GUIDELINES FOR MANAGEMENT OF ANAPHYLAXIS IN EDUCATIONAL ESTABLISHMENTS DHSSPS /DOE 2010

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GUIDELINES FOR MANAGEMENT OF ANAPHYLAXIS IN
EDUCATIONAL ESTABLISHMENTS DHSSPS /DOE 2010
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OBJECTIVES OF SESSION

• Update your knowledge on anaphylaxis
• Be aware of the emergency treatment prescribed
  for children with this condition
• Practise the correct technique for auto-injector
  administration
• Be aware of how to safely dispose of the
  auto-injector

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WHAT IS ANAPHYLAXIS?

• Anaphylaxis is a severe, life-threatening,
  generalised or systemic hypersensitivity
  reaction. It is characterised by rapidly
  developing life-threating problems involving the
  airway and /or breathing and /or circulation. In
  most cases, there are associated skin and mucosal
  changes

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COMMON CAUSES

• Peanuts
• Tree nuts
• Milk
• Egg
• Sesame
• Fish
• Shellfish

• Wasp
• Bee
• Latex
• Penicillin
• Blood Products
• Drugs
• Kiwi

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TYPES OF REACTION

• Uni-phasic rapidly developing severe reaction
  involving the airway or circulation.
• Bi-phasic early oral and abdominal symptoms,
  then a symptom-free period of 1 2 hours, then
  increasing symptoms involving breathing and
  circulation.

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MINOR REACTION

• Feeling hot or generalised flushing of the skin
• Intense itching and rapid development of a nettle
  like rash welts
• Burning sensation of lip and /or metallic taste
  in mouth
• Red, itchy, watery, swollen eyes or swollen lips
  or face
• Vomiting and diarrhoea with abdominal pain
• Itchy, runny or congested nose and / or sneezing
• Dizziness and feeling faint/pallor may indicate
  severe reaction in the very young.

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TREATMENT FOR MINOR REACTION

• ANTIHISTAMINE AND INHALERS
• Follow the childs individual care plan.
  Administer the prescribed antihistamine e.g.
  Piriton and/or inhaler
• Record the time given and stay with the child
• Contact parent.

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SEVERE REACTION

• Difficulty in breathing / noisy breathing, wheeze
  or stridor
• Swelling of mouth / tongue or feeling of
  tightness or lump in throat
• Decreased level of consciousness
• Collapse, lack of breathing
• Absent or very weak pulse

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TREATMENT OF SEVERE REACTION

• Give prescribed auto-injector record time
• If unconscious but breathing place in recovery
  position
• Call paramedic ambulance 999
• Contact parent / carer (contact numbers given
  over)
• If no improvement within 5 minutes give
  auto-injector record time
• If no signs of life commence CPR (cardiopulmonary
  resuscitation) and continue until professional
  help arrives
• Put used auto-injector in sharps disposal box
• IF IN DOUBT GIVE AUTO-INJECTOR
• If auto-injector is given the child MUST go to
  hospital for observation even if they have made a
  full recovery

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AUTOINJECTOR

• An auto-injector Epipen or Jext is prescribed
  according to the childs weight to deliver a
  single dose of adrenaline and reverse the
  symptoms of anaphylaxis.
• Child dose 0.15mgs
• Adult dose 0.3mgs

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STORAGE OF EMERGENCY BOX

• Accessible at all times during the school day
  NOT in a locked room or cupboard.
• Contains completed care plan with medication in
  date
• Avoid extremes of temperature.
• Clearly labelled with childs name.

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ROLES AND RESPONSIBILITIES

• The Childs Parent -
• Will ensure that the school are fully informed
  about the childs allergy including when no
  longer allergic to particular foods or substances
• Care plan to be completed by parent and returned
  to school promptly
• Will accept responsibility for maintaining and
  replacing in school, two up to date auto
  injectors. If the child has been prescribed an
  auto injector device that the school has no
  experience of using, the school and school
  nurse should be immediately informed.

