Epinephrine Auto-Injector for Anaphylaxis School Training This - - PowerPoint PPT Presentation

Epinephrine Auto-Injector for Anaphylaxis School Training

This presentation meets training criteria for school staff. Upon completion on the Western Region Public Health Training Center site, you will receive a certificate.

This presentation has been developed by the following collaborators to assist in teaching school staff about anaphylaxis and auto-injector epinephrine.

Natalia Billias

Health Service Administration MPH Candidate, University of Arizona Mel & Enid Zuckerman College of Public Health Senior Research Specialist, University of Arizona Asthma & Airway Disease Research Center

• Dr. Heather Cassell

Clinical Associate Professor, University of Arizona College of Medicine Pediatric Allergy & Immunology, Banner University Medical Center Principal Investigator, University of Arizona Asthma & Airway Disease Research Center

• Dr. Lynn Gerald

Professor, University of Arizona Mel & Enid Zuckerman College of Public Health Canyon Ranch Endowed Chair Director, Clinical Research, University of Arizona Asthma and Airway Disease Research Center Presentation is in collaboration with the following organizations:

Introduction

Course Summary Increasing preparedness and confidence of school personnel to take proper action with their stock epinephrine when an event of anaphylaxis occurs. Learning Objectives – Recognizing Anaphylaxis – Identifying Symptoms – Administering Epinephrine – School Action Steps:

• Following an Event
• Year Round for Annual Training &

Maintenance of Stock Epinephrine

Policy Review

• Arizona Revised Statute

§ 15-341, A, 35 (a)

– Permits pupils who have been diagnosed with anaphylaxis by a licensed health care provider to carry and self-administer emergency medications, including auto-injectable epinephrine, while at school and at school-sponsored activities.

• Arizona Revised Statute § 15-157

Arizona Administrative Code R7-2-809

– Directs public school districts and charter schools to stock epinephrine by auto-injectors

• 2 pediatric doses and 2 adult doses
• Based on funding provided by the legislature

– In addition to school nurses or athletic trainers, at each school there should be at least 2 other personnel trained in giving auto-injector epinephrine to children or adults who are showing symptoms of anaphylaxis.

• Please note that authorized personnel are immune from civil liability with respect

to all decisions made and actions taken that are based on good faith implementation of the requirements of ARS § 15-157, except in cases of wanton or willful neglect.

R7-2-809, 2018.

Agenda

Lesson 1: Anaphylaxis Basics Lesson 2: Recognizing Anaphylaxis Lesson 3: Administering Epinephrine Lesson 4: School Action Steps

ANAPHYLAXIS BASICS

• Definition
• Causes
• Significance
• Prevention & Treatment

What is Anaphylaxis?

Anaphylaxis is a severe, life-threatening allergic reaction that is rapid in

• nset and requires immediate response and medical attention.

Symptoms may include: The most dangerous symptoms of anaphylaxis include breathing difficulties and a drop in blood pressure or shock that are potentially fatal.

Anaphylaxis & Treating Severe Allergic Reactions, 2018.

What causes Anaphylaxis?

Anaphylaxis & Treating Severe Allergic Reactions, 2018.

Why this is important?

Millions are constantly at risk Anaphylaxis can happen anywhere Only epinephrine can stop it

FARE, 2018.

Food allergy is the most common cause of anaphylaxis

Food Allergy Facts (FARE’s Facts and Statistics, 2018) U.S. Statistics (FARE’s Facts and Statistics, 2018)

• 15 million Americans diagnosed with a known

food allergy, including 5.9 million children under 18 years old

• About 1 in 13 children have a food allergy, that is

roughly about two in every classroom.

• Even ingesting a tiny amount of the food

allergen may cause anaphylaxis

• Anaphylaxis may occur immediately

after, or even up to 4 hours after ingestion

• Teenagers and young adults with allergies

are at the highest risk of fatal food- induced anaphylaxis

• Not treating anaphylaxis promptly with

epinephrine increases the risk of a fatal reaction.

Why this is important?

U.S. Statistics on Anaphylaxis

• Every three minutes, a food allergy reaction sends someone to the emergency room (FARE’s Facts and

Statistics, 2018)

• More than 15 % of school-aged children with food allergies have had a reaction in school (FARE’s Facts

and Statistics, 2018)

• Approximately 20-25 % of epinephrine administrations are in schools (Neighbors, 2018)
• Peanut caused about 45 % of food-induced anaphylaxis admissions to PICUs,
• followed by tree nuts and seeds (19 %) and milk (10 %) (Ramsey et al., 2018)

Anaphylaxis is serious, but may be prevented and treated!

