Assisting Students With Severe Allergies:

Epinephrine Auto-injector Training

Date:Instructor’s Name:

July 2006 2

Training Overview PURPOSE:

Students with severe allergies may experience life-threatening allergic reactions known as anaphylaxis.

Trained school employees who respond quickly and appropriately may save a student’s life.

The purpose this educational activity is to train identified school employees to respond successfully and appropriately if an anaphylactic emergency occurs for specific students when a licensed nurse is not available.

July 2006 3

Training Overview Training Content:

Anaphylaxis Basics Student Specific Instructions Responding in Case of Anaphylaxis

Verbal/Written Description Demonstration Return Demonstration

Documentation & Reporting Written Test & Skills Check Off Review of Specific Student Information Certificate of Completion

July 2006 4

Training Overview

To receive a Certificate of Completion you must: Attend the full training session Demonstrate that you can correctly carry

out the treatments needed Get a score of 100% on the knowledge

test and skills check off

July 2006 5

Training Overview The Certificate of Completion will mean

that: You have attended the full training session. You have demonstrated that you can correctly

perform the treatments. You have passed the knowledge test. You are eligible (if officially assigned by the

school administrator) to perform the treatments for which you were trained only for the specific student(s) assigned to you if the school nurse is not available.

July 2006 6

Training Overview Please note that:

The skills taught during this training are to be used at school or school related functions only for meeting the needs of the student(s) that you are assigned to assist.

The skills are not transferable to other settings. You cannot delegate the tasks to others or

supervise others in performing the tasks.

July 2006 7

Training Overview Applicable School District Policies and

Procedures Note to Instructor: List and provide copies of

any of the school district’s specific policies and procedures. District procedures should ensure immediate access to the epinephrine auto-injector and the medical prescriber’s written orders and instructions. Immediate transport to an emergency medical facility should be required after administration of epinephrine.

July 2006 8

Training Overview Pretest

Give it your best shot. We’ll cover the answers as we go through this learning activity.

July 2006 9

Anaphylaxis Basics

What is anaphylaxis? Anaphylaxis is an allergic emergency. Anaphylaxis is a severe allergic reaction

that can result in death within minutes. Death may be caused by:

Swelling that shuts off the airway or A dramatic drop in blood pressure.

July 2006 10

Anaphylaxis Basics What causes anaphylaxis?

It is a rapid, severe allergic reaction that occurs when a person is exposed to an allergen (something to which the person is allergic).

Exposure to the allergen triggers the body to release chemicals into the bloodstream to protect itself from the allergen.

In people with severe allergies the chemicals released by the body can cause breathing difficulty, swelling, dizziness, shock, and even death.

July 2006 11

Anaphylaxis Basics What are some common triggers for

anaphylaxis? Bee, wasp, yellow jacket and fire ant stings Foods such as peanuts, milk, eggs, fish, shellfish

and some food additives Medications Latex, found in elastic waistbands, balloons, and

some gloves Exercise (rare) In some cases the exact trigger is not known

July 2006 12

Anaphylaxis Basics

What are the common signs and symptoms of anaphylaxis? Most distinctive signs and symptoms:

Hives, itchy skin Swelling or flushing (sudden redness) of the

throat, lips, tongue, or around the eyes Wheezing, shortness of breath, coughing,

hoarseness

July 2006 13

Anaphylaxis Basics

Other common symptoms include: Metallic taste or itching in the mouth Abdominal cramps, nausea, vomiting, or

diarrhea Increased heart rate Sudden decrease in blood pressure and

paleness

July 2006 14

Anaphylaxis Basics

More signs and symptoms Sudden feeling of weakness Anxiety or an overwhelming sense of

doom Collapse Loss of consciousness

July 2006 15

Anaphylaxis Basics

Every person is different and symptoms vary.

It is important, if possible, to know the specific symptoms for the student that you will assist.

Symptoms appear within a few seconds after the exposure to the trigger.

July 2006 16

Anaphylaxis Basics

Anaphylaxis is a medical emergency. Death can occur within minutes. Anaphylaxis requires immediate

attention.

July 2006 17

Anaphylaxis Basics

How is anaphylaxis treated? Preventing anaphylaxis is the first goal. Persons with a known allergy should try

to avoid substances that trigger severe allergic reactions.

Avoiding allergens is not always possible. Difficult to predict the movement of flying

insects (bees) Ingredients in food are not always obvious

July 2006 18

Anaphylaxis Basics So, what treatment is needed in the

event of anaphylaxis? Epinephrine injection is the medication

used to treat anaphylaxis. Epinephrine used for students with

known allergies comes in a spring loaded syringe already filled with the right amount of medication (epinephrine auto-injector).

Instructor: Show sample (or pictures)

July 2006 19

Anaphylaxis Basics Epinephrine is a

chemical that narrows the blood vessels and opens the airways.

This reverses the low blood pressure and wheezing caused by the allergic reaction.

How is epinephrine packaged? 0.30 milligrams

(mg) – usually for individuals weighing more than 66 pounds

0.15 mg – usually for individuals weighing less than 66 pounds

July 2006 20

Anaphylaxis Basics

The student’s health care provider will decide how much epinephrine is right for the student.

The epinephrine auto-injectors will already have the prescribed amount in the syringe.

