Anaphylaxis Management Policy (QA2) ✅

Woodlands - Anaphylaxis Management Policy 

Anaphylaxis is a severe and sometimes sudden allergic reaction that is potentially life-threatening. It can occur when a person is exposed to an allergen (such as food or an insect sting). Reactions usually begin within minutes of exposure and can progress rapidly over a period of up to two hours or more. Anaphylaxis should always be treated as a medical emergency, requiring immediate treatment. Most cases of anaphylaxis occur after a person is exposed to the allergen to which they are allergic, usually a food, insect sting, or medication. 

National Quality Standard (NQS)

Quality Area 2: Children’s Health and Safety
2.1.1	Wellbeing and comfort	Each child’s wellbeing and comfort is provided for, including appropriate opportunities to meet each child’s needs for sleep, rest and relaxation
2.1.2	Health practices and procedures	Effective illness and injury management and hygiene practices are promoted and implemented.
2.2	Safety	Each child is protected
2.2.1	Supervision	At all times, reasonable precautions and adequate supervision ensure children are protected from harm and hazard
2.2.2	Incident and emergency management	Plans to effectively manage incidents and emergencies are developed in consultation with relevant authorities, practiced and implemented

Education and Care Services National Regulations

Children (Education and Care Services) National Law NSW
90	Medical conditions policy
90(1)(iv)	Medical Conditions Communication Plan
91	Medical conditions policy to be provided to parents
92	Medication record
93	Administration of medication
94	Exception to authorisation requirement—anaphylaxis or asthma emergency
95	Procedure for administration of medication
96	Self-administration of medication

Related Policies

• Administration of First aid Policy
• Incident, Illness, Accident, Trauma Policy 
• Medical Conditions Policy 
• Supervision Policy

Purpose

We aim to minimise the risk of an anaphylactic reaction occurring at our Service by ensuring all staff members are adequately trained to respond appropriately and competently to an anaphylactic reaction.  

Scope

This policy applies to children, families, staff, management, and visitors of the Service.

Duty Of Care

Woodlands has a legal responsibility to provide:

• A safe environment for children
• Adequate Supervision of children

 Our focus is on keeping children safe. Staff members including relief staff need to be aware of children at the Service who suffer from allergies that may cause an anaphylactic reaction.

Background

The most common allergens in children are:

• Peanuts
• Eggs
• Tree nuts (e.g. cashews)
• Cow’s milk
• Fish and shellfish
• Wheat
• Soy
• Sesame 
• Certain insect stings (particularly bee stings)

The key to the prevention of anaphylaxis within the Services is knowledge of those children who have been diagnosed as at risk, awareness of allergens, and prevention of exposure to those allergens. Communication between the Service and families is vital in helping children avoid exposure.

 Adrenaline given through an adrenaline autoinjector (such as an EpiPen®) into the muscle of the outer mid-thigh is the most effective first aid treatment for anaphylaxis. 

Implementation

We will involve all educators, families, and children in regular discussions about medical conditions and general health and wellbeing throughout our curriculum. The Service will adhere to privacy and confidentiality procedures when dealing with individual health needs, this includes having families sign a permission form to display the child’s action plan in prominent positions within the Service. 

A copy of all medical conditions policies will be provided to all educators and volunteers and families of the Service. It is important that communication is open between families and educators to ensure appropriate management of anaphylactic reactions are effective.

It is imperative that all educators and volunteers at the Service follow a child’s Medical Management Plan in the event of an incident related to a child’s specific health care need, allergy, or medical condition. 

