The Henderson Repository is a free resource of the HonorSociety of Nursing, Sigma Theta Tau International. It isdedicated to the dissemination of nursing research, research-related, and evidence-based nursing materials. Take credit for allyour work, not just books and journal articles. To learn more,visit www.nursingrepository.org

Item type Presentation

Format Text-based Document

Title Keeping the Child with Food Allergies Safe at School

Authors Spain, Scarlet R.

Downloaded 10-Jul-2018 07:40:03

Link to item http://hdl.handle.net/10755/603042

THE EFFECTS OF AN EVIDENCE-

BASED FOOD ALLERGY

MANAGEMENT PLAN TO KEEP

CHILDREN WITH FOOD

ALLERGIES SAFE AT SCHOOL

Scarlet R. Spain DNP, CNS, FNP-BC

No Disclosures

Objectives

• Identify key factors to

keeping children with

allergies safe

• Understand

recommendations for

school implementation

Background- Prevalence in children has

increased 18% from 1997 to 2007

- 30,000 visits to the emergency room each year related to food allergies

- More than 200 deaths will occur in the US this year from food allergies

PREVALENCE IN CHILDREN HAS INCREASED 18% FROM 1997 (ALLERGY AND ASTHMA FOUNDATION OF AMERICA, 2014)

- One in 13 kids has a food allergy

- Average classroom has 2 kids with food allergies

- 5.9 million kids with food allergies

(Food Allergy Research and Education, 2014)

School Issues

• 84% of children who have food allergies will experience an allergic reaction while at school

• Reactions are unpredictable in nature and severity– A child who experienced a mild

reaction from a food trigger may quickly experience anaphylaxis with secondary exposure (Powers, Bergren, & Finnegan, 2007)

• Literature shows often the child is not prepared with emergency care plan (ECP) or required medications

Evidence-Based

Practice Project

• Project developed for local charter school

– School in Northwest, IN

– 500 students, K to 8th grade

– 18 children with food allergies Spring 2014; 22 children with food allergies enrolled Fall 2014

PICOT

“In the elementary school setting,

how does implementation of a

revised food allergies management

policy affect staff adherence to best

practice recommendations and

students’ episodes of food allergy

reactions over a 4 month period?”

Literature Review

- Conducted to gather evidence

- Sought to identify safety measures related to food

allergy management in school

- Multiple types of evidence was found

Review of

Literature

Key terms used- Food allergy- Food hypersensitivity- Peanut allergy- Education- School- Class- Teacher- School nurse- School health nursing

Inclusion criteria- Less than 10 years old- English language- Peer reviewed

Review of LiteratureDatabase Initial

Articles

Incl/Excl

Criteria

Duplicate

Articles

Final

Articles

JBI 0 0 0 0

Cochrane 0 0 0 0

ERIC 9 4 4 4

CINAHL 10 9 8 8

Health Source

Nur Acad Ed

6 4 2 0

MEDLINE 41 9 6 2

ProQuest 180 5 4 0

Nat Guideline

Clearinghouse

4 0 0 0

Total 14

Levels of EvidenceJohn Hopkins Nursing Evidence-Based

Practice Research Evidence Appraisal & Non-Research Evidence Appraisal Tools

– Level 1: 0 (experimental)

– Level 2: 1 (quasi-experimental)

– Level 3: 9 (non-exp, qual, & metasyn)

– Level 4: 0 (sys reviews & clinical prac

guidelines)

– Level 5: 4 (org, expert opinion, case

study, & lit reviews)

Decision to Change Practice

• Best practice for management of food allergies in the

school setting remains complete avoidance of trigger

foods for the affected child (Carlisle et al., 2010; Cavanaugh &

Strickland, 2011; Gupta, 2014; Weiss et al., 2014).

• Food allergies and anaphylaxis demonstrate a wide

variability in symptoms and triggers. Each student

should have their own emergency care plan available

at all times with required medications (Carlisle et al., 2010;

Cavanaugh & Strickland, 2011).

• Evidence supports staff education regarding food

allergies in school systems (Weiss et al., 2004; Young et al., 2004).

