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Anaphylaxis

epipenPolicy Statement

Values

One World Children’s Centre believes that the safety and wellbeing of children who are at risk of anaphylaxis is a whole-of-community responsibility. One world Children’s Centre is committed to:

  • providing, as far as practicable, a safe and healthy environment in which children at risk of anaphylaxis can participate equally in all aspects of the children’s program and experiences
  • raising awareness about allergies and anaphylaxis amongst the centre’s community and children in attendance
  • actively involving the parents/guardians of each child at risk of anaphylaxis in assessing risks, developing risk minimisation strategies and management strategies for their child
  • ensuring each staff member and other relevant adults have adequate knowledge of allergies, anaphylaxis and emergency procedures
  • facilitating communication to ensure the safety and wellbeing of children at risk of anaphylaxis

Purpose

The aim of this policy is to:

  • minimise the risk of an anaphylactic reaction occurring while the child is in care at One World
  • ensure that staff members respond appropriately to an anaphylactic reaction by initiating appropriate treatment, including competently administering an adrenaline auto-injection device
  • raise the centre’s community’s awareness of anaphylaxis and its management through education and policy implementation

Scope

The Children’s Services Act 1996 requires proprietors of licensed children’s services to have an anaphylaxis management policy in place. This policy will be required whether or not there is a child diagnosed at risk of anaphylaxis enrolled at the centre.  It will apply to children enrolled at the centre, their parents/guardians, staff and licensee as well as to other relevant members of the service community, such as volunteers and visiting specialists.  The Children’s Services Regulations 2009 include the matters to be included in the policy, practices and procedures related to anaphylaxis management and staff training.

Background and legislation

Anaphylaxis is a severe, life-threatening allergic reaction.  Up to two per cent of the general population and up to five per cent (0-5years) of children are at risk.  The most common causes in young children are eggs, peanuts, tree nuts, cow milk, sesame, bee or other insect stings and some medications.

Young children may not be able to express the symptoms of anaphylaxis.

A reaction can develop within minutes of exposure to the allergen, but with planning and training, a reaction can be treated effectively by using an adrenaline auto-injection device.

The licensee recognises the importance of all staff/carers responsible for the child/ren at risk of anaphylaxis undertaking training that includes preventative measures to minimise the risk of an anaphylactic reaction, recognition of the signs and symptoms of anaphylaxis and emergency treatment, including administration of an adrenaline auto-injection device.

Staff /carers and parents/guardians need to be made aware that it is not possible to achieve a completely allergen-free environment in any service that is open to the general community.  Staff /carers should not have a false sense of security that an allergen has been eliminated from the environment.  Instead the licensee recognises the need to adopt a range of procedures and risk minimisation strategies to reduce the risk of a child having an anaphylactic reaction, including strategies to minimise the presence of the allergen in the service.

Legislation

Children’s Services Act 1996

Children’s Services Regulations 2009

Health Act 1958

Health Records Act 2001

Occupational Health and Safety Act 2004

Definitions

Anaphylaxis: A severe, rapid and potentially fatal allergic reaction that involves the major body systems, particularly breathing or circulation systems.

Anaphylaxis medical management action plan: a medical management plan prepared and signed by a Registered Medical Practitioner providing the child’s name and allergies, a photograph of the child and clear instructions on treating an anaphylactic episode.  An example of this is the Australian Society of Clinical Immunology and Allergy (ASCIA) Action Plan.

Anaphylaxis management training: accredited anaphylaxis management training that has been recognised by the Secretary of the Department of Education and Early Childhood Development and includes strategies for anaphylaxis management, recognition of allergic reactions, risk minimisation strategies, emergency treatment and practise using a trainer adrenaline auto-injection device.

Adrenaline auto-injection device: A device containing a single dose of adrenaline, delivered via a spring-activated needle, which is concealed until administered.

EpiPen®: This is one form of an auto-injection device containing a single dose of adrenaline, delivered via a spring-activated needle, which is concealed until administered.  Two strengths are available, an EpiPen® and an EpiPen Jr®, and are prescribed according to the child’s weight.  The EpiPen Jr® is recommended for a child weighing 10-20kg.  An EpiPen® is recommended for use when a child is in excess of 20kg.

Anapen®. Is another adrenaline auto injection device containing a single dose of adrenaline, recently introduced to the Australian market.

NB: The mechanism for delivery of the adrenaline in Anapen® is different to EpiPen®.

