Comprehensive Policy Analysis: Epinephrine Use and

Supply in Florida Schools

Dianne Mennitt

NGR 6897L

Learning Objectives

• Synthesize the evolving federal and state legislation related to epinephrine use and supply in Florida schools

• Analyze proposed policy development process for implementation of approved legislation

• Consider stakeholder risks and benefits • Plan for policy adoption through

interprofessional collaboration

2004 Federal Legislation

• Congress passed House Resolution (H.R.) 2023: Asthmatic Schoolchildren’s Treatment and Health Management Act

• This federal law (Public Law No: 108-377) gives preference in awarding certain federal grants to states that allow students to self-administer medication for asthma and anaphylaxis

2005 Epinephrine Legislation in Florida

• The 2005 Florida Legislature amended section 1002.20, Florida Statutes (F.S.), to give public school students the right to carry and self-administer an epinephrine auto-injector if the school has been provided with parent and physician authorization

Epinephrine Policy Development in Florida

• A provision of the 2005 epinephrine legislation provided the State Board of Education and the Department of Health with joint rulemaking authority for the use of epinephrine auto-injectors at school

• Rule 6A-6.0251, Florida Administrative Code (F.A.C.), was promulgated in order to implement the epinephrine legislation (i.e., Kelsey Ryan Act)

• The Florida Department of Education, working in partnership with the Department of Health as well as public and private stakeholders, developed a technical assistance paper (TAP, 2006) to provide guidance to school districts for the development of local policy and procedures for the care of students with life-threatening allergies in accordance with the Kelsey Ryan Act and Rule 6A-6.0251, F.A.C.

2010 Federal Legislation

• Congress passed H.R. 2751: FDA Food Safety Modernization Act (Public Law No: 111-353)

• A provision in this legislation directs the Secretary of Health and Human Services to develop voluntary food allergy and anaphylaxis management guidelines for schools and early childhood education programs

2013 Epinephrine Legislation in Florida

• The 2013 Florida Legislature amended sections 1002.20 & 1002.42, F.S. to allow public and private schools the OPTION to purchase and maintain a supply of epinephrine auto-injectors from a “wholesale distributor” licensed in Florida, as defined in section 499.003, F.S.

2013 Epinephrine Legislation Provisions…

• Requires participating school districts and private schools to adopt a protocol by a physician

• Requires the school-supplied epinephrine auto-injectors to be maintained in a locked location

• Allows an authorized student to self-administer an auto-injector that was purchased by the school

2013 Epinephrine Legislation Provisions in Florida

• Requires training for school personnel to recognize when a student is having an anaphylactic reaction

• Allows trained school personnel to administer an epinephrine auto-injector without parent authorization

• Removes school employees’ liability arising from administration of an epinephrine auto-injector and removes liability from the physician who developed the epinephrine protocol

Epinephrine WorkgroupName/Agency Email Address

Julie BaconEmergency Medical Services for Children (EMSC) Advisory Committee Chairperson

  JulielBacon@aol.com

Heather DiamondCoordinator, USF Student Support Services Project

  hdiamond@usf.edu

Jessica HoagCitrus Student Health Specialist

 HoagJ@citrus.k12.fl.us

Peggy HowlandFDOH School Health Services Program Supervisor

  Peggy_Howland@doh.state.fl.us

Phillip JohnsonFlorida Pharmacist

 johnsonp44@gmail.com

Melissa KeaheyEMSC Program Manager

 Melissa_Keahey@doh.state.fl.us

Amanda KraftOsceola Supervisor of Health Services

 Krafta@osceola.k12.fl.us

Dianne MennittUSF Student ServicesFSU DNP Student

  dmennitt@usf.edu

Jamie WarringtonFDOE/School Transportation

 Jamie.Warrington@fldoe.org

Barbara WilliamsUSF Student Services

 williams5@usf.edu

Epinephrine Workgroup Topics…

• Development of sample protocol and algorithm

• School personnel training issues and recommendations

• Parent notification to explain epinephrine• Clarification of legislative intent regarding

the use of stock epinephrine auto-injectors

Epinephrine Workgroup Topics

• Medication issues related to the donation, purchasing, storage, expiration date, and exchange program

• Linkages to Emergency Medical Services (EMS) system at the local level

• Involvement of the Florida Poison Network as a reporting system for anaphylactic situations and/or when an epinephrine auto-injector was administered in the school setting

Epinephrine Workgroup

Communication

National Guidelines

Position Statement

Tool Kit

School Nurses: Partnering to Prevent & Respond to Anaphylaxis Video Series

Online Get Trained Program

Epinephrine Training Materials

Epinephrine Resource School Nurse Program

2013 Federal Legislation

• Congress passed H.R. 2094: School Access to Emergency Epinephrine Act that President Obama signed into law on November 13, 2013

• This federal law (Public Law No: 113-48) gives preference in awarding certain federal grants to states that allow students to self-administer medication for asthma and anaphylaxis that includes civil liability protection for trained school personnel who administer epinephrine to a student reasonably believed to be having an anaphylactic reaction

National Association of State Boards of Education

Federal & State Epinephrine Legislation Timeline

Questions/Comments?