ImplementationSetting and Sample:

–Local charter school

–Children with food allergies in grades K to 8

Theoretical Frameworks:

–Adult Learning Theory & ACE Star Model

Intervention:

–Policy development with educational in-service

Outcomes :

–Primary - Food allergy reactions

–Secondary - Policy compliance

Best Practice Project

Policy Development

– Avoidance

– ECP/ Medication

– Staff Education

Educational In-

Services

• 4 educational in-services were held that educated staff and volunteers. (n=115)– PowerPoint Presentation

– Demo and Return Demo by all participants of two common epinephrine auto-injectors

Primary Outcomes

Comparison of Reactions

Pre Post

Variable M

(SD)

M

(SD)

t df p value

Number

of

Reactions

.2222

(.54832)

.2727

(.76730)

-.234 38 .816

Policy Compliance

Outcome Pre

(n) %

Post

(n) %

X2 p value

ECP on file (15)

83.3%

(20)

91.0%

.519 .471

Recommended ECP

on file

(15)

83.3%

(19)

86.4%

.071 .471

Rec meds available (8)

44.4%

(12)

54.5%

.404 .525

Meds traveled with

student

(1)

.05%

(12)

54.5%

10.831 .001*

Secondary Outcomes

* p < .05

Evaluation of Educational In-Service Likert-type Questions

Survey Item Responses (n) %SD D N A SA

Instructor knowledge (1)0.9% 0 0 (8)7% (93)88.7%

Well developed/ easy to understand.

(1)0.9% 0 (2)1.7% (9)7.8% (90)78.3%

Instructor communication (1)0.9% 0 (2)1.7% (5)4.3% (94)81.7%

Policy was clearly explained (1)0.9% 0 (3)2.6% (13)11.3% (85)73.9%

Identification of the signs of reaction

(1)0.9% 0 (1)0.9% (24)20.9% (76)66.1%

Administration the Auvi-Q auto-injector

(1)0.9% 0 (2)1.7% (11)9.6% (86)74.8%

Administration EpiPen auto-injector

(1)0.9% 0 0 (12)18.3% (89)77.4%

Policy guidelines manageable (1)0.9% (1)0.9% (2)1.7% (21)10.4% (77)67%

Increase in knowledge (1)0.9% (1)0.9% (2)1.7% (17)14.8% (80)69.6%

Increased confidence (1)0.9% (1)0.9% (2)1.7% (26)22.6% (72)62.6%

Responses to Open-ended Evaluation Items

Questions (n) %

1. What did you find most

useful about the

presentation?

Hands on demo of

auto injectors

(34) 29.6%

2. How might the

presentation be

improved?

NA/ No response/

No rec.

(83) 72.3%

3. How will participation

in this pres change how

you deal with the child

with food allergies?

Increased

confidence/ better

awareness

(45) 39.1%

Conclusions

•No significant difference in incidence of

food allergy reactions after policy

implementation

•Adherence to recommended practice

increased after policy implementation

with one parameter, medications

traveled with student, reflecting a

significant difference

•Implementation of policy based on best

practice provides a safer environment for

the child with food allergies

Strengths/ Limitations

• Strengths

- High participation rate

- Use of best practice

recommendations and evidence

• Limitations

– Small sample size

– Short timeframe

Recommendations

•Continue policy monitoring to

assess outcome changes over

longer time period

•Expand policy to include other

schools in system

•Update policy recommendations

with new evidence to reflect most

current guidelines

Acknowledgments

• Valparaiso University

• Sigma Theta Tau

International- Zeta Epsilon

Chapter

*Special Dedication to Lilly Spain*

Questions & Answers…

ReferencesAbbott, C., Dremsa, T., Stewart, D., Mark, D., & Swift, C. (2006). Adoption of a Ventilator-

associated pneumonia clinical practice guideline. Worldviews on Evidence-Based Nursing, 3, 139-152.

Academic Center for Evidence Based Practice (ACE). (2012). University of Texas Health

Science Center. Retrieved from www.acestar.uthscsa.edu

Bonis, S., Taft, L., & Wedler, C. (2007). Strategies to promote success on the NCLEX-RN: An evidence-based approach using the ACE star model of knowledge transformation. Nursing Education, 28, 82-87.

Centers for Disease Control and Prevention. (2013). Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs. Washington, DC: US Department of Health and Human Services.

Carlisle, S., Vargas, P., Noone,S., Steele, P., Sicherer, S., Burks, W., & Jones, S.(2010). Food allergy education for school nurses: A needs assessment survey by the consortium of food allergy research. The Journal of School Nursing, 26 (5). 360-367.

Cavanaugh, R. & Strickland, J. (2011). Research to practice: Developing an integratedanaphylaxis education curriculum for school nurses. The Journal of School Nursing, 27 (3), 197- 208.

