Massachusetts developed guidelines for managing severe food allergies in schools. In response to parent concerns, the state department of education engaged organizations in a collaboration to create guidance for safe school environments and to help schools use a team approach. The needs were to help staff understand food allergy management in school, including how to identify students at risk, procedures to prevent inadvertent exposure to allergens, appropriate emergency response, and staff education.

Existing regulations included rules permitting nurse delegation of administration of epinephrine by auto-injector to trained unlicensed personnel.  A network of schools was already reporting medication administration activities including the numbers of students with emergency kits at school. The department of health had previously prepared regulations that permitted school nurses to train staff in the handling and use of auto-injectors, developed a training curriculum for nurses to use and encouraged districts to register for training of unlicensed staff; however, few schools participated.

As a result of a collaborative process, the group prepared user-friendly guidelines that covered the role of schools in managing life-threatening food allergies, team planning (including individualized health care plans), strategies to prevent inadvertent exposure, and emergency responses. Support materials included the curriculum for training staff to administer epinephrine and roles of specific parties (parents, students, nurse, etc). The guidelines recommended that a school with a student at high risk be staffed with a full-time nurse.

The guidelines were released at well-attended regional education sessions. The number of schools registering to have staff trained to administer the auto-injected epinephrine increased by 73% in the first year (still short of the 100% goal).  Informally, nurses appreciate having standards on which to base care plans and administrators reported increased understanding of the need for school policies and preparation.  Recently the health department drafted regulations to require reporting of cases when epinephrine is administered at school to monitor the prevalence of anaphylaxis.

(Sheetz A. et al. J Sch Health. 2004;74(5):155-160)

Comment:  The 84-page document can be downloaded from the state education agency’s nutrition program at www. doe.mass.edu/cnp/2002/news/allergy.pdf.  The inclusive process used is similar to a school health advisory body which is a model for addressing many school health issues.       --J.O.