School health assistants fall short in anaphylaxis treatment knowledge
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Key takeaways:
- The survey polled school nurses and health assistants at all 39 public schools in Portland, Oregon.
- Questions asked about autoinjector location and timing as well as allergy training.
ANAHEIM, Calif. — Despite training, school personnel may not know how to administer epinephrine to children with anaphylaxis, according to a poster presented at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.
Barriers may impede this training, Maria Wetzel, BA, a medical student at Oregon Health & Science University, told Healio.
“Our goal was to identify knowledge gaps in anaphylaxis management in elementary schools in Portland,” Wetzel said.
Because of the increasing prevalence of food allergies, there is a need for comprehensive training in anaphylaxis care in schools and other nonhospital settings, according to the researchers.
Due to the ages of their students, the researchers continued, elementary schools may depend more on well-trained staff to provide this care.
However, the researchers said, there are no standardized guidelines for allergy management across schools, and few staff who have been trained to handle allergic reactions, inhibiting improvements.
“We adapted a survey from an organization called Code Ana, which works with schools to teach allergy management across the country,” Wetzel said.
The researchers distributed an electronic version of the survey to five school nurses and 25 school health assistants (SHAs) in all 39 elementary schools in the Portland Public School District. School nurses oversee between one and four schools each, and SHAs oversee one school each.
The survey asked these professionals about how often they update their allergy training plans and about anaphylaxis treatment. The results indicated that most schools updated their training plans at least once per year.
Specifically, one SHA (0.04%) and two nurses (16.7%) said they update their plans less than once a year. Also, 13 (52%) SHAs and 10 nurses (83.3%) said they update their plans once a year. Finally, 11 SHAs (44%) but none of the nurses update their plans more than once a year.
Next, the survey asked if the outer thigh or the front thigh was the best location for injecting epinephrine. Nineteen of the 21 SHAs and all five of the nurses said the outer thigh was the best location, which was the correct answer.
“There’s less fat there. That’s the better answer,” Wetzel said. “But we still found some school health assistants got that wrong and selected the wrong area.”
The survey also asked if epinephrine should be given immediately when anaphylaxis occurs. Again, 19 of the 21 SHAs and all five nurses said that epinephrine should be given immediately, which was the correct answer.
“Despite this pretty frequent training, at least once yearly, there’s still gaps in basic knowledge based on epinephrine administration,” Wetzel said. “That’s something we should target with future studies.”
The respondents reported a variety of barriers in training as well. The most common barriers were allotted time for training, staff education, limited numbers of instructors, staff resistance, legalities, parent resistance and funding, among other obstacles.
“A lot of the main barriers that they were able to identify were just not enough time and not enough people to do the training, so I think that is the goal,” Wetzel said.
Courses are available, she continued.
“But I think right now, it’s just having enough staff to be able to provide that training course,” Wetzel said. “That would be the biggest barrier.”
The researchers offered two recommendations as well.
“We were thinking about, in terms of future directions, something that Code Ana has kind of already instituted, but we would like to bring out to the Portland area,” Wetzel said.
First, the researchers suggested short, targeted education sessions and post-education assessments.
“We’re also working on possibly creating posters or graphics that we could put up in classrooms that would better alert the kids to allergic reactions, and how they could manage them,” Wetzel said.