July 2006 21

Anaphylaxis Basics Side effects of

epinephrine include: Severe headache Blurred vision Flushed skin Fast or irregular

heart rate Sweating Nausea and

vomiting

Pale skin Dizziness Weakness or

muscle tremors Apprehension,

nervousness, and anxiety

July 2006 22

Anaphylaxis Basics

How should the epinephrine auto-injector be stored? Keep at room temperature. Do not refrigerate. Keep out of direct sunlight. Store in its plastic container.

July 2006 23

Anaphylaxis Basics After using an epinephrine auto-injector it is

important to call 911 to get emergency care for the student.

Emergency care is important because the effects of epinephrine can wear off and there is a chance of a second reaction.

Send the used epinephrine auto-injector with the student to the emergent care facility.

July 2006 24

Anaphylaxis Basics Instructor: Show video or provide

demonstration. Note to instructor: Provide trainee with a copy of written

instructions from the manufacturer of the epinephrine auto-injector that is being used by the specific student for which the person is being trained. Some manufacturers have video demonstrations on their websites. Be sure to cover recommended injection site, whether clothing must be removed, and the amount of time that injector must be held in place following the injection; this information is included in the knowledge test that trainees must pass.

Questions and Answers

July 2006 25

Student Specific Instructions Confidentiality

The Family Educational Rights & Privacy Act (FERPA) is a federal law that requires school employees to keep information about students confidential.

The information shared during this training about a student may be shared with others in the school setting only if there is a legitimate need for the other person to have knowledge of the student’s information.

Information about a student may be shared with emergency care workers called to assist the student in the event of an emergency.

July 2006 26

Student Specific Instructions

Review Student’s Individual Health Care Plan

Review Student’s Emergency Action Plan

Instructor: Allow time for questions.

July 2006 27

Responding in Case of Anaphylaxis Standard Precautions

Standard Precautions are safeguards that are taken to reduce the risk of transmission of bloodborne pathogens.

Bloodborne pathogens are disease causing organisms such as viruses that can be transferred from person to person through blood or other body fluids.

Standard Precautions should be taken in all situations where there is possible exposure to blood and body fluids other than sweat.

Instructor: Review school district policy related to OSHA requirements and location of personal protective equipment.

July 2006 28

Responding in Case of Anaphylaxis

Epinephrine Auto-injector Caution

Accidental injection into the hands or feet may result in loss of blood flow to the affected area. If this occurs go immediately to the nearest emergency department for treatment.

Do not remove the safety cap until you are ready to inject this medication. Never put your fingers over the tip when removing the safety cap or after the safety cap has been removed.

July 2006 29

Responding in Case of Anaphylaxis

Medications Six rights related to providing a

medication: Right student Right medication Right dose (amount) Right time (appropriate time) Right route (method of giving the

medication) Right reason

July 2006 30

Responding in Case of Anaphylaxis Epinephrine Auto-injector Procedure

Written & Verbal Description of Process Instructor Demonstration Return Demonstration

Note to instructor: Use written instructions provided by the manufacturer of the epinephrine auto-injector that is being used by the specific student for which the person is being trained. Some manufacturers have video demonstrations on their websites.

The nurse is responsible for monitoring the expiration date of the epinephrine auto-injectors maintained at school. Remind parents that they are responsible for monitoring the expiration date of epinephrine auto-injectors for students who are self-medicating.

July 2006 31

Responding in Case of Anaphylaxis

Scenarios based on student’s emergency action plan

Practice Time

July 2006 32

Documentation Forms Your documentation will provide a description of the

events and the care that you provided. The documentation sheet will become a part of the

student’s health record and will be considered a legal document.

If you make a mistake when writing your notes, _________________ (Instructor: Fill in the blank with your school district’s procedure for correcting documentation errors.)

Do not use abbreviations. Sign your legal name.

July 2006 33

Documentation What to document?

Note time of event What you observed What the student reported or did What you did What happened after you did what you did Note time of call for emergency assistance and the

time of arrival Note time of call to parent/legal guardian and the

results of call Note notification of appropriate individuals following

event

July 2006 34

Reporting Student Assistance

Any assistance provided to an assigned student must be reported immediately to the school administrator on duty and/or the school nurse.

The nurse who is providing oversight for the school must be notified within 24 hours.

A nurse will review the event and actions taken.

July 2006 35

Thank You!

Questions or concerns Your questions, comments, concerns are

always welcome. Now, and If you think of something later do not

hesitate to ask me for clarification.

July 2006 36

References American Academy of Allergy, Asthma & Immunology (www.

aaai.org) Anapen (www.anapen.com) (www.anapen.com/a_anapen/a_

anapen.htm) EpiPen (www.allergic-reactions.com) (

www.allergic-reactions.com/pdf.PatientInsert.pdf) (www.allergic-reactions.com/howtouse.aspx)

Food Allergy & Anaphylaxis Network (www.foodallergy.org) Litarowsky, Murphy, & Carham (October 2004). Evaluation

of an Anaphylaxis Training Program for Unlicensed Assistive Personnel, The Journal of School Nursing, 20(5), 279 – 284.

National Association of School Nurses, Position Statement: The Role of School Nurses in Allergy/Anaphylaxis Management. (www.nasn.org)

Twinject (www.twinject.com) (www.twinject.com/hcp/useinstru.asp)