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Written by Judy Hoffman, District Nurse   

District Plan for Student with Peanut Allergy in the School



Outline of the Plan

1. Communication with Parent/Guardian prior to school starting

2. Individual Health Care Plan

3. Transportation

4. Food Service/Custodian

5. School Wide Plan

6. Training and Education of All Staff

7. Field Trips

8. Nurse Student Communication

9. Medications

10. Attachments

People involved in the Plan

1. Nurses

2. Parents

3. Physicians

4. Food Service Personnel

5. Teachers

6. Principals

7. Transportation Employees

8. Custodians

9. Medical Director and Physician Assistant

A heartfelt thanks to the following people who participated in creating this Document: Paul Alexander, Director of Facilities; David Bacharach, Director of Transportation; Nan Brown, Principal; Pam Ellis RN; Joan Grossman, Teacher; Joyce Hickes RN; Judy Hoffman RN; Marci Kidd, Parent/Teacher; Cathy Malecki RN; Dale McLean, Director of Food Service; Dr. Smith, Allergist; Dr. Uphoff, Medical Director for ICSD; the ICSD School Nurses

This plan is written primarily for elementary school students. There are some recommendations for middle school students.

We recommend that all high school students be able to self-medicate and carry their epi-pens with them. They should also have an epi-pen in the health office. There may need to be exceptions made on an individual basis. Similarly, the goal is for middle school students to be able to self-medicate.

Teachers in ALL schools should have an emergency plan in their substitute teacher plans with a picture of the student on the plan.

1. Communication with Parents Prior to School Starting

The school nurse should arrange a meeting with the parent/guardian prior to school starting for all new entrants with peanut allergies. The nurse will invite the principal and classroom teacher to come if possible. The nurse and parent/guardian will decide if the student should be invited.

The goal of this meeting will be to create an environment that minimizes the chance of an allergic reaction. Participants will discuss how and what information will be shared with classmates and other staff (like posting of pictures, etc.).

A written individual health care plan will be developed in concert with the parent/guardian. All parties involved will signify their agreement to the plan by signing this document.

The nurse will contact all returning students by phone to discuss any changes, obtain medical orders and medications. A meeting will be arranged if necessary.

The following must be addressed in the development of the plan:

1. History of allergy

2. History of allergic reactions

3. Symptoms of allergic reaction **(see important note)

4. Medication

5. School plan including field trips

6. Physician’s written orders (requested by the nurse before the meeting)

7. Release to talk to physician

**IMPORTANT NOTE: Anaphylaxis is a spectrum of symptoms. The type of reaction that a student may experience one time does not predict the severity of the next reaction. A student may experience mild symptoms following the ingestion of a peanut or peanut product while experiencing life-threatening anaphylaxis the next exposure.

2. Individual Health Care Plan

The school nurse will write an Individual Health Care Plan and Emergency Action Plan to be signed by the parent/guardian. This plan will be based on the severity of the student’s allergy and needs. Included in the plan will be consent on how information will be shared with school representatives (i.e., custodians, cafeteria staff) on a need to know basis.

3. Transportation

Prior to the start of school, the school nurse will write a bus card with medical information and forward it to the transportation supervisor. This information will be shared with the student’s bus driver(s).

Transportation will send a letter to all families explaining the district plan when bus route information is sent home. A copy of this letter is included as attachment #2. This letter includes information to parents and students about hand washing and that students will not be allowed to eat food on the bus during all daily runs to and from school. Exceptions are made for medical needs, for example, students with diabetes.

The head nurse will speak to all of the bus drivers at their mandatory driver training session in August. Information will be given on how to support students with peanut allergies on the school bus. The nurse will review the district wide plan and responsibilities for all students riding on the school bus.

The bus driver will talk to all students riding the bus and explain that there is to be NO EATING at any time on the bus going to or from school. The bus driver will remind students throughout the year, especially at Halloween.

Monitoring food consumed on the bus for field trips and athletic contests will be the responsibility of the school official in charge of the event. This adult will be responsible for determining if there are any students with peanut allergies and closely monitoring the food consumed to help ensure these students are not exposed to any peanut products. The adult in charge will also be responsible for knowing and implementing the plan for the student with a peanut allergy, if they have a reaction. The school nurse will be responsible for providing all necessary information.

The adult in charge of the trip will also be responsible for making sure that students do not leave any food or garbage on the bus.

Due to the length of some trips, exclusion of all food is not always possible. Food should be avoided to decrease the risk of exposure whenever possible.

Due to the length of some trips, exclusion of all food is not always possible. Food should be avoided to decrease the risk of exposure whenever possible.

4. Food Service/Custodian

There will be “peanut-free” tables clearly labeled in the cafeteria. Signs will be posted near the tables. Examples of signs are included as attachment #3. There will be separate sponges and buckets used for the peanut-free table(s). The parent/guardian of middle school students will discuss with the school nurse whether or not to implement this plan. It is not recommended for high school students.

Peanut butter and jelly sandwiches, and all other foods containing peanut products, will be made in a separate area of the kitchen. That area will be cleaned with supplies used only for that area.

The school nurse will encourage the family to provide all food for the student from home. The best people to read the labels and review foods are family members. Regardless of the vigilance from staff, there is always a potential for error.

Food service personnel and custodians will be educated about food allergies. The head nurse will attend the mandatory pre-school meetings for all custodians and food service workers to review this information.