Common Food Allergens

Anaphylaxis & Treating Severe Allergic Reactions, 2018.

Other foods can also cause

• anaphylaxis. Please refer to the

individual’s food allergy action plan for complete information.

Prevention & Treatment

Prevention

• Avoidance of known allergen,

however, when an accidental exposure occurs, you will be able to properly treat anaphylaxis after completing this training.

– This training is available to you, because knowing that you are prepared for an emergency will give you peace of mind.

Treatment

• Epinephrine Auto-Injector

– By making sure you are have all of the information you need and practicing with the training device, you will be well-prepared to use the auto-injector when anaphylaxis occurs.

Treatment continued…

Available Epinephrine Auto-Injectors

Side effects:

• Increase heart rate
• Paleness
• Perspiration
• Tremor
• Headache
• Nausea

Doses:

• Junior (0.15 mg) for

children weighing 33 to 66 lbs

• Adult (0.3 mg) for

adults and children weighing 66 lbs or more

Anaphylaxis & Treating Severe Allergic Reactions, 2018.

*Please note that other foods can also cause anaphylaxis. Please refer to the individual’s food allergy action plan for complete information

New Auto-Injector available for 2019 from Teva Generics

This additional section is available at no cost on the Western Region Public Health Training Center website: https://moodle.publichealth.arizona.edu/. After creating an account, type in the course title Epinephrine Auto-Injector for Anaphylaxis School Training on the search bar to directly access this course.

Administering Epinephrine

• What to do if someone is

having an anaphylactic reaction?

• Epinephrine Auto-Injector

Instructions

• Epinephrine Auto-Injector

Demonstration Videos

• How to hold a child for

administration

This additional section is available at no cost on the Western Region Public Health Training Center website: https://moodle.publichealth.arizona.edu/. After creating an account, type in the course title Epinephrine Auto-Injector for Anaphylaxis School

School Supply

Standing orders include directive and serve as a prescription.

• Use up-to-date standing
• rders
• Click here to obtain the

template for Standing Orders for Auto-Injectable Epinephrine in a School Setting

• Purchase from pharmacy or

pharmaceutical company.

• Prescription for epinephrine

will need to be renewed annually or when signature changes.

• Send pharmacy copy of newly

signed order, or physician can call in a verbal renewal order.

Karen Kasmauski for The New York Times [Photograph]. Retrieved from https://nyti.ms/2Gany3A

Maintenance

Storage

• Stored in a secure, unlocked, easily accessible location at school

district and charter schools.

• A list of the people authorized to administer auto-injectable

epinephrine stored next to the school’s supply auto-injectable epinephrine.

– The list should also be maintained in the school’s administrative offices and made available upon request.

• Store at room temperature between temperatures of 68°-77° F. (with

an acceptable range of 59°-86° F).

– Do not refrigerate auto-injectable epinephrine. – Keep epinephrine auto-injectors protected from excessive heat or cold. – The auto-injectors should be covered and protected from light.

AAAAI, FARE, & Neighbors, 2018

Maintenance continued..

Storage

• Each school should document monthly that they have checked to ensure the

following:

– auto-injector epinephrine is being properly stored, – epinephrine solution is clear, – no particles in the solution, and – expiration date has not been passed. Please note that the auto-injector should be replaced:

• Before its expiration date
• If the solution is discolored or if it contains a precipitate

Disposal

• Give the used auto-injectors to emergency response personnel with the time and

date that they were used and the patient’s name written on the injector.

• Do not discard auto-injectors into regular trash. Contact local waste management
• n proper disposal instructions.

Sample Maintenance Log

Month & Year Auto-Injector’s Brand and Lot # Dose Expiration Date Condition (Good,

Not Clear, Precipitate, Temp Excursion, Light Exposure, or Disposed)

Stored Room # Initial & Date

• f Recorder

December 2018 Generic, Lot # 1 0.3 mg May 2019 Not clear 2346 LA 12/21/2018 Generic, Lot # 2 0.3 mg May 2019 Good 2346 LA 12/21/2018 Generic, Lot # 3 0.15 mg May 2019 Good 2346 LA 12/21/2018 Generic, Lot # 4 0.15 mg May 2019 Disposed 2346 LA 12/21/2018 List of Authorized Personnel for the past month of December, 2018:

• Sally Joe, Susan Espinoza, Maria Lourdes Almada, Alejandra Calles, Elizabeth Smith

List of Authorized Personnel for the upcoming month of January, 2019:

• Sally Joe, Susan Espinoza, Maria Lourdes Almada, Alejandra Calles

Any anaphylaxis events for the past month of December, 2018? If yes, please report dates, used epinephrine auto-injector lot #, and administrator’s name.

