DISCUSSION
This pilot study explored whether a training programme would improve
school staff’s overall self-reported preparedeness in the management of
the child with severe allergies. We moved beyond the focus of other
studies (impact of training on school staff and confidence [16-18; 25;
26]), and assessed the head teacher’s response to policy review and
implementation of preventative measures.
The fact that a number of trained schools, implemented an emergency
management protocol for the first time following the training, confirms
the value of training programmes in supporting schools with and without
registered pupils with allergies (7).
A key element of the emergency management protocol is the storage and
accessibility of the emergency medication (1). During the training,
staff were encouraged to visit the emergency kit location to assess
whether this was the most appropriate should an emergency arise.
Post-training all schools had reviewed the accessibility of the
emergency kit by staff.
Special supervision for children at high risk during meals is one of the
fundamental recommendations for schools (1, 20, 21). As a minimum, young
children with severe food allergies should be supervised by designated
staff member(s) during mealtimes and also during indoor/outdoor
activities (1, 20). This recommendation was adopted by a significant
number of trained schools.
An area of practice which the majority of schools needed to review as a
matter of urgency was the food consumption during pupils’ transfer. A
‘no eating policy on transport to and from school’ (unless medically
necessary) was not in place. Schools seemed to respond to this call
however further reinforcement is required.
Evidence suggests that the ‘no-nut’ policy does not offer additional
protection as it has not been proven to reduce the antigen exposure. In
addition, measures such as a general allergen-ban on their own are
inefficient in preventing anaphylaxis as it is not possible to eliminate
all allergenic foods from the school environment (21). Instead, holistic
approaches to the management of allergies should be encouraged (1). Our
training helped schools improve this holistic approach and they
proceeded to review their ‘no-nut’ policy
Similarly, following training, schools reported that they had started
providing pupils with teaching material and practical skills to
self-manage their allergies. By engaging children as active participants
in the management of their allergies, it is hoped that this may lead
them to develop adaptive behavioural strategies in responsibility taking
and self-management of their condition (22).
Trained schools also seemed to acknowledge the need for regular and
specialised staff training in anaphylaxis. This correlated with
the increased number of requests received by the local allergy services
following training for further support. However school nurses, who would
be the most suitable group of school staff to receive more specialised
allergy training in mananging the needs of the severely allergic child,
have been redeployed to other community posts (23).
Yearly training and practice drills for all school staff are recommended
(1, 6, 21). We have previously reported that schools recognize that
there is a lack of standardization in the management of the pupil with
severe allergies and believe that a national policy along with support
in implementing this are needed to enhance safety at school (7).
Several of the requirements for a safe school environment for children
with allergies have been set out in detail in the recent published
guidance from the Department of Education (6). However very little has
been done to support schools in implementing these measures (19). We
showed that schools require support, guidance, and regular training in
order to feel confident in managing pupils with allergies. Several
schools here reported willingness to implement additional measures to
improve preparedness and agree with the generic provision of AAI.
The majority of the trained schools reported increased confidence and
preparedness in dealing with the severely allergic child, even in pupils
with no previous history of severe allergic reactions. Retention of
knowledge and skills over time were not measured here. It has previously
been reported that levels of self-rated confidence, preparedness, remain
significant after 4-12 weeks follow ups (15) and decline 6 months after
training (14, 24). A combination of yearly face-to-face training with
online training after six months has been recommended before (6). A
clear step by step ‘manual’ that guides school staff and offers
troubleshooting if an issue arises along with face-to-face training for
the implementation of an allergy policy and emergency protocol are
required. This should be generated centrally and made available to all
schools for implementation as mandatory. Schools should be able to prove
their competency towards a safer environment for pupils with allergies;
their performance in this area should be measured yearly and they should
receive constructive feedback along with recommendations for those areas
of practice that require improvement.
We acknowledge a number of limitations in this study. Due to the sample
being small, not all of the areas tested post training reached
statistical significance, however a general trend towards improving
preparedness was observed. The results would have been strengthened by
comparing the intervention group to a control group and by recording
changes in self-reported preparedness over time to assess retention of
knowledge. Lastly, it has been suggested that staff perceived confidence
is a good indicator of the school preparedness in managing severe
allergic reactions (25). However, self-reported confidence and
preparedness may be an ineffective way of measuring actual preparedness
on its own.