TAM (Treatments and Medicines) NHS Highland
General Practitioners (GPs)
Assessment and Diagnosis:
- Conduct initial assessments and take allergy-focused clinical histories as per NICE, ALLERGY (Paediatric Guidelines) and CYANS Guidelines.
GPs are generally NOT expected to undertake allergy testing like SPT or specific IgEs.
Referral
- Appropriate referral of children with suspected food allergies to: General Paediatrics and or Paediatric Dieticians as per: ALLERGY (Paediatric Guidelines)
Prescription / Training:
- Antihistamines
- If indicated, especially if history of anaphylaxis, prescribe adrenaline autoinjectors (2 for carers and 2 for nursery / school) and ensure parents and caregivers are trained and understand their use. See: Primary-Health-Professionals-Risk-Assessment-for-Prescribing-an-AAI.pdf
If AAI is initiated in primary care, it is primary care responsibility to undertake training at point of contact and not wait for a Paediatric outpatient appointment.
Management:
- Provide parents with written information (an emergency allergy action plan). Example: Paediatric Allergy Action Plans - BSACI
- Advise on avoidance and refer to Paediatric Dieticians.
Follow-up:
- At usual routine booking of patients, at their request.
Transition to adult Life:
- Currently no service exists for transition, this would occur at the request of parents or young people at usual routine bookings.
GP Practice Nurses
Support in Diagnosis:
- Assist GPs in taking clinical histories and conducting preliminary assessments.
Education and Training:
- At GP request, provide training to parents and children on the correct use of adrenalin autoinjectors. Eg, opportunistically, at time of routine bookings or as internally agreed.
- As a minimum, enquire with parents at routine appointments if they are in need of a refresher on the use of adrenalin autoinjectors and direct carers to online resources.
Paediatricians
Specialist Assessment:
- Conduct detailed assessments for complex cases referred by GPs.
Management Plans:
- Develop comprehensive management plans (including written emergency action plans) for children with confirmed food allergies and communicate these to GPs and parents.
Training:
If AAI is initiated in the hospital or outpatient Paediatric clinics.
- Provide training to parents on managing severe allergic reactions, the use of adrenaline auto injectors and provide allergy action plans.
Follow up:
- Once Diagnosis is confirmed / finalised: discharge to GP with a clear plan.
- Coordinate with other healthcare providers to ensure a cohesive approach to the child’s care.
Community Pharmacists
Dispensing:
- Dispense prescribed adrenaline autoinjectors and provide advice on their storage and use.
- Fulfil signed orders from schools to supply adrenaline autoinjectors as per Highland Council guidance.
Education:
- At the time of dispensing, pharmacists to enquire with parents if they need refresher training on the use of adrenaline autoinjectors.
- Those pharmacists who are trained could offer training (opportunistically) for parents and caregivers on the use of adrenaline.
- As a minimum, always direct parents / carers to online training resources.
Support:
- Act as a point of contact for any medication-related queries and provide support.
Teachers and Education Authorities (Highland Council)
Identification and Management:
- Identify children with food allergies and ensure their needs are documented in Individual Healthcare Plans (IHPs).
- Request parents to share information (with Educational and Catering services in schools) .
- Request parents to pass on any emergency written allergy action plan issued by a GP or a Paediatrician.
The NHS has NO capacity to renew written emergency allergy plans: they will ONLY be re-issued if there is a clinical change in the child’s allergens or medications.
Training:
- Ensure all school staff are periodically trained in recognizing allergic reactions and administering adrenaline autoinjectors.
Emergency Response:
- Develop and implement emergency response plans for allergic reactions, including:
- easy access to the devices
- Ensure spare adrenaline autoinjectors are purchased, appropriately stored and in date.
- Ensure Food and Catering policies, including advice on avoidance of allergens, but also incidents reporting and investigations are documented and learnt from.
Communication:
- Maintain open communication with parents, healthcare providers, and the child to ensure a safe school environment.
Note: NHS Staff will not fill school administrative forms or questionnaires related to allergy. It’s the schools’ and parents’ responsibility to share such information.
Hospital Pharmacists and Children’s Ward / Day case Nurses
Medication Management:
- Ensure the availability and proper storage of adrenaline autoinjectors within the hospital.
Education and Training:
- Provide training, to parents of admitted children and those who attend day case and Paediatric outpatient clinics, on the use of adrenaline autoinjectors and management of allergic reactions.
Support:
- Assist in the development of hospital protocols for managing food allergies and anaphylaxis.
Coordination:
- Work with paediatricians and other healthcare providers to ensure seamless care for children with food allergies.
GP Practice Pharmacy Teams
Medication Review:
- Conduct regular reviews of prescribed medications, including adrenaline autoinjectors, to ensure they are up-to-date, are the right dose for age / weight and are used correctly.
- Check for potential drug interactions.
Patient Education:
- At the time of issuing / dispensing, pharmacy team member to enquire with parents if they need of a refresher training on the use of adrenaline autoinjectors.
- Those who are trained, could offer training (opportunistically) for parents and caregivers on the use of adrenaline.
- As a minimum, always direct parents or caregivers to online training resources.
Parents
Education and Training:
- Attend training sessions on recognizing allergic reactions and the correct use of adrenaline autoinjectors.
Management:
- Ensure that the child’s adrenaline autoinjectors is always accessible and within its expiry date.
Communication:
- Maintain open communication with healthcare providers, school staff, catering services and other caregivers about the child’s allergy management plan.
Emergency preparedness:
- Be prepared to act quickly in case of an allergic reaction, including administering the adrenaline autoinjectors and seeking emergency medical help.
Support:
- Provide emotional and practical support to the child, helping them understand and manage their food allergies.
Training and Education
Initial Training:
- All professionals involved should receive periodic training on food allergies and the use of adrenaline autoinjectors, following NICE Guideline GG116: Food allergy in under 19s: assessment and diagnosis.
Ongoing Education:
- Regular refresher courses and updates on best practices should be provided to ensure all staff remain competent in managing food allergies.
- There should be a system to record the training, accreditation, and re-accreditation of the trainers.
Monitoring and Review (all services)
Regular Audits:
- Conduct regular audits of the service to ensure compliance with the guideline and identify areas for improvement.
Feedback Mechanism:
- Establish a feedback mechanism for parents and caregivers to report any issues or suggestions for the service.
By adhering to this guideline, the collaborative efforts of all involved professionals and agencies will ensure a comprehensive and effective food allergy service for children in the area.