• Yes, Lot # 4 on 12/14/2018, Alejandra Calles

Any replacements required? If yes, please include reason and submit order. Yes 1) Lot # 4 administered on 12/14/2018, need replacement to meet minimum stock requirement of 2 auto-injectors for each dose. 2) Lot # 1 solution was not clear, need replacement.

School’s Name

Post Event Evaluation

School’s Documentation

• Document the following:

– Time and dose of epinephrine given – Describe symptoms before & after epinephrine – Write names of people involved in giving epinephrine and in caring for person

• Notify

– School administrators – School health office – Parents/guardians/family member – Physician who signed standing

• rders

Arizona Department of Health Services

• Send Report to AZDHS

Bureau of Emergency Services, including:

– Name and location of school – Name of individual who was injected – Age of the individual injected – Incident date and time – Name of individual that administered the injection. – Number of doses of epinephrine given – Reasons for giving epinephrine – Describe any problems with giving epinephrine – Time 911 was called

Sicherer & Mahr, 2010 Arizona Department of Health Services, 2018

Post Event Evaluation

Arizona Department of Health Services

• Send Report to ADHS

Bureau of Emergency Services, including:

– Name and location of school – Name of individual who was injected – Age of the individual injected – Incident date and time – Name of individual that administered the injection. – Number of doses of epinephrine given – Reasons for giving epinephrine – Describe any problems with giving epinephrine – Time 911 was called

Link for ADHS reporting http://www.azdhs.gov/audiences/index.p hp#schools-home Questions about reporting ADHS Bureau of Emergency Services (602) 364-3275 Noreen.adlin@azdhs.gov

Arizona Department of Health Services, 2018

Authorized personnel are immune from civil liability with respect to all decisions made and actions taken that are based on good faith implementation of the requirements of ARS § 15-157, except in cases of wanton or willful neglect.

ALL STAFF NEEDS ANNUAL TRAINING BY REGULATED HEALTH PROFESSIONAL

R7-2-809, 2018.

Please note that all content in this training were approved by a licensed allergist. Per the Arizona Board of Education, this training meets the minimum standard required to teach school staff about anaphylaxis and auto-injector epinephrine.

Direct Links to Resources

Food Allergy Research & Education (FARE)

• Additional training at https://bit.ly/2E0kiVBAZDHS

Emergency Use of Epinephrine in Schools

– Protocol for Emergency Administration of Epinephrine in School – School Training Presentation for Use of Epinephrine Auto- Injector for Anaphylaxis – Template for Standing Orders for Auto-Injectable Epinephrine in a School Setting (word) – Report Form for School Emergency Administration of Auto- Injectable Epinephrine (word)

References

American Academy of Allergy, Asthma, & Immunology. www.aaaai.org.

• Anaphylaxis. (2018). Retrieved from https://www.foodallergy.org/life-with-food-allergies/anaphylaxis.

Arizona Department of Health Services. (2018). Retrieved from https://azdhs.gov/audiences/index.php#schools-home. Facts and Statistics. (2018). Retrieved from https://www.foodallergy.org/life-with-food-allergies/food-allergy-101/facts-and-statistics How to hold your child like an Epi-Pen Ninja. (2015, November 19). Retrieved from http://foodallergyninja.com/?p=727 Neighbors, K. C. (2018). Effectiveness of Implementing a Defined Food Allergy Management Plan in the Public School Setting. Journal of Allergy and Clinical Immunology,141(2). doi:10.1016/j.jaci.2017.12.511. Ramsey, N. B., Guffey, D., Coleman, N. E., & Davis, C. M. (2018). Characteristics, morbidity, and mortality of anaphylaxis-associated admissions to North American PICUs, 2010-2015. Journal of Allergy and Clinical Immunology,141(2). doi:10.1016/j.jaci.2017.12.473 R7-2-809. Emergency Administration of Auto-Injectable Epinephrine. (2018). Retrieved from http://www.azed.gov/state-board-education/files/2014/01/r7-2-809- epinephrine.pdf. Sicherer, S. H., & Mahr, T. (2010). Management of Food Allergy in the School Setting. Pediatrics,126(6), 1232-1239. doi:10.1542/peds.2010-2575. Treating Severe Allergic Reactions. (2018). Retrieved from https://www.foodallergy.org/life-with-food-allergies/epinephrine/treating-severe-allergic-reactions.