DSHS Update: Focus

on Food Allergy

Guidelines

Anita Wheeler, RN, MSN

School Health Coordinator/School Nurse Consultant

Anita.wheeler@dshs.state.tx.us

512-776-2909

Learn

ing

Obje

ctiv

es

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 GuidelinesTexas Style

Breanna- Age 4 Bryan- Age 6

CornWheat MilkNitrites

(and an aversion to fish)

Senate

Bill 2

7

Key Deadlines of the Bill

• December 1, 2011

• May 1, 2012

• August 1, 2012

Texas Education Code

Chapter 38, Section 38.0151

Texas G

uid

elin

e

Deve

lopm

ent

Review of National Guidelines

Review of Other State

Guidelines

Review of National

Organization(s) Resources

Review of Evidence-based

Practice

Centra

l

Them

es

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 StudentsHouse Bill-742, 82nd Legislative Session

• Amends Texas Education Code, Chapter 25,

by adding Section 25.0022

“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.

Suggest

ed

Str

ate

gie

s to

Identi

fy

Stu

dents

1) Student Handbook (TASB Policy)2) Emergency Care Form3) Specific Form for Food Allergies4) Pre-K and K Round-up and Early

Registration Events5) Other ideas ???

Development of

Care Plans

Food Allergy Action Plan (FAAP)Emergency Action Plan (EAP)Individualized Healthcare Plan (IHP)Section 504 Plan (504)

FAA

P a

nd E

AP

• Developed by the healthcare provider

• Includes information about:

• Specific Student’s Allergy

• Specific foods

• Signs and symptoms

• Treatment and Medications

• Emergency Contacts

• Other information to support the student

IHP a

nd 5

04

Pla

ns

• IHP-Developed by Registered Nurse (LVN can assist but not develop as per Scope of Practice)

• 504 Plan-Developed by district 504 committee

Reducin

g R

isk

of E

xposu

re• Identifying

“high-risk” areas

• Limiting, reducing food in classrooms

• Notifying staff and parents

• Reviewing classroom activities

• Developing procedures for:

• Snack time

• Cleaning

• Classrooms

• Field trips

• Buses

• Hand Washing

Sta

ff T

rain

ing

• 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:• At Least Annually

• After An Allergic Reaction

• 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

Interventi

on Classifications(NIC)

Nursing

Outcome Classifications(NOC)Student Outcomes

National Association of School NursesResearch, Resources and Guidance Documents

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

Delegation

Documentation

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 NursesAsthma 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

http://www.nasn.org/ToolsResources/FoodAllergyandAnaphylaxis

National Association of School Nurses Food Allergy Tool Kit

QUESTIONS?

DSHS Communicable

Disease Chart

Com

munic

able

D

isease

Chart

Updated Chart Due for Dissemination

January/February 2013Rules posted 8/24/2012 for 30 day

Comment Period

Propose

d C

hanges

to th

e R

ule

s/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

(Pro

pose

d)-

New

Report

able

C

ondit

ions

• Amebic meningitis and

encephalitis; • anaplasmosis; • babesiousis; • Chagas’ disease; • shiga-toxin producing

Escherichia coli infection;

• novel influenza; • poliovirus infection, non-

paralytic• Hepatitis E

Oth

er

Propose

d

Changes Changes to “Who

Shall Report”Adds language related

to an Influenza Pandemic

QUESTIONS?

Immunization

Update

Changes

to

Imm

uniz

ati

on

Ava

ilabili

ty

-Increased Accountability to use

vaccines for designated

population in VFCP. (Federal Program)

-Decrease in state funding

-Affordable Care Act

QUESTIONS?