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The Need for Required Stock Epinephrine in All Schools: A Work Group Report of the AAAAI Adverse Reactions to Foods Committee. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1068-1082.e1. [PMID: 36716997 DOI: 10.1016/j.jaip.2022.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 01/30/2023]
Abstract
Epinephrine is the first line of treatment for anaphylaxis that can occur outside a medical setting in community environments such as schools. Patients with diagnosed IgE-mediated food allergy at risk of anaphylaxis are prescribed self-injectable epinephrine and given an individualized anaphylaxis action plan. As students, such patients/families provide their school with completed medication forms, a copy of their anaphylaxis plan, and additional student-specific epinephrine. However, students approved to self-carry prescribed self-injectable epinephrine may forget to do so or have other reasons for lacking prescribed epinephrine such as familial inability to fill the prescription due to cost or other access barriers. Undiagnosed students lacking prescribed epinephrine may also experience anaphylaxis at school. The presence of non-student-specific school stock epinephrine allows school nurses and other staff the ability to treat anaphylaxis onsite while awaiting Emergency Medical Services. Notably, not all states legally mandate K-12 schools to stock epinephrine. In states with laws only voluntarily allowing schools to stock epinephrine, it provides the ability to opt-out. Herein, we present a comprehensive review of barriers to school stock epinephrine, related improvement strategies, and workgroup recommendations supporting the need for mandated stock epinephrine in all schools in every state. Proposed solutions include ensuring legal immunity from liability for prescribers; advocacy for legislation to stabilize cost of self-injectable epinephrine; educational initiatives to schools promoting merits and safety of epinephrine and related anaphylaxis training; and partnerships between patient advocacy groups, medical and nursing organizations, public health departments and other health professionals to promote laws and district policies addressing need for stock epinephrine and school nurses to train and supervise school staff.
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Muniz EA, Queiroz MVO, Pinheiro PNDC, Silva MRFD, Moreira TMM, Oliveira EN, Almeida IFDPD, Barbosa Filho VC. Guia de Enfermagem Escolar para promoção da saúde de jovens estudantes: construção e validação. Rev Bras Enferm 2023. [DOI: 10.1590/0034-7167-2022-0260pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivos: descrever o processo de construção e validação do Guia de Enfermagem Escolar para promoção da saúde de jovens estudantes. Métodos: estudo metodológico, realizado de fevereiro a dezembro de 2021, composto por Pesquisa Convergente-Assistencial fundamentada no Modelo de Promoção da Saúde de Pender. A partir da literatura e diálogo com 11 enfermeiros nos sete grupos focais online, foram construídas ações. Posteriormente, 24 juízes avaliaram o conteúdo e a aparência. Resultados: o guia propõe estratégias para o desenvolvimento das práticas de enfermagem escolar enfocando a promoção da saúde. O Índice de Validade de Aparência variou de 0,63 a 1,0, e o total foi de 0,84. O Índice de Validade de Conteúdo variou de 0,95 a 1,0, e o total foi de 0,997. Conclusões: o guia incorporou as necessidades dos jovens reconhecidas pelos profissionais, e a fase de avaliação confirma sua validação, podendo ser utilizado no contexto da prática com jovens.
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Affiliation(s)
- Emanoel Avelar Muniz
- Instituto Federal de Educação, Ciência e Tecnologia do Ceará, Brazil; Universidade Estadual do Ceará, Brazil
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Muniz EA, Queiroz MVO, Pinheiro PNDC, da Silva MRF, Moreira TMM, Oliveira EN, de Almeida IFDP, Barbosa VC. School Nursing Guide for student health promotion: construction and validity. Rev Bras Enferm 2022; 76:e20220260. [PMID: 36542056 PMCID: PMC9749768 DOI: 10.1590/0034-7167-2022-0260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/02/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES to describe the process of construction and validity of a School Nursing Guide for student health promotion. METHODS a methodological study, carried out from February to December 2021, composed of Convergent Care Research based on Pender's Health Promotion Model. Based on the literature and dialogue with 11 nurses in the seven online focus groups, actions were constructed. Subsequently, 24 judges assessed content and appearance. RESULTS the guide proposes strategies for developing school nursing practices focusing on health promotion. The Appearance Validity Index ranged from 0.63 to 1.0, and the total was 0.84. The Content Validity Index ranged from 0.95 to 1.0, and the total was 0.997. CONCLUSIONS the guide incorporated the needs of young people recognized by professionals, and the assessment phase confirms its validity, and can be used in the context of practice with young people.
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Affiliation(s)
- Emanoel Avelar Muniz
- Instituto Federal de Educação, Ciência e Tecnologia do Ceará. Acaraú, Ceará, Brazil,Universidade Estadual do Ceará. Fortaleza, Ceará, Brazil
| | | | | | | | | | | | | | - Valter Cordeiro Barbosa
- Universidade Estadual do Ceará. Fortaleza, Ceará, Brazil,Instituto Federal de Educação, Ciência e Tecnologia do Ceará. Aracati, Ceará, Brazil
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Gereige RS, Gross T, Jastaniah E. Individual Medical Emergencies Occurring at School. Pediatrics 2022; 150:188345. [PMID: 35757966 DOI: 10.1542/peds.2022-057987] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/24/2022] Open
Abstract
Children and adults may face emergency medical situations because of injuries, complications of chronic health conditions, or unexpected major illnesses that occur in schools. The American Academy of Pediatrics published a policy statement in 2001 titled "Guidelines for Emergency Medical Care in Schools," and in 2008, published its revision, "Medical Emergencies Occurring at School." Those statements focused on the preparedness of schools to address individual student emergencies. The increase in the number of children with special health care needs and chronic medical conditions attending schools, together with the added challenges faced by school districts to ensure that schools have access to on-site, licensed health care professionals on an ongoing basis, have contributed to added risks that medical and nonmedical personnel face in dealing with medical emergencies in schools. This newly revised policy statement serves as an update of the statement published in 2008 and reaffirmed in 2017, and intends to increase pediatricians' awareness of schools' roles in preparing for individual student emergencies and provide recommendations for the medical home and school physicians on how to assist and support school personnel. This statement does not address schoolwide or communitywide emergencies that might occur as a result of natural or man-made disasters.