Adrenaline auto-injection device training: training in the administration of adrenaline via an auto-injection device provided by allergy nurse educators or other qualified professionals such as doctors, first aid trainers, through accredited training or through the use of the self paced trainer CD ROM and trainer auto-injection device.

Children at risk of anaphylaxis: those children whose allergies have been medically diagnosed and who are at risk of anaphylaxis.

Auto-injection device kit: An insulated container, for example an insulated lunch pack containing a current adrenaline auto-injection device, a copy of the child’s anaphylaxis medical management action plan, and telephone contact details for the child’s parents/guardians, the doctor/medical service and the person to be notified in the event of a reaction if the parent/guardian cannot be contacted.  If prescribed an antihistamine may be included in the kit.

Procedure

The Licensee shall:

1. In all children’s services :

  • ensure that all staff members have completed first aid and anaphylaxis management training that has been approved by the Secretary by January 2012 then at least every 3 years
  •  ensure there is an anaphylaxis management policy in place containing the matters prescribed in Schedule 3 of the Children’s Services Regulations 2009
  •  ensure that the policy is provided to a parent or guardian of each child diagnosed at risk of anaphylaxis at the service
  •  ensure that all staff in all services whether or not they have a child diagnosed at risk of anaphylaxis undertakes training in the administration of the adrenaline auto-injection device and cardio- pulmonary resuscitation every 12 months and recording this in the staff records.

2. In services where a child diagnosed at risk of anaphylaxis is enrolled the licensee shall also:

  • conduct an assessment of the potential for accidental exposure to allergens while child/ren at risk of anaphylaxis are in the care of the service and develop a risk minimisation plan for the service in consultation with staff and the families of the child/ren.
  • ensure that a notice is displayed prominently in the main entrance of the children’s service stating that a child diagnosed at risk of anaphylaxis is being cared for or educated at the service
  • ensure staff members on duty whenever a child diagnosed at risk of anaphylaxis is being cared for or educated have completed training approved by the Secretary in the administration of anaphylaxis management and that practice of the adrenaline auto-injection device is undertaken every 12 months
  • ensure that all staff members are aware of the child at risk of anaphylaxis,symptoms of an anaphylactic reaction,, the child’s allergies, the individual anaphylaxis medical management action plan and the location of the auto-injection device kit
  • ensure that no child who has been prescribed an adrenaline auto-injection device is permitted to attend the centre without the device
  • implement the communication strategy and encourage ongoing communication between parents/guardians and staff regarding the current status of the child’s allergies, this policy and its implementation
  • display an Australasian Society of Clinical Immunology and Allergy inc (ASCIA) generic poster called Action Plan for Anaphylaxis in each play room, the kitchen and staff room
  • display Emergency contact numbers by all telephones
  • comply with the procedures outlined in Schedule 1 of the model policy
  • ensure that a child’s individual anaphylaxis medical management action plan is signed by a Registered Medical Practitioner and inserted into the enrolment record for each child. This will outline the allergies and describe the prescribed medication for that child and the circumstances in which the medication should be used.
  • ensure that all staff in the service know the location of the anaphylaxis medical management plan and that a copy is kept with the auto-injection device Kit
  • ensure that the auto-injection device kit is stored in a location that is known to all staff, including relief staff; easily accessible to adults (not locked away); inaccessible to children; and away from direct sources of heat
  • ensure that the staff member accompanying children outside the service carries the anaphylaxis medication and a copy of the anaphylaxis medical management action plan with the auto-injection device kit.
  • ensure staff regularly check the adrenaline auto-injection device expiry date.  (The manufacturer will only guarantee the effectiveness of the adrenaline auto-injection device to the end of the nominated expiry month)
  •  ensure that all staff follow the child’s anaphylaxis medical management action plan in the event of an allergic reaction, which may progress to anaphylaxis
  •  in the situation where a child who has not been diagnosed as allergic, but who appears to be having an anaphylactic reaction:
    • Call an ambulance immediately by dialling 000
    • Commence first aid measures
    • Contact the parent/guardian
    • Contact the person to be notified in the event of illness if the parent/guardian cannot be contacted

Parents of children shall:

  • inform staff at the children’s service, either on enrolment or on diagnosis, of their child’s allergies
  • develop an anaphylaxis risk minimisation plan with service staff
  • provide staff with an anaphylaxis medical management action plan signed by the Registered Medical Practitioner giving written consent to use the auto-injection device in line with this action plan
  • provide staff with a complete auto-injection device kit
  • regularly check the adrenaline auto-injection device expiry date
  • assist staff by offering information and answering any questions regarding their child’s allergies
  • notify the staff of any changes to their child’s allergy status and provide a new anaphylaxis action plan in accordance with these changes
  • communicate all relevant information and concerns to staff, for example, any matter relating to the health of the child
  • comply with the service’s policy that no child who has been prescribed an adrenaline auto-injection device is permitted to attend the service or its programs without that device
  • comply with the procedures outlined in Schedule 1 of the model policy.