Management, Nominated Supervisor/ Responsible Person will ensure:

• That all staff members have completed first aid and anaphylaxis management training approved by the Education and Care Services National Regulations at least every 3 years and are recorded, with each staff members’ certificate held on the Service’s premises.
• That all staff members, whether or not they have a child diagnosed at risk of anaphylaxis undertakes training in the administration of the adrenaline auto-injection device and cardiopulmonary resuscitation every 12 months, recording this in the staff records.
• That all staff members are aware of symptoms of an anaphylactic reaction, the child at risk of anaphylaxis, the child’s allergies, anaphylaxis action plan, and EpiPen kit.  
• That a copy of this policy is provided and reviewed during each new staff member’s induction process. 
• A copy of this policy will be provided to a parent or guardian of each child diagnosed at risk of anaphylaxis at the Service.
• Updated information, resources, and support are regularly given to families for managing allergies and anaphylaxis.
• They remain up to date with changes to action plans
• The Service receives an up to date copy of the action plan every 12 to 18 months or if changes have occurred to the child’s diagnosis. 

In Services where a child diagnosed at risk of anaphylaxis is enrolled the Nominated Supervisor shall also:

•  Conduct an assessment of the potential for accidental exposure to allergens while child/children 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/children.
• Ensure that no child who has been prescribed an adrenaline auto-injection device is permitted to attend the Service without the device.
•  Display an Australasian Society of Clinical Immunology and Allergy Inc. (ASCIA) generic poster called Action Plan for Anaphylaxis for each child with a diagnosed risk of anaphylaxis, in key locations at the Service, for example, in the children’s room, the staff room or near the medication cabinet.
• 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 responsible for the preparation of food are trained in managing the provision of meals for a child with allergies, including high levels of care in preventing cross-contamination during storage, handling, preparation, and serving of food. Training will also be given in planning appropriate menus including identifying written and hidden sources of food allergens on food labels.
• Ensure that a notice is displayed prominently in the main entrance of the Service stating that a child diagnosed at risk of anaphylaxis is being cared for or educated at the Service.
• Ensure that all relief staff members in the Service have completed training in the administration of anaphylaxis management including the administration of an adrenaline auto-injection device, awareness of the symptoms of an anaphylactic reaction, the child at risk of anaphylaxis, the child’s allergies, the individual anaphylaxis medical management action plan and the location of the auto-injection device kit.
• 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 Emergency contact card by the telephone.
• 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 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.

Educators will:

• Ensure a copy of the child’s anaphylaxis medical management action plan is visible and known to staff in the Service.
• Follow the child’s anaphylaxis medical management action plan in the event of an allergic reaction, which may progress to anaphylaxis.
• Practice the administration procedures of the adrenaline auto-injection device using an auto-injection device trainer and ‘anaphylaxis scenarios’ on a regular basis, preferably quarterly.
• Ensure the child at risk of anaphylaxis will only eat food that has been prepared according to the parent's or guardian's instructions. 
• Ensure tables and benchtops are washed down effectively after eating. 
• Ensure handwashing for all children upon arrival at the Service and before and after eating.
• Increase supervision of a child at risk of anaphylaxis on special occasions such as excursions, incursions, parties, and family days.
• Ask all parents/guardians as part of the enrolment procedure, prior to their child’s attendance at the Service, whether the child has allergies and document this information on the child’s enrolment record. If the child has severe allergies, ask the parents/guardians to provide a medical management action plan signed by a Registered Medical Practitioner.
• Ensure that an anaphylaxis medical management action plan signed by the child’s Registered Medical Practitioner and a complete auto-injection device kit (which must contain a copy the child’s anaphylaxis medical management action plan) is provided by the parent/guardian for the child while at the Service and kept up to date. 
• 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 auto-injection device kit containing a copy of the anaphylaxis medical management action plan for each child at risk of anaphylaxis is carried by a staff member accompanying the child when the child is removed from the Service e.g. on excursions that this child attends.
• Regularly check and record 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) 
• Provide information to the Service community about resources and support for managing allergies and anaphylaxis.
• In the event where a child who has not been diagnosed as allergic, but who appears to be having an anaphylactic reaction:

1. Call an ambulance immediately by dialing 000
2. Commence first aid measures
3. Contact the parent/guardian when practicable
4. Contact the emergency contact if the parents or guardian cannot be contacted when practicable
5. Notify the regulatory authority within 24 hours
6.  