Fineout-Overholt, E., Stillwell, S., Williamson, K., Cox, J., & Robbins, B. (2011). Teaching evidence-based practice in academic settings. In Melnyk, B. M., & Fineout-Overholt, Evidence-based practice in nursing and healthcare.(2nd ed.), (pp. 291-329). Philadelphia, PA: Lippincott Williams & Wilkins

Food Allergy and Anaphylaxis Network. (2010). School food allergy program. Retrieved from http://www.foodallergy.org/school.html.

Food Allergy and Anaphylaxis Network. (2014). Resources for Kids. Retrieved from www.foodallergy.org/resources/kids

Food Allergy Research and Education (FARE). (2014). Emergency action plan. Retrieved from http://www.foodallergy.org/document.doc?id=234 .

Food Allergy Research and Education (FARE). (2014). Keeping children with food allergies safe at school. Retrieved from http://www.foodallergy.org/document.doc

Gupta, R. (2014). Anaphylaxis in the young adult population. The American Journal of Medicine,

127(1), S17-S24.

Houle, C., Leo, H., & Clark, N. (2010). A developmental, community, and psychosocial Approach

to food allergies in children. Current Allergy and Asthma Reports, 10, 381-386.

INFED. (2014). Malcolm Knowles, informal adult education, self-direction and

andragogy. Obtained from http://infed.org/mobi/malcolm-knowles-informal-adult-education-

self- direction-and-andragogy

International Food Information Council (IFIC). (2008). IFIC-SNA 2008 school food allergy survey:

Having a food allergy plan is key to prevention, p. 2-6.

Jackson, V. (2013). School nurse’s role in supporting food allergy safe schools. NASN School

Nurse, 28, 76-77.

John Hopkins Nursing Evidence Based Practice Tool. (n.d). Retrieved from

http://www.nursingworld.org/ research-toolkit/johns-hopkins-nursing-evidence-based-

practice

Knowles, Malcolm. (1973). The adult learner: A neglected species. Madison, WI: Gulf.

McIntyre, C., Sheetz, A., Carroll, C., & Young, M. (2005). Administration of epinephrine for life-

threatening allergic reactions in school settings. Pediatrics, 116 (5),1134-1140.

Munoz-Furlong, A. (2004). Food allergy in schools: Concerns for allergists, pediatricians, parents,

and school staff. The Food Allergy & Anaphylaxis Network, 93, S47-S50.

Neilson, W. & Lindsey, K. (2010). When there is no school nurse- Are teachers prepared for

students with peanut allergies?, School Nurse News, 27 (1), 12-5.

Papageorgiou, P. (2002). Plant food allergens: Clinical aspects of food allergy. Biochemical

Society Transactions, 30 (6), 901-906.

Powers, J., Bergren, M., & Finnegan, L. (2007). Comparison of school food allergy

emergency plans to the food allergy and anaphylaxis network’s standard plan. The

Journal of School Nursing, 23, 252-257.

.

Pulcini J., Marshall, G., & Naveed, A. (2011). Presence of food allergy emergency action plans in Mississippi. Annals of Allergy, Asthma and Immunology, 107, p. 127-132

Pulcini, J., Sease, K., & Marshall, G. (2010). Disparity between the presence and absence of food allergy action plans in one school district. Allergy and Asthma Proceeding, 31,141-146.

Shah, S., Parker, C., & Davis, C. (2013). Improvement of teacher food allergy knowledge in socioeconomically diverse schools after educational intervention. Clinical Pediatrics 52(9), 812-820.

Sicherer, S., Noone, S., & Munoz-Furlong, A. (2004). The impact of childhood food allergy on quality of life. Annuals of Allergy, Asthma and Immunology, 87, 461-464.

Twycross, A. (2002). Education nurses about pain management: The way forward, Journal ofClinical Nursing, 11, 705-714.

Wahl, A., Stephens, H., Ruffo, M., & Jones, A. (2014). The evaluation of a food allergy and epinephrine auto injector training program for personnel who care for children in schools and community settings. Journal of School Nursing, Obtained from

http://www.ncbi.nlm.nih.gov/pubmed

Weiss, C., Munoz-Furlong, A., Furlong, T., & Arbit, J. (2004). Impact of food allergies on school nursing practice. The Journal of School Nursing, 20 (5), 268-278.

Young, M. Munoz-Furlong, A, & Sicherer, S. (2009). Management of food allergies in schools: A perspective for allergists. American Academy of Allergy, Asthma & Immunology, 124, 175-182.