and staff indemnity is provided for those schools using theLocal Authority’s insurance scheme. They will then be covered in the event of a claim for negligence, as long as they have acted reasonably and within the scope of their training and employment. Where Foundation and VoluntaryAidedSchools buy insurance outwith the LA system, staff should check with their own Governing Body that similar insurance indemnity exists for those who volunteer to administer medication.

If staff are not willing to administer treatment, it is essential that appropriate emergency aid is summoned urgently by telephoning for an ambulance on 999. You must give your exact location and the message ‘Anaphylactic reaction’. The ambulance crew will then be prepared to administer the medication en route to the nearest hospital. In any event they will be able to radio for advice and give advance warning of the child’s condition before arriving at the hospital. As a matter of routine, all schools must have a clear procedure for summoning an ambulance in an emergency. However, in the unlikely event of a severe allergic reaction occurring, immediate adrenalin treatment will be necessary while waiting for the ambulance to arrive.

Individual Health Care Plans (IHCPs)

For the most severe medical conditions it is important to establish an Individual Healthcare Planfor the pupil in consultation with parents and the School Health Service. See Appendix 1 for an anaphylaxis specific template. It will be necessary to arrange for periodic reviews of Individual Healthcare Plans to allow for the changing health needs of the pupils concerned.

Schools should ensure that they have contingency plans in case for any reason the normal routine for treatment breaks down, e.g. the trained staff members are absent. This should be included in the ITP for the pupil and is likely to include calling for an ambulance.

It is important that all staff, particularly those on temporary or supply contracts can easily recognise the pupils at risk of anaphylactic reaction. One way of achieving this is to highlight the names of the pupils within the school register so that all are aware of the possible needs of the pupil concerned.

Notifying the Local Authority of pupils with Anaphylaxis

It is no longer necessary for schools to complete a form and inform the Local Authority’sCorporate Health and Safety Team when a pupil is identified as having Anaphylaxis. It is, however, necessary for you to implement good local arrangementsbased on this Safety Advice Note,as your arrangements may be looked at as part of the safety audit process.

Day-to-day measures

It will be necessary to ensure that measures are in place for food management, awareness of the child’s needs in relation to the lunch menu, individual meal requirements and snacks in school.

Meal timesWhere school kitchen staff are employed by a separate organisation from the general school staff, it is important that the catering supervisor is made aware of the needs of those individual pupils with such extreme allergies so that they can put appropriate measures in place and instruct their staff.

It is recommended that pupils with severe food allergies be supplied with a home packed lunch, particularly in the case of nursery and infant school age pupils as they are less likely to be aware of what they can and cannot eat.

Educational visitsArrangements for outdoor activities and school trips should be discussed with the parents in advance. Careful planning and awareness amongst peers and staff is essential. Individual Treatment Plans can be uploaded to the Evolve notification and approval system for educational visits.

Cookery/scienceExperiments with food may present difficulties, and appropriate control measures to reduce the risk of an anaphylactic reaction should be identified in advance as part of the general risk assessment process. Suitable alternatives should be agreed.

Some schools have effectively introduced a nut-free environment, but this can be difficult to achieve. It must, however, be accepted by everyone concerned that while school staff will endeavour to ensure that a pupil does not come into contact with a particular allergen, this cannot ever be guaranteed.

Storage of and access to medication

Parents are responsible for checking expirydates of all medication and should replace themas necessary. The ideal time to do this is at theend of each term when the kit should be takenhome. Medication should not be left on schoolpremises during school holidays. The container must not be used for storing general first aid equipment. It can, however, be used for storing other emergency medication for that pupil, e.g. Insulin etc.

Some pupils, particularly those at a senior level, may wish to carry their own medication about their person. This is acceptable in some circumstances but must have prior agreement with the parents. It is important, however, to ensure that a spare ‘pen’ is held in an alternative place which is accessible in an emergency, should the pupil not have the ‘pen’ to hand.

If a pupil is going off-site on a supervised visit or activity, it is important that the emergency details, Individual Treatment Plan and spare ‘pens’ are carried, and that an appropriately trained person accompanies the pupil’s group.

Further information

Reference should also be made to Safety Advice Note SAN(M)1 – Administration of Medication and the DfE Guidance ‘Managing Medicines in Schools and Early Years Settings’ (March 2005), copies of which can be accessed via the schools’ portal or online below:

Internet links

This website offers information to help schools and school healthcare professionals support all pupils with medical conditions.

The Anaphylaxis Campaign website contains Guidance for schools, which discusses anaphylaxis, treatment, setting up a protocols, and support for pupils and staff. It also includes a sample protocol. The Anaphylaxis Campaign helpline is 01252 542029. The Anaphylaxis Campaign has also published the 'Allergy in schools'website which has specific advice for pre-schools, schools, school caterers, parents, students and nurses.

CHSU/SJMC1of 10

SAN(M) 2Anaphylaxis – Revised July 2015

APPENDIX A

Allergy and Anaphylaxis

INDIVIDUAL CARE/TREATMENT PLAN

This pupil is at risk of Anaphylaxis

Name of pupil:

Date of birth:

Current year/class:

GP/local hospital no:

(Name) may suffer from an anaphylactic reaction

if he/she is exposed to

(Name)also suffers from the following medical

conditions:

His/her usual allergic symptoms are:

Emergency procedures

The attached emergency procedures form part of this home/school agreement.

Awareness

The Headteacher will arrange for the teachers and other staff in the school to be briefed about his/her condition and about other arrangements contained in this document.

The school staff will take all reasonable steps to ensure that he/she does not eat any food items unless they have been prepared or approved by his/her parents.

The parents will remind their child regularly of the need to refuse any food items that might be offered to them by other pupils.

In particular, (name) parents/carers will provide for him/her the following food items:

Medication/Staff training

The school will hold, under secure conditions, appropriate medication, clearly marked for use by designated staff or qualified personnel and showing an expiry date.It is the parents’ responsibility to ensure the school has appropriate up-to-date medication and that medication is collected from school at the end of each term.

The following volunteers from the school have agreed to administer the medication. A training session was attended by:

Name: Date/s:

Name:Date/s:

Name:Date/s:

Name:Date/s:

Name:Date/s:

Further advice is available to school staff at any point in the future where they feel the need for assistance. The medical training will be repeated

If proposed arrangements lead to (name) leaving the school site for educational purposes, prior discussions will be held between the school staff and his/her parents to agree appropriate provision and safe handling of his/her medication.

Staff indemnity

The County Council provides a staff indemnity for any school staff (of those schools which buy into the Cumbria County Council Insurance scheme) who agree to administer medication to a pupil following the full agreement of the parents and the school.

Agreement and conclusion

A copy of these notes will be held by the school and the parents. A copy will be sent to the GP for information.Any necessary revisions will be the subject of further discussions between the school and parents.

Signed:Headteacher: Date:

Signed: Parent/guardian: Date:

Signed: Health Professional: Date:

(e.g. school nurse, GP, Consultant)

Review date:

EMERGENCY ACTION PLAN - ANAPHYLAXIS

(Stepsto be agreed with Medical Professional)

In the event of an anaphylactic reaction, staff will follow this emergency action plan.

One adult will remain with the pupil and follow the emergency procedures given below.

Second adult will obtain correct ‘pen’ for the pupil and check expiry date.