References…Centers for Disease Control and Prevention. (2013). Voluntary Guidelines for

Managing Food Allergies in Schools and Early Care and Education Programs. Retrieved from

http://www.cdc.gov/healthyyouth/foodallergies/

Chapter 2005-75. House Bill No. 279. (2005). Retrieved

from http://laws.flrules.org/files/Ch_2005-075.pdf

Chapter 2013-63. (2013). Committee Substitute for Senate Bill No. 284. Retrieved from http://laws.flrules.org/2013/63

Definitions of terms used in this part. (2013). Section 499.003, Florida Statutes. Retrieved from http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0499/Sections/0499.003.html

Florida Department of Education. (2013). Department of Public Schools Memo: 2013-83. 2013 Legislation: Senate Bill 284. Retrieved from https://asset1.basecamp.com/1797070/projects/3950242-epinephrine/attachments/54622651/EpinephrineMemo.pdf

References…

Implementing the Kelsey Ryan Act, Technical Assistance Paper. (2006). Retrieved from

http://www.fldoe.org/ese/pdf/y2006-7.pdf

National Association of School Nurses. (2012). Allergy/ Anaphylaxis Management in the School Setting. Retrieved from

https://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNPositionStatementsFullView/tabid/462/ArticleId/9/Allergy-Anaphylaxis-Management-in-the-School-Setting-Revised-June-2012

National Association of School Nurses. (2012). Get Trained Program. Retrieved from https://www.nasn.org/ToolsResources/FoodAllergyandAnaphylaxis/GetTrained

National Association of School Nurses. (2013). Food Allergy and Anaphylaxis Tool Kit. Retrieved from

https://www.nasn.org/ToolsResources/FoodAllergyandAnaphylaxis

References…

National Association of School Nurses. (2013). Epinephrine Resource School Nurse Program. Retrieved from

https://www.nasn.org/ToolsResources/FoodAllergyandAnaphylaxis/EpinephrineResourceSchoolNurseProgram

National Association of School Nurses. (2013). Saving Lives at School: Anaphylaxis and Epinephrine. Retrieved from

http://portal.nasn.org/media/SavingLivesatSchool_Handbook.pdf

National Association of School Nurses. (2013). School Nurses: Partnering to Prevent & Respond to Anaphylaxis. Retrieved from

https://www.nasn.org/ToolsResources/FoodAllergyandAnaphylaxis/SNPPRA/episode1

National Association of State Boards of Education [NASBE]. (2013). Anaphylaxis and Schools: Developing Policies for Treating Students with

Severe Allergic Reactions. Retrieved from http://www.nasbe.org/wp-content/uploads/Anaphylaxis-Discussion-Guide_10-30-13.pdf

References…National Institutes of Health [NIH] National Institute of Allergy and Infectious Diseases [NIAID]. (2010). Guidelines for the Diagnosis and Management of Food Allergy in the United States. Retrieved from http://www.niaid.nih.gov/TOPICS/FOODALLERGY/CLINICAL/Pages/default.aspx Public Law 108-377, H.R. 2023 (2004). Retrieved from http://www.gpo.gov/fdsys/pkg/PLAW-108publ377/content-detail.html Public Law 111-353, H.R. 2751 (2011). Section 112, Food Allergy and Anaphylaxis Management. Retrieved fromhttp://www.gpo.gov/fdsys/search/pagedetails.action?st=Public+Law+111-353+%282011%29&granuleId=&packageId=PLAW-111publ353

Public Law 113-48, H.R. 2094 (2013). School Access to Emergency Epinephrine Act. Retrieved from http://beta.congress.gov//bill/113th-congress/house-bill/2094/text

The Florida House of Representatives. (2005). Student and Parent Rights Bill Analysis. Retrieved from http://archive.flsenate.gov/data/session/2005/House/bills/analysis/pdf/h0279e.EDC.pdf

ReferencesThe Florida Senate. (2013). Student Safety Bill Analysis and Fiscal Impact

Statement. Retrieved from http://www.flsenate.gov/Session/Bill/2013/0284/Analyses/uQ1/lIDw4knz4BTdylulPnTcHzw=|14/Public/Bills/0200-0299/0284/Analysis/2013s0284.ms.PDF

Russell, A.F. & Huber, M.M. (2013). Food allergy management in elementary school: Collaborating to maximize student safety. Journal of

Asthma & Allergy Educators, 4(6), 290-304. doi:10.1177/2150129713486671

Use of Epinephrine Auto-Injectors. (2008). Rule 6A-6.0251, Florida Administrative Code. Retrieved from

https://www.flrules.org/gateway/ruleNo.asp?id=6A-6.0251