Managing Life Threatening Allergies in SchoolsBackground: Texas Senate Bill 27 (82nd Legislative Session) requires all school boards and governing bodies of public and open enrollment charter schools to adopt and administer a policy for the care of students with diagnosed food allergy at risk for anaphylaxis.Anaphylaxis is a sudden, severe allergic reaction. The most dangerous symptoms include breathing difficulties, a drop in blood pressure or shock. Common examples of potentially life threatening allergies are those to foods or stinging insects. Other allergic reactions may also occur to medications, latex or while exercising. The emergency treatment is epinephrine, which is usually supplied in epinephrine auto-injectors (example: EpiPen® and EpiPen Jr® or TWINJECT®). Wichita Falls ISD has developed guidelines to manage students with these life threatening allergies, so that they may safely participate in the educational process.WFISD food allergy management plan will be individualized to all students who have severe food allergies and are at risk for anaphylaxis. Students at risk for anaphylaxis from other allergens will also have individualized management plans.The goals for the District-wide food allergy management plan include:
School Guidelines For Managing Students With Food AllergiesFood allergies can be life threatening. The risk of accidental exposure can be reduced in the school setting if schools work with student, parents, and physicians to minimize risks and provide a safe educational environment for food-allergic students.Family's Responsibility
- Provide a safe and healthy learning environment for students with food allergies;
- Reduce the likelihood of severe or potentially life-threatening allergic reactions;
- Ensure a rapid and effective response in the case of a severe or potentially life-threatening allergic reaction, and
- Protect the rights of food-allergic students to participate in all school activities.
- Notify the school of the child's allergies. As part of the enrollment process, complete the student's Health History Inventory and mark Anaphylaxis.
- Work with the principal and the school nurse to develop a plan that accommodates the child's needs throughout the school including the classroom, in the cafeteria, during school-sponsored activities and on the school bus.
- Provide written medical documentation, instructions and medications as directed by a physician, using the WFISD Anaphylaxis Care Plan (click link to print this form).
- Provide properly labeled medications and the completed Anaphylaxis Care Plan that includes physician directions for anaphylaxis medications. Be sure to replace medications after use or upon expiration.
- Educate the child in the self-management of their food allergy including:
- safe and unsafe foods
- strategies for avoiding exposure to unsafe foods
- symptoms of allergic reactions
- how and when to tell an adult they may be having an allergy-related problem
- how to read food labels (age appropriate).
- Provide emergency contact information. Update this information anytime changes occur.
- Review policies/procedures with the school staff, the child's physician, and the child (if age appropriate) after a reaction has occurred.
- Be knowledgeable about and follow applicable Federal laws including ADA, IDEA, Section 504, and FERPA as well as any state laws or district policies that apply.
- Include food-allergic students in school activities. Students should not be excluded from school activities solely based on their food allergy.
- Identify a core team consisting of, but not limited to, school nurse, teacher, principal, school food service/nutrition manager and counselor (if available) to work with the parents and the student (age appropriate) to establish a prevention plan.
- Changes to the prevention plan to promote food allergy management should be made with the core team participation.
- School nurse will strive to identify students with a history or risk for anaphylaxis by reviewing current school year electronic Health Inventory, previous school year student Health Condition and Critical Alert information in Skyward computer system.
- Review the health records submitted by the parents and physicians.
- Assure that all staff has a basic understanding of food allergy, possible signs and symptoms, and know what to do in an emergency.
- Train staff (teachers, PE teachers/coaches, administrative staff, etc.) who regularly interact with a specific student about the foods that trigger an allergic reaction, student-specific signs and symptoms, and a detailed emergency response plan including the administration of epinephrine. Review the student's Classroom Action Plan--prepared by the school nurse (RN) from information listed on the student's individual Anaphylaxis Care Plan.
- Designate school personnel who are properly trained to administer medications in accordance with the Texas state law and the Good Samaritan Laws governing the administration of emergency medications.
- Be prepared to handle a reaction and ensure that there is a staff member available who is properly trained to administer medications during the school day regardless of time or location.
- Students may carry their own epinephrine, if age appropriate, after approval from the student's physician/clinic, parent and school nurse.