 In the event that a child suffers from an anaphylactic reaction, the Service and staff will:

• Follow the child’s anaphylaxis action plan.
• Call an ambulance immediately by dialing 000
• Commence first aid measures
• Contact the parent/guardian when practicable
• Contact the emergency contact if the parents or guardian can’t be contacted when practicable
• Notify the regulatory authority within 24 hours

Families will: 

•  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
• Read and be familiar with the policy
• Identify and liaise with the nominated staff member
• Bring relevant issues to the attention of both staff and licensee
• Provide an updated action plan every 12-18 months or if changes have been made to the child’s diagnosis. 

Educating Children 

• Educators will talk to children about foods that are safe and unsafe for the anaphylactic child. They will use terms such as ‘this food will make ______ sick’, ‘this food is not good for _____’, and ‘ _____ is allergic to that food’.
• Staff will talk about symptoms of allergic reactions to children (e.g. itchy, furry, scratchy, hot, funny).
• With older children, staff will talk about strategies to avoid exposure to unsafe foods, such as taking their own plate and utensils, having the first serve from commercially safe foods, and not eating food that is shared.
• Child care staff will include information and discussions about food allergies in the programs they develop for the children, to help children understand about food allergy and encourage empathy, acceptance, and inclusion of the allergic child.
• We recommend reading stories to the children, asking questions to retain their new knowledge 

Reporting Procedures

• After each emergency situation, the following will need to be carried out:
• Staff members involved in the situation are to complete an Incident Report, which will be countersigned by the person in charge of the Service at the time of the incident.
• If necessary, send a copy of the completed form to the insurance company; and
• File a copy of the Incident Report on the child’s file. 
• The Nominated Supervisor will inform the Service management about the incident.
• The Nominated Supervisor or the Licensee is required to inform the Regulatory Authority about the incident within 24 hours. 
• Staff will be debriefed after each anaphylaxis incident and the child’s Individual Anaphylaxis Health Care Plan evaluated. 
• Staff will need to discuss the effectiveness of the procedures that were in place. 
• Time is also needed to discuss the exposure to the allergen and the strategies that need to be implemented and maintained to prevent further exposure.

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.  
• ASCIA has updated the Anaphylaxis Action Plan for 2018. It is recommended that older Action Plans should no longer be used
• Refer to the following website for an updated action plan 
• https://www.allergy.org.au/health-professionals/anaphylaxis-resources/ascia-action-plan-for-anaphylaxis
• There are two types of ASCIA Action Plans for Anaphylaxis:
• Personal versions (RED) is for individuals who have been prescribed adrenaline autoinjectors. This plan includes personal information and an area for a photo.
• General versions (ORANGE) do not contain any personal information and can be used as posters.
•  There is also an ASCIA Action Plan for Allergic Reactions (GREEN), for individuals with medically confirmed mild to moderate allergies, who need to avoid certain allergens but have not been prescribed adrenaline autoinjectors. This plan includes personal information and an area for a photo. 
• Anaphylaxis Australia Inc., at Allergy Facts, is a non-profit support organization 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 [phone].
• 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 [phone] or Email: [e-mail]
• Department of Education and Early Childhood Development website at www.education.vic.gov.au/anaphylaxisprovides information related to anaphylaxis, including frequently asked questions related to anaphylaxis training.

Additional Information: 

www.education.vic.gov.au/childhood/parents/health/Pages/anaphylaxis.aspx           

Source

• Australian Children’s Education & Care Quality Authority.  
• Guide to the Education and Care Services National Law and the Education and Care Services National Regulations 
• ECA Code of Ethics.
• Guide to the National Quality Standard. 
• Staying Healthy in Child Care. 5th Edition 
• Revised National Quality Standard
• ASCIA Action Plans for Anaphylaxis 

Review

Policy Reviewed	Modifications	Next Review Date
October 2017	New Policy Introduced Updated the references to comply with revised National Quality Standard	July 2018
July 2017	Updated to comply with changes to ASCIA Action plans. See ‘Contact details for resources and support’ above.	July 2019
January 2020	Branding and formatting updated Policy links added Service-specific information amended not affecting the delivery of policy	July 2020