This procedure outlines the steps to care for students with anaphylaxis, ensuring their safety through prompt and appropriate actions. It includes the use of a state standing order for stocked epinephrine to manage severe allergic reactions effectively.

Parent/Guardian Responsibility

• Prior to enrolling a student, the parent/guardian will inform the school of the medically diagnosed allergy(ies) and risk of anaphylaxis and reach out to the school nurse.
• It is the parent/guardian's responsibility to provide a health provider signed medication authorization form, dietary prescription form, and emergency medication.
• Parents/guardians are responsible for notifying the school if the student’s condition changes and for providing health provider’s letter stating so.
• The district recommends that a medical alert bracelet is always worn by the student.

Nursing Responsibility

• Provide a written emergency plan that will identify the student’s allergies, symptoms of exposure, practical strategies to minimize the risks and how to respond in an emergency.
• The school nurse connects with the parent/guardian prior to and/or by the first day of attendance to develop an emergency care plan and review the medication authorization form and dietary prescription form.
• If the treatment plan includes self-administration of medications, the parents, students and staff will comply with procedure 3419, Self-Administration of Asthma and Anaphylaxis Medication.
• The care plan will be distributed to appropriate staff in the school building that will be interacting with the student.

Annually and/or by the first day of attendance, the student health file will contain:

1. A completed nursing care plan.
2. A written description of the treatment order, signed by a licensed health care provider.
3. An adequate and non-expired supply  of emergency medication.

If any of these are not complete, the student shall be excluded from school immediately and may return only once they have all been provided to and approved by the school nurse.

Staff Training

• Annually, each school principal will ensure that anaphylaxis training is completed through Vector Training and/or in a staff meeting. This training will cover how to minimize exposure to allergens, recognize symptoms of anaphylaxis, follow emergency protocols during an anaphylactic episode, and administer emergency epinephrine.
• Additional student-specific training and additional information may be provided by the school nurse to teachers, teacher assistants, clerical staff, food service workers and bus drivers who will have known contact with students diagnosed with anaphylaxis.

Controlling the Exposure to Allergens

• The district will take reasonable precautions to reduce the risk of students with a history of anaphylaxis coming into contact with their allergen(s).

• The district will discourage the sharing of food, utensils and containers.

• The schools will follow the recommended guidelines found in the most current OSPI Guidelines for the Care of Students with Anaphylaxis

STANDING ORDER PROTOCOL:  
The following Standing Order Protocol will be utilized for the administration of stock epinephrine in the event of a serious adverse allergic reaction, including anaphylaxis. For students displaying the symptoms of a life-threatening allergic reaction (anaphylaxis), activate Emergency Medical Services (EMS) by calling or directing a bystander to call 911.  

Student with a prescription for an epinephrine autoinjector for a previously diagnosed life-threatening allergy:  
The school nurse may administer epinephrine or an epinephrine autoinjector or designated trained school personnel may administer an epinephrine autoinjector to a student who has symptoms or reports exposure or is suspected of exposure according to:

• Medication Authorization Order

• The student’s established health plan

Student without a prescription for an epinephrine autoinjector:

If a school nurse is available, using reasonable and prudent professional judgment, they may determine that an individual is displaying the symptoms of anaphylaxis and may administer the school’s supply of stock epinephrine or epinephrine autoinjector.  
The school nurse will ask or estimate the individual’s body weight and administer:

• 0.1mg epinephrine IM in lateral thigh for a body weight 16.5 - <33 lbs.
• 0.15mg epinephrine IM in lateral thigh for body weight less than 33 - <66 lbs.
• 0.3mg epinephrine IM in lateral thigh for body weight greater than >66 lbs.

The school nurse may refer to this information on recognizing and responding to anaphylaxis.

For all individuals displaying the symptoms of a life-threatening allergic reaction (anaphylaxis):

1. Activate Emergency Medical Services (EMS) by calling or directing a bystander to call 911.
2. Administer emergency medication:
   • Known anaphylaxis by any trained staff member.
   • Unknown anaphylaxis- School nurse may administer stock epinephrine.
3. Contact the student’s parent/guardian.
4. If epinephrine is administered, note the time and anatomical site (location on body) of injection and report the information to emergency services personnel.
5. Closely monitor the individual until EMS arrives, do not leave the person alone:
   • Keep the person in a supine or recovery position unless they are having difficulty breathing or are vomiting.
   • If the person is vomiting, turn them onto their side.
   • If they are having difficulty breathing, the head may be elevated, provided blood pressure is adequate to prevent loss of consciousness.
   • If they lose consciousness, check if they are breathing and have a pulse. If not, begin CPR (cardiopulmonary resuscitation), call out for help, and continue CPR until the individual regains a pulse and is breathing or until EMS arrives and takes over.
   • The school nurse (if present) will monitor vital signs every 5-10 minutes until EMS arrives.
6. When EMS arrives:
   • Inform them of the symptoms, and any change in the symptoms.
   • Inform them of the time and anatomical site of any epinephrine administered and give them the used autoinjector.
7. If the individual is not transported by EMS, refer the individual to a licensed health care provider for medical evaluation, even if symptoms are resolved completely. Symptoms may recur after the epinephrine wears off, as much as 24 hours later.
8. Document the event in student’s health record.
9. Fill out the student injury report form.
10. Notify health services of the incident and request a new stock autoinjector, if stock supply is used.
11. Notify the student’s licensed health care provider (if known) of the anaphylactic reaction.

The student without a previous prescription for epinephrine on file must present emergency medication and a medication authorization form from a licensed health care provider on or before their return date to school. Students with a prior prescription and used supplied medication must provide a new supply on or before their return to school.

Management of stock epinephrine and epinephrine autoinjectors:  

• Epinephrine is light sensitive and should be stored in the outer case provided to protect it from light.  
• Store at 20°-25°C (68°-77°F), do not refrigerate.  
• Before using it, check to make sure the solution in the autoinjector is clear and colorless. 
• School staff should ensure that stock epinephrine and stock epinephrine autoinjectors are not expired. 
• Dispose of expired unused epinephrine consistent with current school medication procedure. 

In every case when epinephrine is administered, emergency medical services (EMS) must be activated!

References:

• RCW 28A.210.320 Children with life-threatening health conditions-Medication or treatment orders-Rules. 
• RCW 28A.210.383-Epinephrine and epinephrine autoinjectors (EPI pens) School supply—Use. 
• Washington State Department of Health 348-1049 August 2024 
• Washington Office of Superintendent of Public Instruction-Guidelines of Care of Students with Anaphylaxis

Washington Office of Superintendent of Public Instruction-Guidelines of Care of Students with Anaphylaxis.

Highline School District 401
Approved by the Superintendent: May 15, 2012, 04.25