Related documents

Related documents at the service:

  • Enrolment checklist for children at risk of anaphylaxis (Schedule 2 of the model policy)
  • Risk Minimisation Plan (Schedule 3 of the model policy)
  • Brochure titled “Anaphylaxis – a life threatening reaction”, available through the Royal Children’s Hospital, Department of Allergy

Evaluation

The licensee shall:

  • discuss this policy and its implementation with parents/guardians of children at risk of anaphylaxis to gauge their satisfaction with both the policy and its implementation in relation to their child
  • respond to complaints and notify the Department within 48 hours (r.105)
  • review the adequacy of the response of the service if a child has an anaphylactic reaction and consider the need for additional training and other corrective action.

Schedule 1- Risk minimisation plan

The following procedures have been developed in consultation with the parent or guardian and implemented to help protect the child diagnosed at risk of anaphylaxis from accidental exposure to food allergens:

In relation to the child at risk:

  • This child should only eat food that has been specifically prepared for him/her
    • Where the service is preparing food for the child, ensure that it has been prepared according to the parent’s instructions
    • Some parents will choose to provide all food for their child
  • All food for this child should be checked and approved by the child’s parent/guardian and be in accordance with the risk minimisation plan
  • Bottles and or food  provided by the parents/guardians for this child should be clearly labelled with the child’s name
  • There should be no trading or sharing of food, food utensils and containers with this child
  • In some circumstances it may be appropriate that a highly allergic child does not sit at the same table when others consume food or drink containing or potentially containing the allergen.  However, children with allergies should not be separated from all children and should be socially included in all activities
  • Where this child is very young, provide his/her own high chair to minimise the risk of cross-contamination
  • When the child diagnosed at risk of anaphylaxis is allergic to milk, ensure non-allergic babies are held when they drink formula/milk
  • Increase supervision of this child on special occasions such as excursions, incursions or family days

In relation to other practices at the centre:

  • Ensure tables, high chairs and bench tops are washed down after eating
  • Ensure hand washing for all children before and after eating and, if the requirement is included in a particular child’s anaphylaxis medical management action plan, on arrival at the children’s service
  • Restrict use of food and food containers, boxes and packaging in crafts, cooking and science experiments, depending on the allergies of particular children
  • All children need to be closely supervised at meal and snack times and consume food in specified areas.  To minimise risk children should not ‘wander around’ the centre with food
  • The risk minimisation plan will inform the children’s service’s food purchases and menu planning
  • Food preparation personnel (staff and volunteers) should be instructed about measures necessary to prevent cross contamination between foods during the handling, preparation and serving of food – such as careful cleaning of food preparation areas and utensils
  • Where food is brought from home to the service, all parents/guardians will be asked not to send food containing specified allergens or ingredients as determined in the risk minimisation plan

Schedule 2 - Enrolment Check list for Children at Risk of Anaphylaxis

  • A risk minimisation plan is completed in consultation with the parent/guardian, which includes strategies to address the particular needs of each child at risk of anaphylaxis, and this plan is implemented.
  • Parents/guardians of a child diagnosed at risk of anaphylaxis have been provided a copy of the service’s Anaphylaxis management policy.
  • All parents/guardians are made aware of the Anaphylaxis management policy.
  • Anaphylaxis medical management action plan for the child is signed by the child’s  Registered Medical Practitioner and is visible to all staff. A copy of the anaphylaxis medical management action plan is included in the child’s auto-injection device kit.
  • Adrenaline auto-injection device (within expiry date) is available for use at any time the child is in the care of the service.
  • Adrenaline auto-injection device is stored in an insulated container (auto-injection device Kit), in a location easily accessible to adults (not locked away), inaccessible to children and away from direct sources of heat.
  • All staff, including relief staff, are aware of each auto-injection device kit location and the location of the anaphylaxis medical management action plan.
  • Staff who are responsible for the child/ren diagnosed at risk of anaphylaxis undertake accredited anaphylaxis management training, which includes strategies for anaphylaxis management, risk minimisation, recognition of allergic reactions, emergency treatment and practise with an auto-injection device trainer, and is reinforced yearly and recorded .
  • The service’s emergency action plan for the management of anaphylaxis is in place and all staff understand the plan.
  • Parent/guardian’s current contact details are available.
  • Information regarding any other medications or medical conditions (for example asthma) is available to staff.
  • If food is prepared at the service, measures are in place to prevent contamination of the food given to the child at risk of anaphylaxis.

