Life Threatening Allergies

Life Threatening Allergy Management Policy

The Wellesley Public Schools is committed to providing a safe and nurturing environment for students.  Recognizing the increasing prevalence of life threatening allergies among the school population, the Wellesley Public Schools will work in cooperation with parents, students and physicians to minimize risks and to provide a safe educational environment for all students.  The focus of allergy management will be prevention, education, awareness, communication and emergency response.  With prevention in mind, all school departments and school programs will make efforts to utilize latex free products. This protocol will assist students to assume more individual responsibility for their health and safety as they mature and optimize full participation in educational programs and school sponsored activities.

Goals:

Define a process for identifying, managing and ensuring continuity of care for students with life-threatening allergies.

Maintain the health and protect the safety of children who have life-threatening allergies.

Identify interventions and develop individual health care plans for students with life-threatening allergies that are based on medically accurate information and evidence based practices.

References

• Food allergy and Anaphylaxis Network http://www.foodallergy.org

• MA Department of Public Health: 105 CMR 210.100

• Managing Life Threatening Allergies in Schools. DESE 2016

Voted by School Committee:  June 3, 2014

Life-Threatening Allergy Management Protocol

Allergic reactions can span a wide range of severity of symptoms.  The most severe and potentially life-threatening is anaphylaxis.  This protocol is to be used for students who are at risk for anaphylaxis and in the circumstances where a previously undiagnosed life-threatening allergic response occurs.  This document has a strong emphasis on food allergies but other major causes of an allergic reaction and potential for anaphylaxis are insect stings, medication and contact with latex.

Anaphylaxis is a collection of symptoms that can affect multiple systems within the body, the most dangerous of which are breathing difficulties and dop in blood pressure.  Severe allergic reactions can occur within minutes of ingestion, contact,or inhalation.  The reaction can be delayed for up to two or more hours.  

The most common medication prescribed for anaphylaxis is epinephrine (the brand name “Epi-Pen” is used throughout this document to represent all types of auto-injectors or epinephrine).  Parents of students with a life-threatening allergy are encouraged to leave an Epi-pen at school for use in case of an emergency.  It is also recommended that students carry another Epi-pem in a designated spot in their backpacks if they participate in before or after school activities.  

The Wellesley Public Schools have stock epinephrine in each school.  This will be used in emergencies for students with unknown allergies who develop an anaphylactic reaction and for students with known allergies as a “back-up”.  

There is a medication order, issued by the school physician, in place for the emergency administration of epinephrine.

All food provided by Food Services are tree nut and peanut free.

Guidelines:

There are no food celebrations. If the school principal determines that a celebration or event that includes food is warranted the following procedure will be followed to ensure both inclusion and safety:  

• The principal or teacher(s) will provide notice to all parents of students participating in the event.  

• In advance of the event the principal or teacher will supply a list of all food items and ingredients to the parents of participating students to ensure all religious practices and food allergies/intolerance are addressed.

• The nursing department provides all appropriate staff with student specific allergy alerts in PowerSchool.

• The nursing department does not review ingredient lists/labels.

• Protected health information of students cannot be shared with non-WPS staff.

In order to avoid the potential for cross contamination, there is no eating on the buses except when medically necessary.

Due to the increase in numbers of students with latex allergies, all school departments and school programs will make every effort to utilize latex free products including balloons.

Expectations of the Parent/Guardian of a Student with a Life-Threatening Allergy

1. Teach your child to:

• Recognize the symptoms of an allergic/anaphylactic reaction.

• Speak with a teacher or nurse as soon as your child feels a reaction is starting.

• Encourage self-advocacy.

• Carry his/her own epinephrine injector when appropriate.

• Not to share snacks, lunches, drinks or utensils. 

• Understand the importance of hand washing before and after eating.

• Report teasing and/or bullying that may relate to your child’s allergy.

• Read labels and encourage education on label reading and ingredient safety.

• Develop awareness of their environment, including allergy-controlled zones and to practice age appropriate behavior regarding health and safety.

2. Inform the school nurse of your child’s allergies as soon as possible after diagnosis and at the beginning of every school year with updated medical documentation. 

3. Provide an Allergy Emergency Care Plan, medication orders with parent authorization  and an up-to-date Epi-pen each school year.  Medication provided will comply with the Massachusetts Department of Public Health policy of being in the original pharmacy packaging with appropriate labeling information.