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Affiliation(s)
- Rani S Gereige
- Director of Medical Education, Department of Medical Education, Nicklaus Children's Hospital, Miami, Florida
| | - Toni Gross
- Emergency Medicine, Children's Hospital New Orleans, New Orleans, Louisiana
| | - Ebaa Jastaniah
- Department of Pediatrics, Section of Pediatric Emergency Medicine, Arkansas Children's Hospital/UAMS, Little Rock, Arkansas.,Department of Emergency Medicine, Section of Pediatric Emergency Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
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Shiraishi Y, Ishikawa Y, Shiraishi Y, Matsumura M. Effectiveness of epinephrine auto-injector skill training for school nurses. J Gen Fam Med 2019; 21:30-31. [PMID: 31911888 PMCID: PMC6942934 DOI: 10.1002/jgf2.282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Yuko Shiraishi
- Division of General Internal Medicine Jichi Medical University Hospital Shimotsuke Japan
| | - Yukiko Ishikawa
- Division of General Internal Medicine Jichi Medical University Hospital Shimotsuke Japan
| | | | - Masami Matsumura
- Division of General Internal Medicine Jichi Medical University Hospital Shimotsuke Japan
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Tarr Cooke A, Meize-Grochowski R. Epinephrine Auto-Injectors for Anaphylaxis Treatment in the School Setting: A Discussion Paper. SAGE Open Nurs 2019; 5:2377960819845246. [PMID: 33415240 PMCID: PMC7774401 DOI: 10.1177/2377960819845246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 03/04/2019] [Accepted: 03/23/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction:Anaphylaxis is a serious, life-threatening systemic allergic reaction that may occur in individuals not previously diagnosed with an allergy. Emergency first-line treatment of choice for acute anaphylaxis is intramuscular administration of epinephrine via an auto-injector. In the school setting, students with known allergies typically keep or carry an epinephrine auto-injector (EAI). For students who do not have a known allergy or for those whose personal EAIs are unavailable, an anaphylactic event could have serious adverse outcomes if an EAI is not available via an undesignated stock supply in the school. Methods:We searched the published literature from 2000 through 2018 in CINAHL, MEDLINE, and PubMed using the following search terms: anaphylaxis, school setting, epinephrine auto-injector, and food allergies. Throughout this article, undesignated stock EAIs, stock EAIs, EAI stock, and open-order EAIs are used interchangeably. Conclusion:Anaphylaxis is increasing worldwide as the incidence of food allergies increases. Although stock EAIs for students in schools can have important benefits, the availability of EAIs in the school setting is limited. Barriers to undesignated stock EAIs include the lengthy administrative process for developing school policies and protocols; gaps in nurses' self-perceived knowledge versus objective knowledge on the topic of anaphylaxis; limited resources in many school districts; and complex role demands, lack of confidence in trained staff, or insufficient school nurse staffing. It is important that epinephrine be readily available in schools. Barriers to facilitating stock EAIs include those that can be addressed directly by nurses and those that may require policy changes. Nurses, particularly those working in school settings or pediatrics, could take the lead in discussions about the benefits of stock EAIs in schools, advocating for policy changes as warranted. Fully informed nurses can be better prepared to serve as advocates in ensuring that EAIs are available in school settings.
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Affiliation(s)
- Abigail Tarr Cooke
- Department of Nursing, San Juan College, Farmington, NM, USA
- College of Nursing, University of New Mexico, Albuquerque, NM, USA
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Aktas ON, Kao LM, Hoyt A, Siracusa M, Maloney R, Gupta RS. Implementation of an Allergic Reaction Reporting Tool for School Health Personnel: A Pilot Study of Three Chicago Schools. J Sch Nurs 2018; 35:316-324. [DOI: 10.1177/1059840518777303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Food allergy (FA) impacts 8% of U.S. children, thus it is critical to document allergic reactions to assist schools in managing FAs. We implemented and evaluated an online tool to assist school health personnel in tracking the characteristics of allergic reactions occurring at schools. The Online School Allergic Reaction Registry (OScARR) was modified from the Epinephrine Administration Form developed by the Massachusetts Department of Public Health, adapted for integration into existing school health records, and implemented in three Chicago schools during the 2016–2017 school year. All allergic reactions occurring at participating schools were recorded by school nurses. Twenty-five percent of the 20 allergic reactions reported were characterized as anaphylaxis by school nurses. School nurses reported that they would recommend OScARR for use in other schools. Detailed data obtained from three Chicago schools underscore the importance of proper documentation to improve the understanding of the causative allergen and location and management of allergic reactions in schools.
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Affiliation(s)
- Ozge N. Aktas
- Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lauren M. Kao
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Alice Hoyt
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, TN, USA
| | - Mary Siracusa
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Rebekah Maloney
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Ruchi S. Gupta
- Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
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