Schedule 3 - Risk Minimisation Plan for Anaphylaxis

How well has the children’s service planned for meeting the needs of children with allergies who are at risk of anaphylaxis?

1. Who are the children?

Kai (Sunny) Ngan – Allunga Monday to Friday pms

Kai (Sunny) Ngan – kinder 3 Allunga Monday to Friday ams

Tyson Clarke – kinder 4 Tues and casual days

Isla Broster – Ballah Monday and Wednesday ad

2. What are they allergic to?

Kai (Sunny) Ngan : Nuts -  the centre is a nut free zone, ceased any recycled containers that have contained nuts ie cereal boxes

Tyson Clarke: Nuts and Eggs - the centre is a nut free zone, ceased any recycled containers that have contained nuts ie cereal boxes, the menu is planned to avoid eggs on the days Tyson attends. This is checked by the food forms that the kitchen receives daily indicating any allergies. Egg cartons are not used in the play rooms.

Isla Broster: Dairy – the kitchen make meals that reflect non dairy and if this is not possible the cook makes a specific meal.  Staff ensure Isla has direct supervision at meal and snack times.  Staff ensure children do not walk around with bottles, and when they are finished they are cleaned and put away.

3. Does everyone recognise the at risk children?

All children’s anaphylaxis plans are displayed in all playrooms, kitchen and staff room. These plans have a recent photo of the child.

Do families and staff know how the service manages the risk of anaphylaxis?

  • Record when each family of an at risk child is provided a copy of the service’s Anaphylaxis management policy.
  • Record when each family member provides a complete auto-injection device kit.
  • Test that all staff, including relief staff, know where the auto-injection device kit is kept for each at risk child.
  • Regular checks of the expiry date of each adrenaline auto-injection device are undertaken by a nominated staff member and the families of each at risk child.
  • Service writes to all families requesting that specific procedures be followed to minimise the risk of exposure to a known allergen.  This may include requesting the following are not sent to the service:
    • Food containing the major sources of allergens, or foods where transfer from one child to another is likely, for example peanut, nut products, whole egg, chocolate, sesame.
    • Food packaging of risk foods (see known allergens at point 2), for example cereal boxes, egg cartons and so on.
  • A new written request is sent to families if the food allergens change.
  • Ensure all families are aware of the policy that no child who has been prescribed an adrenaline auto-injection device is permitted to attend the service without that device.
  • The service displays the ASCIA generic poster, an action plan for anaphylaxis, in a key location and locates a completed emergency contact card by the telephone/s.
  • The auto-injection device kit including a copy of the anaphylaxis medical management action plan is carried by a staff member when a child is removed from the service eg excursions.

Do all staff know how the children’s service aims to minimise the risk of a child being exposed to an allergen?

  • Think about times when the child could potentially be exposed to allergens and develop appropriate strategies, including who is responsible for implementing them (See following section for possible exposure scenarios and strategies).
  • Menus are planned in conjunction with parents/guardians of at risk children:
    • Food for the at risk child is prepared according to their parents’/guardians’ instructions to avoid the inclusion of food allergens
    • As far as practical the food on the menu for all children should not contain ingredients such as milk, egg and peanut/nut or sesame products to which the child is at risk
    • The at risk child should not be given food if the label for the food states that the food may contain traces of a known allergen.
  • Hygiene procedures and practices are used to minimise the risk of contamination of surfaces, food utensils and containers by food allergens.
  • Consider the safest place for the at risk child to be served and consume food, while ensuring they are socially included in all activities, and ensure this location is used by the child.
  • Service develops procedures for ensuring that each at risk child only consumes food prepared specifically for him/her.
  • NO FOOD is introduced to a baby if the parent/guardian has not previously given this food to the baby.
  • Ensure each child enrolled at the service washes his/her hands before and after eating and on arrival if required as part of a particular child’s medical management plan.
  • Teaching strategies are used to raise awareness of all children about anaphylaxis and no food sharing with the at risk child/ren and the reasons for this.
  • Bottles and food containers provided by the family of the at risk child should be clearly labelled with the child’s name.

