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Epinephrine Use in Schools for Food-Induced Anaphylaxis
Saturday, March 5, 2016
South Exhibit Hall H (Convention Center)
Angela Tsuang, MD, MSc, Haidi Demain, Kathleen Patrick, RN, Michael Pistiner, MD MMSc, Julie Wang, MD FAAAAI
Rationale: This study aims to assess epinephrine use in schools to treat food-induced anaphylaxis.  

Methods: An anonymous questionnaire was distributed to all attendees at the Colorado school nurse training sessions in spring of 2015.  Chi-squared test was used to compare proportions (STATA11). 

Results: 201 of 261 surveys were completed (77% response).  Most of the nurses had 1-5 years of experience (26%) or 6-10 years (26%).  40% of nurses covered 5 or more school buildings, and 9% reported epinephrine being given at least once by unlicensed staff.

In the 2014-2015 school year, 5% reported epinephrine was given by unlicensed staff at least once in schools with one nurse covering <5 buildings.  In contrast, significantly more unlicensed staff members administered epinephrine at least once (14%) in schools with one nurse covering 5 or more buildings (p=0.027).  The proportion of nurses covering 5 or more school buildings was similar among the rural, suburban and urban settings.  There was no significant difference in the proportion of schools where epinephrine was given by unlicensed staff at least once among the 3 settings (p=0.084).

The majority of nurses reported that school staff received anaphylaxis training (81%); however 63% reported that the staff received training for only < 30 minutes.  Nurses felt that in-person training (79%) and hands-on demonstration (56%) are the most effective. 

Conclusions: Schools with a high building to nurse ratio had significantly more unlicensed staff members administering epinephrine.  Training should be extended to non-nursing staff in the form of hands-on training in order to increase student safety.