- Work with the district's transportation administrator to assure that school bus driver training includes symptom awareness and what to do if a reaction occurs.
- Follow federal and state laws and regulations regarding sharing medical information about the student.
- Take threats or harassment against an allergic child seriously.
5. Allergic Reaction Event
- Review the allergic-student's Classroom Action Plan (prepared by the school RN from information listed on the student's Anaphylaxis Care Plan).Have the plan readily available.
- School nurse will provide the "List of Foods to Avoid Completely" (form 499-042) which contains the student's picture to place in the substitute teacher folder.
- Eliminate the use of food allergen(s) in educational tools, arts & craft projects, or incentives.
- Elementary home room teacher - use the parent letter, Food Allergy Classroom Parent Letter. This letter anonymously discloses to parents the presence of a student with a severe food allergy.
- Discuss field trips with the family of the food-allergic student to decide appropriate strategies for managing the food allergy.
- Take threats or harassment against an allergic child seriously.
- Follow the student's written Anaphylaxis Care Plan/Classroom Action Plan.
- School nurse will complete the Report of Epinephrine Administration following an anaphylaxis event with epinephrine administration.
- Review policies/prevention plan by the core team members, parents/guardians, student (age appropriate) and physician (if applicable) after a reaction occurs.
- After the review, make any necessary changes to the student specific food allergy management plan, including the emergency action plan.
WFISD Student Health Services Anaphylaxis Management Protocol
- Should not trade food with others.
- Should not eat anything with unknown ingredients or known to contain any allergen.
- Should be proactive in the care and management of their food allergies and reactions based on their developmental level.
- Should notify an adult immediately if they eat something they believe may contain the food to which they are allergic.
1. School Nurse will determine if there is a student with a history or risk of anaphylaxis on the school campus by reviewing:
- Current school year electronic student Health Inventory information completed by parent;
- Student Critical Alert Information in Skyward computer system;
- Health Condition information in Skyward computer system.
2. School Nurse will schedule a meeting with parent/guardian of the student to determine:
- Previous medical history - use Food Allergy Health History form (click link to print form)
- Type and level of care that the parent is seeking for their student
- EpiPen kept in nurse's office?
- Benadryl (if needed) kept in nurse's office?
- EpiPen carried on student (with approval)?
3. School Nurse will collaborate with the student (age appropriate), parent/guardian and physician to:
- As part of the student's completed Anaphylaxis Care Plan, review medical orders for:
- Benadryl (if needed) and/or EpiPen to be administered at school as needed
- Student to carry EpiPen (physician, parent and nurse will need to sign off that student has knowledge/ability to carry EpiPen on self.)
- Have supplies (Benadryl and/or EpiPen) at school or with student per physician orders.
- Obtain paperwork for Food Service/Nutrition Dept. Statement Regarding Meal Substitutions or Modifications (click link to print form).
- Obtain a completed WFISD Anaphylaxis Care Plan (click link to print blank form).
4. School Nurse will:
For additional information about Food Allergies in Schools:Centers of Disease Control and Prevention: http://www.cdc.gov/healthyyouth/foodallergies/
- Prepare the student-specific Classroom Action Plan.
- Prepare the Individual Health Care Plan, as needed.
- Present all staff with a basic overview of food allergy, possible signs and symptoms, and what to do in an emergency.
- Notify appropriate school staff with a need to know of a specific student's condition (teachers, PE teacher/coach, cafeteria staff, and administrative staff).
- Train designated staff on the student-specific signs, symptoms, and medical management of anaphylaxis and document such training.
- Train designated staff on the student's "Classroom Action Plan" and the use of the EpiPen.
- Educate staff that the "Emergency Plan" and medication(s) (Benadryl and/or EpiPen) must accompany student on all field trips.
- Provide retraining of staff as needed throughout the school year.
- After an event, the school nurse will complete an Epinephrine Administration Record. An initial review will take place between the campus nurse, RN supervisor (if applicable) and the Health Care Coordinator regarding what went well and what needs to be improved in the process. Review of the Epinephrine Administration Record is part of this initial review. Additional review of event will be completed by the core team, parent, student (age appropriate) and physician (if applicable). Any necessary changes will be made to the management plan.