Do relevant people know what action to take if a child has an anaphylactic reaction?

  • Know what each child’s anaphylaxis medical management action plan says and implement it.
  • Know who will administer the auto-injection device and stay with the child; who will telephone the ambulance and the parents; who will ensure the supervision of the other children; who will let the ambulance officers into the service and take them to the child.
  • All staff with responsibilities for at risk children have undertaken anaphylaxis management training and undertake regular practise sessions for the administration of the auto-injection device.

How effective is the service’s risk minimisation plan?

  • Review the risk minimisation plan with families of at risk children at least annually, but always upon enrolment of each at risk child and after any incident or accidental exposure.

Possible exposure scenarios and strategies

Scenario

Strategy

Who

Food is provided by the children’s service and a food allergen is unable to be removed from the service’s menu (for example milk)

Menus are planned in conjunction with parents of at risk child/ren and food is prepared according to parents instructions.

Alternatively the parent provides all of the food for the at risk child.

Cook, Primary Nominee, Parent

 

 

Ensure separate storage of foods containing allergen

Licensee & Cook,

 

Cook and staff observe food handling, preparation and serving practices to minimise the risk of cross contamination.  This includes hygiene of surfaces in kitchen and children’s eating area, food utensils and containers.

Cook & Staff

 

There is a system in place to ensure the at risk child is served only the food prepared for him/her.

Cook, Staff

 

An at risk child is served and consumes their food at a place considered to pose a low risk of contamination from allergens from another child’s food.  This place is not separate from all children and allows social inclusion at mealtimes.

Staff

 

Children are regularly reminded of the importance of no food sharing with the at risk child.

Staff

 

Children are supervised during eating.

Staff

Party or celebration

Give plenty of notice to families about the event.

Primary Nominee

Qualified Staff

 

Ensure the at risk child only has the food approved by his/her parent/guardian.

Staff

Protection from insect sting allergies

Specify play areas that are lowest risk to the at risk child and encourage him/her and peers to play in the area.

Staff

 

Decrease the number of plants that attract bees.

Licensee

 

Ensure the at risk child wears shoes at all times outdoors.

Staff

 

Quickly manage any instance of insect infestation.  It may be appropriate to request exclusion of the at risk child during the period required to eradicate the insects.

Licensee

Latex allergies

Avoid contact with latex gloves.

Staff

Cooking with children

Ensure parents/ guardians of the at risk child are advised well in advance and included in the planning process.  Parents may prefer to provide the ingredients themselves.

Staff

Contact details for resources and support

  • Australasian Society of Clinical Immunology and Allergy (ASCIA), at www.allergy.org.au, provides information on allergies.  Their sample Anaphylaxis Action Plan can be downloaded from this site.  Contact details for Allergists may also be provided. 
  • Anaphylaxis Australia Inc, at www.allergyfacts.org.au, is a non-profit support organisation for families with food anaphylactic children.  Items such as storybooks, tapes, auto-injection device trainers and so on are available for sale from the Product Catalogue on this site.  Anaphylaxis Australia Inc provides a telephone support line for information and support to help manage anaphylaxis.  Telephone 1300 728 000.
  • Royal Children’s Hospital, Department of Allergy, at www.rch.org.au, provides information about allergies and the services provided by the hospital.  Contact may be made with the Department of Allergy to evaluate a child’s allergies and if necessary, provide an adrenaline auto-injection device prescription, as well as to purchase auto-injection device trainers.  Telephone (03) 9345 5701.
  • Royal Children’s Hospital Anaphylaxis Advisory Support Line provides information and support about anaphylaxis to school and licensed children’s services staff and parents. Telephone 1300 725 911.
  • Department of Education and Early Childhood Development website at www.education.vic.gov.au/anaphylaxis provides information related to anaphylaxis, including frequently asked questions related to anaphylaxis training.

Training

  • Access the Department of Education and Early Childhood Development website for information about free training for staff members in services where there is a child diagnosed at risk of anaphylaxis enrolled at:
    www.education.vic.gov.au/anaphylaxis .
  • There are a range of providers offering anaphylaxis training, including Royal Children’s Hospital Department of Allergy, first aid providers and Registered Training Organisations.  Ensure that where there is a child diagnosed at risk of anaphylaxis enrolled in the service the anaphylaxis management training undertaken is accredited.

Source

www.education.vic.gov.au/anaphylaxis

Revised May 2010, Published by the Victorian Government Department Education and Early Childhood Development, Melbourne, Victoria, Australia 


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