4. Provide the school with current emergency contact numbers and additional medical information.

5. Work with the school team collaboratively to develop an Individualized Health Care Plan for the classroom, in the cafeteria, in after-care programs and during school-sponsored activities. 

6. Notify the WPS  Transportation Department if your child will require any special provisions during transport to and from school.  

7. Develop with the school nurse an age appropriate plan to increase age-appropriate independence as the student grows and matures. 

8. Encourage your child to wash hands before and after handling food.

9. Inform the school nurse of any changes in your child’s life threatening allergy status.

10. Provide the school nurse with a physician’s statement if your child no longer a life-threatening allergy. 

11.  Discuss your child’s allergy management to the adult responsible for your child while attending any before and after school programming as school nurses are not in the building during these times.  The  Extra-Curricular Medical Information Form is available on the Nursing Services website for you to use in order to have a comprehensive plan in place. 

Expectations of the Student with a Life-Threatening Allergy:

1. Develop a relationship with the school nurse and another trusted adult to assist in identifying issues related to the management of your life-threatening allergy while in school.

2. Know your symptoms that indicate you may be having a reaction.

3. Speak with a teacher or nurse as soon as you suspect symptoms are starting.  Stay with an adult until cleared by the school nurse.  Do not travel to the nurse without an adult with you. 

4. Refrain from sharing food, drinks and utensils.  Understand the importance of hand washing before and after eating, and often during the day.

5. Know how to use your Epi-pen.  Carry one at all times if your parents and school nurse feel it is important.

6. Be aware of your environment as it relates to your allergy.  Learn to read food labels. 

7. Speak up and question food ingredients in restaurants, school, friends’ homes or other new situations. 

Responsibilities of the School Principal:

1. Follow all applicable Federal laws, including ADA, Section 504, and FERPA, as well as state laws and district policies and procedures that may apply.  

2. Ensure district-wide mandatory in-service training and education on reducing life-threatening allergy risks, recognizing allergy symptoms, and emergency procedures for appropriate staff to include the following topics:

• A description/definition of severe allergies and a discussion of the most common allergic reactions.

•  The signs and symptoms of anaphylaxis.

• The correct use of epinephrine.

• Specific steps to follow in the event of an emergency.

A contingency plan will be in place using designated building staff and understood by all staff and students in the event the nurse is not in the office or in the building.  Staff will call 911 in all instances of epinephrine administration.

Responsibilities of the School Nurse:

1. Meet with parents/guardians and the student, if appropriate, and develop an Individualized Health Care Plan and an Allergy Action Plan.

2. Work with the parents/guardians to obtain:

• Documentation of allergy

• Physician order for medication

• Parent consent to administer medication

• Receive Emergency medication from parents/guardians for use at school.

3. Verify that all prescribed medication is up-to-date and readily accessible to staff. 

4. Establish and maintain effective lines of communication with the parent while formulating the health care plan.

5. Encourage the parents/guardians to call the Food Service Director if they are interested in having their child select food at school.

6. Provide information about students with life threatening allergies to WPS staff on a need-to-know-basis.

7. Encourage the parents/guardians to contact the WPS Transportation department if special provisions are needed during transport to and from school.

8. Provide yearly in-service training and education to the school staff regarding life-threatening allergies, symptoms, risk reduction procedures, and emergency procedures including demonstration of how to use Epi-pen.

9. The school nurse will retain documentation of those personnel who have received training on a yearly basis.

10. Familiarize teachers/substitutes with the Emergency Action Plan of their students and any other staff member who has contact with the student on a need-to-know basis. 

11. Nurses are responsible for following the Massachusetts Department of Public Health regulations that permit registration of non-licensed personnel to be trained and to administer epinephrine in an emergency. 

12. Educate parents on appropriate locations for storing more than one Epi-pen at school if their student is involved in before or after school activities.

13. Follow Medical Emergency Response Plan. Activate EMS (911) and then notify the school principal immediately if a student has an allergic reaction and epinephrine is administered.

14. As appropriate, notify the 504 coordinator and participate in 504 planning. 

15. Update allergy information in SNAP Critical Alerts.

16. Update PowerSchool medical alert caduceus with student’s specific allergy and location of emergency medication (nurse’s office or self carry).

17. Store Epi-pens with a copy of the medication order, parental consent for administration and Allergy Action Plan with emergency contact information  in an unlocked area of the Nurse’s Office.

