Anaphylaxis

8. Risk minimisation strategies

Clause 8 of Ministerial Order 706 (PDF) requires a school’s anaphylaxis management policy to include prevention strategies to minimise the risk of an anaphylactic reaction.

How can the risk of anaphylaxis be minimised in schools?

A school’s anaphylaxis management policy must include prevention strategies to be used by the school to minimise the risk of a student suffering an anaphylactic reaction.

It is important to remember that minimisation of the risk of anaphylaxis is everyone's responsibility: including the principal and all school staff, parents, students and the broader school community.

Parents must also assist their child’s school to manage the risk of anaphylaxis (as specified in the Order). For example, parents must:

• communicate their child's allergies and risk of anaphylaxis to the school at the earliest opportunity, in writing and preferably on enrolment
• continue to communicate with school staff and provide up to date information about their child’s medical condition and risk factors
• obtain and provide the school with an ASCIA Action Plan for Anaphylaxis completed by a medical practitioner
• participate in yearly reviews of their child’s individual anaphylaxis management plan
• ensure that their child has an adrenaline autoinjector at school at all times that is current (the device has not expired).

Risk minimisation strategies

Peanuts and nuts are the most common trigger for an anaphylactic reaction or fatality due to food-induced anaphylaxis. To minimise the risk of a student’s exposure and reaction to peanuts and nuts, schools should not use peanuts, tree nuts, peanut butter or other peanut or tree nut products during in-school and out-of-school activities.

It is also recommended that school activities don’t place pressure on students to try foods, whether they contain a known allergen or not. Blanket banning of nuts or other foods associated with anaphylaxis and allergies is not recommended because:

• it can create complacency amongst staff and students
• it cannot eliminate the presence of all allergens.

More information about peanut and nut banning can be found in the ASCIA Guidelines for Prevention of Food Anaphylactic Reactions in Schools, available from the ASCIA website. Allergy & Anaphylaxis Australia also have a helpful list of risk minimisation strategies.

Risk minimisation strategies should be considered for all relevant in-school and out-of-school settings which may include (but are not limited to) the following:

• during classroom activities (including class rotations, specialist and elective classes)
• between classes and other breaks
• in canteens
• during recess and lunchtimes
• before and after school periods during which yard supervision is provided
  Note: the Order does NOT apply to outside school hours care (OSHC) programs, whether run by the school or an external provider
• special events including incursions, sports, cultural days, fetes or class parties, excursions and camps.

School staff should be regularly reminded that they have a duty of care to take reasonable steps to protect students from reasonably foreseeable risks of injury. The development and implementation of appropriate risk minimisation strategies to reduce the risk of incidents of anaphylaxis is an important step to be undertaken by schools in discharging this duty of care.

A number of suggested risk minimisation strategies are included in the Resources tab which, as a minimum, should be considered by school staff, for the purpose of developing such strategies for in-school and out-of-school settings. It is recommended that school staff determine which strategies are appropriate after consideration of all relevant factors including the age of the student at risk, the facilities and activities available at the school, the likelihood of that student’s exposure to the relevant allergen/s whilst at school, and the general school environment. Where relevant, it would be prudent to record the reason why a decision was made to exclude a particular strategy listed in these Guidelines.

The selected risk minimisation strategies must be specified in the school anaphylaxis management policy. This includes any other strategies developed by school staff but which are not contained in these Guidelines.

Where should we store the adrenaline autoinjectors?

It is recommended that:

• adrenaline autoinjectors for individual students, or for general use, be stored correctly and be able to be accessed quickly, because, in some cases, exposure to an allergen can lead to an anaphylactic reaction in as little as 5 minutes
• adrenaline autoinjectors be stored in an unlocked, easily accessible place away from direct light and heat but not in a refrigerator or freezer
• each adrenaline autoinjector be clearly labelled with the student's name and be stored with a copy of the student's ASCIA Action Plan for Anaphylaxis
• an adrenaline autoinjector for general use be clearly labelled and distinguishable from those for students at risk of anaphylaxis and stored with a general ASCIA Action Plan for Anaphylaxis (orange)
• adrenaline autoinjector trainer devices (which do not contain adrenaline or a needle) are not stored in the same location due to the risk of confusion.

Regular review of adrenaline autoinjectors

Schools are encouraged to undertake regular reviews of students’ adrenaline autoinjectors, and those for general use. When undertaking a review, the following factors should be considered:

1. Are adrenaline autoinjectors:
   • stored correctly and able to be accessed quickly? (in some cases, exposure to an allergen can lead to an anaphylactic reaction in as little as 5 minutes)
   • stored in an unlocked, easily accessible place away from direct light and heat? They should not be stored in the refrigerator or freezer
   • clearly labelled with the student's name, or clearly distinguished as being for general use only?
   • signed in and out when taken from their usual place, for example, for camps or excursions?
2. Is each student's adrenaline autoinjector clearly distinguishable from other students' adrenaline autoinjectors and medications?
   Are adrenaline autoinjectors for general use clearly distinguishable from students’ individual adrenaline autoinjectors?
3. Do all school staff know where adrenaline autoinjectors are located?
4. Is a copy of the student's ASCIA Action Plan for Anaphylaxis kept with their individual adrenaline autoinjector?
   Is a copy of the general ASCIA Action Plan for Anaphylaxis (orange) kept with the general use adrenaline autoinjector?
5. Depending on the speed or severity of previous anaphylactic reactions, it may be appropriate to have a student’s adrenaline autoinjector in class or transferred to the yard-duty bag at recess and lunch break times.
6. It is important to keep adrenaline autoinjector trainer devices (which do not contain adrenaline) in a separate location from students' adrenaline autoinjectors.

Schools are also encouraged to arrange for a designated school staff member (for example, the school anaphylaxis supervisor, school nurse, or first aid co-coordinator) to conduct regular reviews of the adrenaline autoinjectors to ensure they are not out of date or cloudy/discoloured.

If the school anaphylaxis supervisor or other designated school staff member identifies any adrenaline autoinjectors which are out of date or cloudy/discoloured, they should:

• immediately send a written reminder to the student's parents to replace the adrenaline autoinjector as soon as possible (and follow this up if no response is received from the parents or if no replacement adrenaline autoinjector is provided)
• advise the principal that an adrenaline autoinjector needs to be replaced by a parent and
• work with the principal to prepare an interim individual anaphylaxis management plan pending receipt of the replacement adrenaline autoinjector.