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• It is the duty of the parent to check the expiry
  date of the auto injectors. The parent should
  return out of date auto-injectors to pharmacy for
  disposal
• Will discuss with the school arrangements for
  lunch and snacks.
• Will regularly remind the child of the need to
  refuse any food items offered by others.
• Will encourage their child to wear a medical
  identification device
• Will remove all medication at the end of the
  school year.
• Will provide a sharps box (available on
  prescription) for safe disposal of used
  auto-injector

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The school -

• The school principal (or designated teacher) will
  notify school nurse on becoming aware of a pupil
  requiring an adrenaline auto-injector device e.g.
  Epipen / Jext or Anapen in school.
• The principal or designated teacher will make
  staff aware of pupils allergic condition and who
  trained staff are (temporary/ substitute
  teachers)
• The principal or designated teacher will identify
  adequate numbers of appropriate staff to attend
  training. Annual updated anaphylaxis centralised
  training will be offered
• Inform staff of activities which could put the
  pupil at risk

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• School trips schools should make arrangements
  for the safe handling and transportation of
  auto-injector
• Should discuss details of care plan and childs
  condition with parents
• The principal will ensure that the care plan is
  signed appropriately
• Will agree with the parents and if necessary, the
  area catering manager on the provision of school
  meals/snacks.
• Will ensure safe storage of, and easy access to,
  the two auto- injectors devices together
  with care plan. All trained staff must be aware
  of where these are stored.
• It is the duty of the parent to check the expiry
  date of auto- injectors, however
  schools should be aware of expiry dates on
  medication to ensure that they not left with out
  of date medication.

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The Pupil (depending on age of child)

• Post primary pupils may be responsible for
  carrying their own auto-injectors WITH THEM AT
  ALL TIMES especially when away from main building
  e.g. sports fields
• Will be aware of the risk of food sharing
• Advised to wear medical identifier
• Report the onset of symptoms to a responsible
  member of staff

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School Health Team -

• Will provide centralised training on the
  recognition and treatment of anaphylaxis in
  partnership with SELB and give advice and support
  to school staff.
• Will participate in any debriefing session/follow
  up of major or minor incident
• Will contact the parents and school, on an annual
  basis, seeking updated information
• Will send a copy of care plan to parents for
  completion
• School nurse along with school designated teacher
  will review care plan when returned by parent and
  sign appropriately

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Minor reaction
F

• Keep calm, stay with pupil and call for help
• Give prescribed medication e.g. Piriton
• if asthmatic give 4-6 puffs of reliever (blue)
  inhaler
• Record medication administered and the time it is
  given
• Locate pupils prescribed auto-injector
• Contact parent or carer

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• Give prescribed auto-injector record
  time__________
• If unconscious but breathing place in recovery
  position
• Call paramedic ambulance 999
• Contact parent / carer (contact numbers given
  over)
• If no improvement within 5 minutes give
  auto-injector record time_________________
• If no signs of life commence CPR (cardiopulmonary
  resuscitation) and continue until professional
  help arrives
• Put used auto-injector in sharps disposal box.
• IF IN DOUBT GIVE AUTO-INJECTOR

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Frequently asked questions

• In an emergency can I use another pupils auto
  injector?
• What do I do if a care plan is not returned by
  parent?
• Who should attend Anaphylaxis Awareness?
• Is prescription required from GP?

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Today you should have

• Updated your knowledge
• Be aware of the emergency treatment prescribed
  for children with this condition
• Practised the correct technique for auto injector
  administration
• Be aware of how to safely dispose of the
  injector.

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WANT MORE INFORMATION?

• Contact the Anaphylaxis Campaign
• Tel [phone]
• www.anaphylaxis.org.uk
• www.allergyinschools.org.uk
• www.cateringforallergy.org
• Schools pack
• Video/DVD
• Managing Medicines in Schools ans Early Years
  Settings. DH/DfES.

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Contact telephone numbers for school nursing

• Armagh 028 3741 2510
• Dungannon 028 8771 3084
• Banbridge 028 4066 2866
• Craigavon 028 3834 1431
• Newry 028 3083 4309
• Kilkeel 028 4176 0829

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• Thank you for your time.