It is important to be aware of foods that may contain peanut products. Food service personnel must read the label for all food items to determine if it has (or may have) peanut products or was processed in a facility where peanut products are used. The school nurse is an excellent resource to help if there are any questions.

The student’s emergency plan will be in the kitchen and a plan to inform substitutes will be in place. This should be considered for middle school students and not recommended for high school students.

The student’s food allergy status will be put in the cafeteria computer located in the kitchen.

The school nurse will provide the head custodian with a written list of all students in the building with peanut allergies. This information will be put in the substitute custodian plans.

5. School Wide Plan

The classroom will be peanut free. Students will wash their hands before class starts and when returning from lunch. All other students and staff will wash their hands before entering the classroom. It will be clearly explained about the importance of washing well to ensure the removal of any peanut oil.

Important Note: Whenever it is recommended that hands be washed, soap and water must be used. Instant hand sanitizer does not remove the peanut allergen.

In elementary schools all “specials”, which include art, music, the library and gym, in addition to the health office, will be peanut free. Signs will be posted outside these rooms.

The teacher should be aware of all food brought into the classroom and try to ensure NO peanut products are introduced. Also, any project that may involve food needs to be closely monitored, like using birdseed, which may contain nuts.

We recommend that the student only eat food brought from home.

Signs will be posted outside the classroom saying this is a peanut free classroom. Example of a sign is included as attachment #4.

Letters will go home to all students and their families before school starts. See included letter as attachment #5.

The teacher and/or school nurse will talk to the students in the class about the reason for the plan. They may choose to show the video “Alexander the Elephant Who Couldn’t Eat Peanuts”. The school nurse will provide the video. This is appropriate for elementary school.

We recommend that students be allowed to eat peanut products in middle and high school classrooms. Staff will be aware of peanut allergies and ways to reduce risk of exposure in the classroom. There will be no use of peanut products for cooking projects in the career center class.

The teacher will put the emergency plan for all students with a peanut allergy in the substitute teacher plans. The plan must be clearly labeled so it cannot be missed. It could be included with a tab sticking out of the plans labeled health alert in big red letters. The emergency plan is recommended for elementary, middle and high school. An example of an emergency plan is included as attachment #1.

There will be walkie-talkies on the playground and in the nurse’s office for communication if needed. This applies to elementary and middle schools. The classrooms will have intercom systems available.

Information will be put in the PTA newsletter and possibly shared at PTA meetings. This should happen at elementary, middle and high school.

Special events like bake sales, evening programs with food and classroom parties should be carefully planned so that there is minimal chance of exposure.

We also recommend the education occur in all schools to inform students about food allergies.

6. Training and Education of All Staff

Prior to school starting ALL staff will be informed about how to maintain a safe environment for the student(s). The School Nurse will demonstrate how to use an epi-pen. Whenever an epi-pen is used, 911 (in some buildings it is 9-911) must be called, and the student transported by ambulance to the hospital.

The school nurse will be ultimately responsible for making sure the student is given the appropriate treatment at school. This is to make sure that epinephrine is administered, if needed. The most serious problems, including death, occur when epinephrine is not given in time.

Periodic updates, reminders and trainings will happen throughout the school year.

7. Field Trips

The school nurse will ask the parent/guardian of elementary, and possibly middle school students, if they can attend the field trip. If the parent/guardian cannot attend, then the school nurse will review how and when to use the epi-pen with the responsible adult going on the field trip. The responsible adult will take the epi-pen and emergency plan on the field trip, always calling 911 if the epi-pen is given.

The school nurse will investigate where the trip is going and the exposure risks involved. The nurse will also determine what the emergency plan should be for the trip and provide it to the adult carrying the epi-pen.

8. Nurse Student Communication

All new students will meet with the school nurse before school starts. The nurse will meet with all other students within the first week of school unless there have been any changes in their health history.

The nurse will talk to the student about their understanding of their allergy, symptoms and reaction. They will discuss how to avoid the allergen and what they would do if they thought they were having an allergic reaction.

The school nurse will periodically review this information with the student.

This is recommended for all students in elementary, middle and high school.

9. Medications

The school nurse will obtain medical orders for the student to have two epi-pens at school if possible. One epi-pen will be kept in the nurse’s office and one in the classroom. All students should have an epi-pen in the health office, but only elementary students will have one in the classroom. Middle and high school students that can self-medicate will carry their epi-pens with them. Students must always be transported to the hospital by ambulance if epinephrine is given.

The epi-pen in the classroom must be out of reach of the children. The teacher should clearly identify the location of the epi-pen in the substitute teacher plans. The classroom should be locked when there is no adult in the room.

The student’s epi-pen in the nurse’s office will be locked. However, the school nurse may choose to keep the “stock” epi-pens unlocked only when he/she can closely watch them and insure that they are not taken. If the building is evacuated the school nurse could then bring those epi-pens quickly. The epi-pen “junior” is for students less than 45 pounds and the adult epi-pen is for students 45 pounds and over.

It will be VERY important to educate staff about when to give the medication. All serious complications, including death, occurred when the medication was given one hour or more after the reaction. It is recommended that if there is any QUESTION that a student may be having an anaphylactic reaction, epinephrine should be given right away. The risks of not giving epinephrine far outweigh the risk of giving the medication. It is important that staff feel comfortable giving the medication and DO NOT WAIT!

10. Attachments

Last Updated ( Monday, 22 February 2010 )
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