{"id":814,"date":"2014-01-26T16:00:44","date_gmt":"2014-01-26T21:00:44","guid":{"rendered":"http:\/\/www.allergyhome.org\/blogger\/?p=814"},"modified":"2014-01-26T23:41:34","modified_gmt":"2014-01-27T04:41:34","slug":"life-threatening-allergies-school-nurses-massachusetts-and-you","status":"publish","type":"post","link":"https:\/\/www.allergyhome.org\/blogger\/life-threatening-allergies-school-nurses-massachusetts-and-you\/","title":{"rendered":"Life-Threatening Allergies, School Nurses, and You: The Massachusetts Journey"},"content":{"rendered":"

It is a great honor and pleasure for AllergyHome to introduce Anne Sheetz, BSN, MPH, NEA-BC. Ms. Sheetz is the former Director of the Massachusetts Department of Public Health, School Health Services Unit, and is a dedicated advocate for student health and school nursing. She has been instrumental and deeply influential in national school health issues, especially the management of students with life-threatening allergies. Thank you, Anne, for joining us!<\/p>\n

The Massachusetts Journey: Before\u00a0Guidelines for Managing Life-Threatening Allergies in School\u00a0<\/i><\/h1>\n

\"Massachusetts<\/a>As parents in many states work with their schools to create safe environments for their children with life threatening allergies, it might be helpful to learn about the Massachusetts journey on this issue.\u00a0 In 1993 the Commonwealth had approximately 900 school nurses.\u00a0 Rates of asthma and allergies were slowly increasing as were other chronic health conditions among children, thus leading to several milestone changes.\u00a0 In that year, through the efforts of the Massachusetts School Nurse Organization, the legislature passed a law requiring that all school nurses be licensed by the then Department of Education.\u00a0 Licensure requirements for school nurses (registered nurses) included a BSN or MSN upon entry as school nursing is a public health profession that requires a wide range of skills.\u00a0 In 1993 the Massachusetts Department of Public Health also promulgated a comprehensive set of Regulations Governing the Administration of Prescription Medications in Public and Private Schools (105 CMR 210.000), which permitted school nurses to train unlicensed personnel in the administration of epinephrine by auto injector to children diagnosed with a life threatening allergic condition.<\/p>\n

Introducing\u00a0Massachusetts’\u00a0Guidelines for Managing Life-Threatening Allergies in School\u00a0<\/i><\/h1>\n

However, after three Massachusetts school-related deaths in 2000, parents from schools within Massachusetts along with the Asthma and Allergy Foundation of America, New England\u00a0Chapter <\/a>approached the Massachusetts Department of Public Health and the Massachusetts Department of Elementary and Secondary Education to address the critical issue of children with life threatening allergies in schools.\u00a0 The focus was on both prevention and emergency response.\u00a0\u00a0 Subsequently the two agencies formed a committee to develop statewide guidelines.\u00a0 Members included parents, allergists, school nurses, nutritionists, school physicians and others.\u00a0 The Massachusetts\u00a0<\/em><\/a>G<\/em>uidelines for Managing Life-Threatening Allergies in School<\/a> <\/i>were published and distributed to every superintendent and school nurse in 2002.\u00a0 School staff training was also provided.<\/p>\n

“The\u00a0Guidelines\u00a0<\/i>recommend that the child with a life-threatening allergy be enrolled in a school with a full-time school nurse.”<\/h1>\n

As demonstrated, the Guidelines <\/i>provide a comprehensive approach supporting food allergy awareness for the whole school, the need for policies and procedures, pre-entry planning for the child with life-threatening allergies, and preparation for an emergency should an unintended exposure occur.\u00a0 They also outline the responsibilities of parents, administrators, food service personnel, school nurses and others. Because preparation for the child is best done by a professional whose primary role is health, the Guidelines <\/i>recommend that the child with life-threatening allergies be enrolled in a school with a full-time school nurse.\u00a0 The school nurse\u2019s responsibilities are clearly delineated: (a) planning prior to entry, (b) development of a care plan, (c) allergy awareness for the entire school population (now, often using the school training materials<\/a> from AllergyHome), (d) training of unlicensed personnel to administer epinephrine,\u00a0 (e) reviewing their skills\u00a0 every six months, and (f) debriefing after any incident.\u00a0 Having a full-time school nurse is clearly the goal; however, not every Massachusetts school had a full-time school nurse\u2014although with the support of parents (of children with life-threatening allergies and other special health conditions, e.g., diabetes), the numbers were rising.<\/p>\n

Mandated Reporting of Epinephrine Administrations: Vast Majority of Epinephrine Administrations Are By the School Nurse<\/h1>\n

In order to assess statewide school response to a life threatening allergic event, as well as provide for quality improvement, in 2004 Massachusetts amended the school medication regulations by requiring schools to report any administration of epinephrine for a life threatening allergic reaction.\u00a0 In the last several years there have been more than 200 such administrations annually in the Commonwealth’s schools, all with positive outcomes for the child.\u00a0 While unlicensed personnel may be trained to administer epinephrine by auto-injector to students diagnosed with life threatening allergies, the vast majority of the administrations have been by the school nurse (close to 90%).<\/p>\n

Challenges in implementing policies and procedures for children with life-threatening allergies<\/h1>\n

The implementation of policies and procedures for children with life-threatening allergies has faced many challenges: (a) the lack of understanding of the critical nature of these allergies, (b) the push back from other parents whose children \u201conly eat peanut butter\u201d, and (c) the creativity needed to establish reasonable practices in classrooms and cafeterias.\u00a0 However, each challenge increases the opportunities to teach others, both in the school and community, about life-threatening allergies. This education is vital because in Massachusetts\u2014like so many states\u2014the numbers of children with life-threatening allergies are increasing.\u00a0 Massachusetts students with epinephrine prescriptions for life-threatening allergies rose from 7.2 per 1000 in 2001 to 25.1 per 1000 in 2012.<\/p>\n

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Parallel to the rising prevalence rates of this and other special health care conditions, the numbers of qualified school nurses has also grown.\u00a0 Schools are increasingly recognizing the important contributions of the professional school nurses to the health, safety and attendance of students.\u00a0 School nurses also free teachers to teach rather than address health conditions!\u00a0 Currently in Massachusetts there are 2100-2300 professional school nurses\u2014although some schools still remain uncovered.<\/p>\n

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No Full-time School Nurse in Your School? The following are some suggestions for families with a child with life-threatening allergies:<\/h1>\n

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