DSHS Update: Focus on Food Allergy Guidelines Anita Wheeler, RN, MSN School Health Coordinator/School Nurse Consultant

Learning Objectives The Learner will be able to: 1) Evaluate the impact of the TX Food Allergy Guidelines for care of students at risk for anaphylaxis related to food allergy on the policy/procedures of the nurse’s school/district. 2) Evaluate the impact of revised communicable disease rules for schools related to exclusion/re-entry procedures for the nurse’s school/district. 3) Analyze the impact of increased federal accountability and decreased state funding on student immunization access.

Texas Food Allergy Guidelines Texas Style

Breanna- Age 4 Bryan- Age 6 Corn Wheat Milk Nitrites (and an aversion to fish)

Senate Bill 27 Key Deadlines of the Bill December 1, 2011 December 1, 2011 May 1, 2012 May 1, 2012 August 1, 2012 August 1, 2012 Texas Education Code Chapter 38, Section

Texas Guideline Development Review of National Guidelines Review of Other State Guidelines Review of National Organization(s) Resources Review of Evidence-based Practice

Central Themes Identification of Students Development of IHPs, 504 Plans, ECPs Reducing the Risk of Exposure Training of Staff Evaluation of Food Allergy Policies and Procedures

Identifying Students House Bill-742, 82 nd Legislative Session Amends Texas Education Code, Chapter 25, by adding Section “On enrollment of a child in a public school, a school district shall request, by providing a form or otherwise, that a parent or other person with legal control of the child…. (1) disclose whether the child has a food allergy or a severe food allergy….. (2) specify the food to which the child is allergic and the nature of the allergic reaction.

Suggested Strategies to Identify Students 1)Student Handbook (TASB Policy) 2)Emergency Care Form 3)Specific Form for Food Allergies 4)Pre-K and K Round-up and Early Registration Events 5)Other ideas ???

Development of Care Plans Food Allergy Action Plan (FAAP) Emergency Action Plan (EAP) Individualized Healthcare Plan (IHP) Section 504 Plan (504)

FAAP and EAP Developed by the healthcare provider Developed by the healthcare provider Includes information about: Includes information about: Specific Student’s Allergy Specific Student’s Allergy Specific foods Specific foods Signs and symptoms Signs and symptoms Treatment and Medications Treatment and Medications Emergency Contacts Emergency Contacts Other information to support the student Other information to support the student

IHP and 504 Plans IHP-Developed by Registered Nurse (LVN can assist but not develop as per Scope of Practice) IHP-Developed by Registered Nurse (LVN can assist but not develop as per Scope of Practice) 504 Plan-Developed by district 504 committee 504 Plan-Developed by district 504 committee

Reducing Risk of Exposure Identifying “high-risk” areas Identifying “high-risk” areas Limiting, reducing food in classrooms Limiting, reducing food in classrooms Notifying staff and parents Notifying staff and parents Reviewing classroom activities Reviewing classroom activities Developing procedures for: Snack time Cleaning Classrooms Field trips Buses Hand Washing

Staff Training Awareness Training Overview of Food Allergies Signs and Symptoms Treatment of Anaphylaxis Comprehensive Training Strategies for Identifying Students Signs and Symptoms of Anaphylaxis Implementing FAAPs and EAPs Development of IHPs and 504 Plans Communication Procedures for Emergency Response Environmental Control Strategies Coordinating with Local Emergency Medical Services Post Anaphylaxis Debriefing and Management of the Food Allergy Management Plan for the School

Policy and procedures should be reviewed: Policy and procedures should be reviewed: At Least Annually At Least Annually After An Allergic Reaction After An Allergic Reaction When the Science Changes in the Care or Treatment of Anaphylaxis When the Science Changes in the Care or Treatment of Anaphylaxis Post Anaphylaxis Reaction Review of Policies and Procedures

Development of the Individualized Healthcare Plan

Nursing Diagnosis NANDA-I Nursing Intervention Classifications (NIC) Nursing Outcome Classifications (NOC)

National Association of School Nurses Research, Resources and Guidance Documents

Nursing Intervention Classifications (NIC) Nursing Intervention Classifications (NIC) Comprehensive Research based Reflects current clinical practice Easy to use (Domains, Classes, Interventions, Activities all have definitions) Uses language that is clear and meaningful Continually updated Field tested

Nursing Interventions for School Nurses Allergy Management Anticipatory Guidance Asthma Management* Calming Technique Caregiver Support Crisis Intervention DelegationDocumentation Emergency Care Emotional Support Family Involvement Promotion Health Education Health Screening Medication Administration Medication Management Nutritional Counseling Parent Education Referral Self-efficacy enhancement Teaching: Individual Telephone: Consultation Vital Signs Monitoring Wound Care

Nursing Outcome Classifications (NOC) Developed inductively and deductively Grounded in clinical practice and research Uses clear, useful language Helps in organizing outcome measures Outcomes can be shared by all disciplines Optimizes information for evaluation of effectiveness. Funded by the National Institute of Nursing Research Page 21

Nursing Outcome Measures for School Nurses Asthma Self- management Compliance behavior- diet and medication Diabetes Self- management Immunization behavior Knowledge: Asthma, Diabetes, Diet, Weight Management * Neurological Status Nutritional Status Personal Autonomy Physical Fitness Respiratory Status Risk Control: Alcohol, Drugs, Sun Exposure, Tobacco Use Self-Esteem Sensory Function: Vision/Hearing Social Interaction Skills Social Involvement Student Health Status Vital Signs

National Association of School Nurses Food Allergy Tool Kit

DSHS Communicable Disease Chart

Communicable Disease Chart Updated Chart Due for Dissemination January/February 2013 Rules posted 8/24/2012 for 30 day Comment Period

Proposed Changes to the Rules/Chart Definition Temperature 100° F Definition Diarrhea 3 or more loose stools in 24 hour period Definition “Fever Free” Head Lice- No longer excludable condition

(Proposed)-New Reportable Conditions Amebic meningitis and encephalitis; Amebic meningitis and encephalitis; anaplasmosis; anaplasmosis; babesiousis; babesiousis; Chagas’ disease; Chagas’ disease; shiga-toxin producing Escherichia coli infection; shiga-toxin producing Escherichia coli infection; novel influenza; novel influenza; poliovirus infection, non- paralytic poliovirus infection, non- paralytic Hepatitis E Hepatitis E

Other Proposed Changes  Changes to “Who Shall Report”  Adds language related to an Influenza Pandemic

Immunization Update

Changes to Immunization Availability -Increased Accountability to use vaccines for designated population in VFCP. (Federal Program) -Decrease in state funding -Affordable Care Act