Responsibilities of the Teacher:

1. Know the signs and symptoms of severe allergic reaction as provided in the student’s emergency care plan, and be aware of and implement the emergency plan if a reaction is suspected.

2. Review the Emergency Care Plan with the school nurse of any student in your classroom with a life-threatening allergy and include relevant staff members.

3. Complete the mandatory life-threatening allergy program at the beginning of every school year and bring the completed post-test to your school nurse.

4. Review Epi-pen administration with the school nurse and return a demonstration of the correct administration procedure.

5.  Limit the use of food for instructional lessons.  Food should not be used as a reward.

6. Teachers must notify parents by written communication of any school related activity that requires the use of food or other allergens at least 5 school days in advance of the project/celebration/activity so that appropriate substitutions can be made. This notice must include a complete list of ingredients (or legible photo of ingredient label) with brand name of product.  Nursing staff do not review ingredient lists for classroom activities. 

7. Reinforce appropriate classroom hygiene practices and hand washing before and after eating.

8. Respond immediately to reports of students being teased or bullied about their allergy.

9.  Follow the Allergy Action Plan and call 911 when life-threatening allergy related symptoms develop.

10. Consider students with life-threatening allergies when planning any changes from the classroom routine such as a field trip.

11. Provide information in the Substitute Folder regarding students with life-threatening allergies so that appropriate plans to keep the student safe remain intact while the teacher is away from the classroom.

Responsibilities of Nutrition Services:

1. Provide in-service to nutritional service employees regarding safe food handling practices to avoid cross contamination with potential food allergens.

2. Food service employees will wear non-latex gloves.  Gloves will be changed during extended use and hands will be washed frequently to avoid cross contamination with potential food allergens.

3. Maintain knowledge of which food products contain allergens.

4. With parental approval, set up reasonable procedures regarding food allergic students, including entering student’s allergy information into a computerized database.

5. Information will remain confidential and shared on a need-to-know basis in compliance with federal privacy regulations. 

6. Respond appropriately to all complaints or concerns from a parent or any student with a life-threatening allergy.

7. All tables should be thoroughly cleaned between lunches. 

Responsibilities during Recess and Physical Education Classes:

1. Children will be under the supervision of an adult at all times.  An Epi-pen will accompany the student outside if indicated in the Allergy Action Plan.  The Epi-pen can be carried by a designated adult or the student if appropriate.

2. There must be some mechanism for communication in case of an emergency such as a walkie-talkie or cell phone. 

Responsibilities on Field Trips:

The teacher will:

• Consult with the school nurse at least 30 days prior to the date of the scheduled trip.

• Provide the nurse with a list of students participating in the field trip.  This list will be reviewed and plans developed to keep all students safe while away from school.

• Place any student with a life-threatening allergy in a group with a teacher and not a parent chaperone unless it is the parent of the child with the allergy.

• The classroom teacher who has completed the Epi-pen training will accompany the class on the field trip and maintain and follow the student’s Allergy Action Plan.

• Consider eating arrangements on field trips and plan for prevention of exposure to allergens. 

• Ensure that a first aid kit, emergency medications, instructions and a cell phone are taken.

• Staff will call EMS (911) FIRST in all instances of Epi-pen administration and then notify the parents/guardians and school nurse.

The school nurse will:

• Review medical plans with teh field trip coordinator.

• Determine if a nurse is required to accompany the students on the field trip.

• Determine that adequate medical accommodations are in place for the planned field trip.

Responsibilities of the WPS Transportation Department:

1. The Director of Transportation will inform all school bus and van drivers of students with life-threatening allergies provided the parent has shared the information with the Transportation Department. 

2. All bus and van drivers will participate in a Medical Emergency Program at the beginning of every school year.   Included in this program is a review of allergy management and the administration of epinephrine with a return demonstration.

3. There will be functioning emergency communication devices (e.g., cell phones, two-way radios, etc.) on each bus and van.  

4. There will be first aid kits on all buses and vans.  Only latex-free gloves will be used.  

5.  The policy of no eating or drinking on the bus will be strictly enforced with the exception of a medically specified situation.

6. Bus and van drivers are not to distribute any food items to students.

FORMS

• Allergy Emergency Care Plan 

• Medication Authorization Form

• Extra-Curricular Emergency Medical Information Form