For students with a medically diagnosed life-threatening allergy (anaphylaxis), the district will take appropriate steps for the student’s safety, including implementing a nursing care plan. The district will utilize the Guidelines for the Care of Students with Anaphylaxis published by the Office of the Superintendent of Public Instruction.
Prior to enrolling a student, the parent/guardian will inform the school in writing of the medically diagnosed allergy(ies) and risk of anaphylaxis. School districts will develop a process to identify students at risk for life-threatening allergies and to report this information to the school nurse. Upon receiving the diagnosis, school staff will contact the parent/guardian to develop a nursing care plan. A nursing care plan will be developed for each student with a medically diagnosed life-threatening allergy.
Nursing Care Plan
The written plan will identify the student’s allergies, symptoms of exposure, practical strategies to minimize the risks and how to respond in an emergency.
The principal or designee (school nurse) may arrange for a consultation with the parent/guardian prior to the first day of attendance to develop and discuss the nursing care plan. The plan will be developed by the parent, school nurse and appropriate school staff. If the treatment plan includes self-administration of medications, the parents, students and staff will comply with model policy and procedure 3419, Self-Administration of Asthma and Anaphylaxis Medication.
Annually and prior to the first day of attendance, the student health file will contain: 1) a current, completed nursing care plan; 2) a written description of the treatment order, signed by a licensed health care provider; and 3) an adequate and current supply of auto-injectors (or other medications). The school will also recommend to the parents that a medical alert bracelet be worn by the student at all times. The parents/guardians are responsible for notifying the school if the student’s condition changes and for providing the medical treatment order, appropriate auto-injectors and/or other medications as ordered by the prescriber.
Students who have a medically diagnosed life-threatening allergy and no medication or treatment order presented to the school will be excluded from school to the extent that the district can do so consistent with federal requirements for students with disabilities under the Individuals with Disabilities Act and Section 504 of the Rehabilitation Act of 1973, and pursuant to the following due process requirements:
- Written notice to the parents, guardians or persons in loco parentis is delivered in person or by certified mail;
- Notice of the applicable laws, including a copy of the laws and rules; and
- The order that the student will be excluded from school immediately and until medications and a treatment order are presented.
Communications Plan and Responsibility of School Staff
After the nursing care plan is developed, the school principal or a designee will inform appropriate staff regarding the affected student. The school nurse (registered nurse) will train appropriate staff regarding the affected student and the nursing care plan. The plan will be distributed to appropriate staff and placed in appropriate locations in the district (class room, office, school bus, lunchroom, near playground, etc.). With the permission of parents/guardian and the student, (if appropriate), other students and parents may be given information about anaphylaxis to support the student’s safety and to control exposure to allergens.
All School Staff Training
Annually, each school principal will work with the school nurse to provide an in-service training on how to minimize exposure and how to respond to an anaphylaxis emergency. The training will include a review of avoidance strategies, recognition of symptoms, the emergency protocols to respond to an anaphylaxis episode (calling 911/EMS when symptoms of anaphylaxis are first observed) and hands-on training in the use of an autoinjector. Training should also include notifications that more than one dose may be necessary in a prolonged anaphylaxis event.
Student-specific training and additional information will be provided (by the school nurse) to teachers, teacher’s assistants, clerical staff, food service workers and bus drivers who will have known contact with a diagnosed student.
Annually, before the start of the school year and/or before the student attends school for the first time, the school nurse will provide student-specific training and additional information to teachers, teacher’s assistants, clerical staff, food service workers and bus drivers who will have known contact with a diagnosed student and are implementing the nursing care plan.
Controlling the Exposure to Allergens
Controlling the exposure to allergens requires the cooperation of parents, students, the health care community, school employees and the board. The district will inform parents of the presence of a student with life threatening allergies in their child’s classroom and/or school and the measures being taken to protect the affected student. Parents will be asked to cooperate and limit the allergen in school lunches and snacks or other products. The district will discourage the sharing of food, utensils and containers. The district will take other precautions such as avoiding the use of party balloons or contact with latex gloves. Additionally, play areas will be specified that are lowest risk for the affected student.
The district will also identify high-risk events and areas for students with life-threatening allergies, such as foods and beverages brought to school for seasonal events as well as school equipment and curricular materials used by large numbers of students (play-dough, stuffed toys, science projects, etc.) and will implement appropriate accommodations.
During school-sponsored activities, appropriate supervisors, staff and parents will be made aware of the identity of the student with life-threatening allergies, the allergens, symptoms and treatment. The lead teacher will ensure that the auto-injector is brought on field trips.
Undesignated Epinephrine Autoinjectors
District Prescription and Standing Order Protocol
The district will maintain a supply of undesignated epinephrine autoinjectors that will be prescribed in the name of the district by a licensed health professional with the authority to prescribe epinephrine autoinjectors. The district prescription is valid for one year only and will be renewed prior to the start of each school year. Each prescription must be accompanied by a standing order for the administration of school-supplied epinephrine autoinjectors for potentially life-threatening allergic reactions. The standing order protocol should include specific symptoms of anaphylaxis, the dose of medication and directions to summon emergency medical services (EMS 911) upon observance of symptoms of anaphylaxis. Parent/guardian notification should occur as soon as possible after EMS is notified.
The district will obtain epinephrine autoinjectors directly from an appropriate practitioner, pharmacist, medical facility, drug manufacturer or drug wholesaler. All epinephrine autoinjectors must be accompanied by a prescription.
School staff will comply with all manufacturer’s instructions as to storage, maintenance, expiration and disposal of epinephrine autoinjectors. School staff will also comply with district medication policy and procedures related to safe, secure management of medications.
Epinephrine autoinjectors may be used on all school property, including buildings, playgrounds and school buses. For school-sponsored events and field trips, the school nurse or designated trained school personnel may carry an appropriate supply of school-supplied epinephrine autoinjectors. This does not negate the need to carry the supply of epinephrine autoinjectors belonging to students with known anaphylaxis.
In the event a student without a current prescription on file with the school or a student with undiagnosed anaphylaxis experiences an anaphylactic event, the school nurse may utilize the school supply of epinephrine to respond under the standing order protocol.
In the event a student with a current prescription for an epinephrine autoinjector on file at the school experiences an anaphylactic event, the school nurse or designated trained school personnel may use the school supply of epinephrine autoinjectors to respond if the student’s supply is not immediately available.
The district will maintain all practices regarding prescriptions and self-medication for children with existing epinephrine autoinjector prescriptions and/or a guided anaphylaxis care plan. Parents of students with identified life-threatening allergies must continue to provide the school with appropriate medication and treatment orders pursuant to RCW 28A.210.320, Life-Threatening Conditions.
School employees (except licensed nurses) who have not previously agreed in writing to the use of epinephrine autoinjectors as part of their job description may file a written letter of refusal to administer epinephrine autoinjectors with the districts. The employee’s refusal may not serve as grounds for discharge, non-renewal or other action adversely affecting the employee’s contract status.
If the school employee or school nurse who administers epinephrine by autoinjector to a student substantially complies with the student’s prescription (that has been prescribed by a licensed health professional within the scope of the professional’s prescriptive authority) and the district’s policy on anaphylaxis prevention and response, the employee, nurse, district, superintendent and board are not liable for any criminal action or civil damages that result from the administration.