Can schools keep spare adrenaline auto-injectors?

From 1 October 2017 the Human Medicines (Amendment) Regulations 2017 will allow all schools to buy adrenaline auto-injector (AAI) devices without a prescription, for emergency use in children who are at risk of anaphylaxis but their own device is not available or not working (e.g. because it is broken, or out-of-date).

The school’s spare AAI should only be used on pupils known to be at risk of anaphylaxis, for whom both medical authorisation and written parental consent for use of the spare AAI has been provided.

The school’s spare AAI can be administered to a pupil whose own prescribed AAI cannot be administered correctly without delay.

Article Contents:

1. How to get a spare adrenaline auto-injector for your school
2. How to store AAIs in school - both spare and prescribed
   1. Spare anaphylaxis kit
   2. Spare asthma kit
   3. AAIs prescribed to pupils
   4. Disposal of used AAIs
3. School Policy and Staff Training
4. Anaphylaxis resources

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How to get a spare adrenaline auto-injector for your school

Schools must provide a written letter on headed school paper when ordering “spare” back-up adrenaline auto-injector devices. In line with legislation, the order must state:

• the name of the school for which the adrenaline auto-injector devices are required;
• the purpose for which that devices are required; and
• the total quantity required for each device.

Download the Department for Health Guidance on the use of adrenalin auto-injectors in schools from the resources below, page 25 has a letter template /sample letter to print on the schools letterhead and use to request a spare adrenalin auto-injector for your school.

AAIs are available in different doses and devices. Schools may wish to purchase the brand most commonly prescribed to its pupils (to reduce confusion and assist with training). Guidance from the Department for Health to schools recommends:

For children age under 6 years:	For children age 6-12 years:	For teenagers age 12+ years:
·  Epipen Junior (0.15mg)       or ·  Emerade 150 microgram    or ·  Jext 150 microgram	·  Epipen (0.3 milligrams)       or ·  Emerade 300 microgram    or ·  Jext 300 microgram	·  Epipen (0.3 milligrams)       or ·  Emerade 300 microgram    or ·  Emerade 500 microgram    or ·  Jext 300 microgram

For more information about the different types of AAI available in the UK read our article: How to use adrenaline auto-injectors like EpiPen, Jext and Emerade

If a school decideds to purchase a "spare" AAI then the school must pay for it. AAIs are not provided for free to schools and there are no funds available to support their purchase. 

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How to store AAIs in school - both spare and prescribed

Spare anaphylaxis kit

Schools with spare AAI's should store them as part of an emergency anaphylaxis kit which should include:

• 1 or more AAI - see tempate letter for how to obtain a spare
• instructions on how to use and store the devices - the manufacturers leaflet which will be included with the AAI will have this information
• a checklist of injectors, identified by their batch number and expiry date with monthly checks recorded along with a record of any use of the devices.

The use of any AAI device must be recorded. This should include:

• Where and when the reaction foor place
• How much medication was given and by whom

Any person who has been given an AAI must be transferred to hospital for futher monitoring. The pupil's parents should be contacted at the earliest opportunity.

The three manuafacturers of EpiPen, Jext and Emerade all offer expiry date reminder services via their websites. It is a good idea to register all the pens stored in school with the relevant reminder services as well as havinf a record held in the emergency anaphylaxis kit.

Spare asthma kit

Schools may wish to keep the emergency kit together with an emergency asthma inhaler kit containing a salbutamol inhaler device and spacer, if the school has chosen to have one.. Many food-allergic children aslo have asthmas, and asthma is a common symptom during food-induced anaphylaxis. Read more about spare asthma inhalers in schools.

AAIs prescribed to pupils

The key thing is that the pupil's AAI is available at all times. Delays in administering adrenaline could be fatal. Guidance from the Spare Pens in Schools website gives the following advice:

"Schools need to ensure they have a proportionate and flexible approach to checking the register, to avoid any delay in using an AAI in an emergency.Curent guidance from the Medicines and Healthcare products Regulatory Agency (MHRA) recommends that 2 AAI devices are prescribed, which patients should have available at all times.In primary schools:

• AAIs should either be kept in the cIassroom, or in a safe and suitably central/accessible location nearby. AAIs should not be located more than 5 minutes away from where they may be needed.
• Pupils/families may forget to send the AAI(s) into school, so schools may find it easier to request AAIs are kept on school premises in term time. However, children at risk of anaphylaxis should always have access to AAI(s), so parents/guardians need to ensure AAI(s) are available for the journey to/from school.
• Healthcare professionals may need to prescribe more than 2 AAIs to pupils: one or two AAIs to be kept with the pupil, and a further device held centrally on the school premises.

In secondary schools:

• Pupils should be encouraged to be independent and keep their own prescribed AAIs with them at all times.
• Some secondary schools may require an additional device to be kept on the school premises, in case pupils forget to bring their AAIs to school. This may be particularly relevant in schools who do not hold “spare” AAIs. Pupils may therefore need to be prescribed an additional AAI to be held centrally on school premises."

Disposal of used AAIs

Adrenaline auto-injectors are designed to be single-use. Once they have been used they must be disposed of safely. They can either be given to the ambulance paramedics or a school can contact their local council to pre-order a sharps bin.

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School Policy and Staff Training

The Department for Health Guidance states that: "Schools must arrange specialist anaphylaxis training for staff where a pupil in the school has been diagnosed as being at risk of anaphylaxis. The specialist training should include practical instruction in how to use the different AAI devices available."

All React First trainers are skilled in the delivery of anaphylaxis training. Our anaphylaxis awareness and AAI (EpiPen) first aid courses cover all of the training requirements of the Resuscitation Council (UK). There are two course options to meet the DforH guidance.

Level 2 Award in Basic Life Support and Anaphylaxis Awareness - for designated members of staff.

Course contents:

• recognition and treatment of severe allergic reactions
• communication and casualty care
• dealing with an unconscious casualty
• different types of auto-injector – Epi-Pen, Jext and Emerade devices
• correct use of an adrenaline auto-injector
• CPR resuscitation – adult and child

The course is fully assessed meaning that all seccessful learners receive a certificate of competence which lasts for three years. Hence this course meets the Department for Education requirements that staff have received suitable training and also that they are competent. The full name of the qualification which is the title on your certificate is: Level 2 Award in Basic Life Support and Anaphylaxis Awareness.

 

First Aid for Schools with Anaphylaxis/EpiPen awareness training - for all staff training

This course is taught at a higher ratio of 1 instructor to 20 attendees. It gives a certificate of attendance and is suitable for staff INSET as part of general first aid training. It covers the D for H guidance that it would be reasonable for ALL staff to:

• be trained to recognise the range of signs and symptoms of an allergic reaction;
• understand the rapidity with which anaphylaxis can progress to a life-threatening reaction, and that anaphylaxis may occur with prior mild (e.g. skin) symptoms;
• appreciate the need to administer adrenaline without delay as soon as anaphylaxis occurs, before the patient might reach a state of collapse (after which it may be too late for the adrenaline to be effective)

Schools should also ensure that all staff:
• be aware of the anaphylaxis policy;
• be aware of how to check if a pupil is on the register;
• be aware of how to access the AAI;
• be aware of who the designated members of staff are, and the policy on how to access their help.

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Anaphylaxis resources

The Spare Pens in Schools website has a lot of free resources and information for schools, pupils and parents: www.sparepensinschools.uk/

Downloads

Download DfH Guidance on the use of adrenaline auto-injectors in schools - Sept 2017

Download DfE Statutory Guidance Supporting Children at School with Medical Conditions

Download a template letter to request a spare AAI

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