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Form 9: School Health Care Plan
Severe Allergies
This plan should be completed by the pupil’s parent/carer and approved by the hospital consultant/specialist nurse/GP. (A letter detailing medication/care and signed by the hospital consultant/specialist nurse or GP can replace this signature.) Once completed, the parent/carer is responsible for taking a copy of this School Health Care Plan to all relevant hospital/GP appointments for updating.
City of Edinburgh Council and NHS Lothian Page 2 of 6
Form 9: School Health Care Plan
Severe Allergies
City of Edinburgh Council and NHS Lothian Page 3 of 6
Form 9: School Health Care Plan
Severe Allergies
The pupil may present with some of the following symptoms: behaviour change, less responsive or confused vomited within 30 minutes. (Continue 4 hourly for 24hrs.) As per action flow chart. 2–10 puffs via spacer, 2 puffs initially then 1 puff per minute.
As per action flow chart.
Parent/carer, please consult your GP when your child has reached 30kg as they will require the adult adrenaline pen.
City of Edinburgh Council and NHS Lothian Page 4 of 6
Form 9: School Health Care Plan
Severe Allergies
Details of emergency care: Follow instructions as per flow chart attached School Management of Severe Allergies (Anaphylaxis) All school staff, supply teachers, visiting teachers and support staff should be made aware of severe allergies and anaphylaxis and the emergency care procedures.
Involved staff will know about the School Health Care Plan. In primary schools, one adrenaline pen will be kept in a zipped ‘poly pocket’, with the Emergency Care Flow Diagram, in the pupil’s classroom. Another adrenaline pen will be kept, with an Emergency Care Flow Diagram in a central, easily accessible place.
In secondary schools, the pupil will carry one adrenaline pen with another adrenaline pen kept in a central, easily accessible place with an Emergency Care Flow Diagram. Emergency Care Flow Diagrams should also be kept in the register folder in each classroom.
It is the responsibility of the parent/carer to ensure that: Medication is supplied to the school.
It is collected at the end of each academic year.
All medication has the original pharmacy label attached stating: the pupil’s name, date of birth and dose.
The class register should be clearly marked to indicate pupils with severe allergies so that when a supply teacher takes a class she/he is aware of any pupils with severe allergies in that class.
Consideration of a pupil’s allergies will be made with regard to classes to be attended, eg food preparation or use of certain materials in science.
City of Edinburgh Council and NHS Lothian Page 5 of 6
Form 9: School Health Care Plan
Severe Allergies
and its contents agreed by the undersigned.
Parent/carerI wish my child to have the medication/care detailed in this plan and I accept that the emergency services will be summoned as required in the event that the school staff are unable to administer the plan at any time where appropriate.
Pupil (if appropriate) I agree to the care arrangements as detailed in this plan.
The head teacher/designated member of staff I agree to the procedures detailed in this plan being administered in school. The medication will be administered by staff who have attended a Severe Allergy Management session within the last two years. In the event that these procedures cannot be implemented at any time the school will follow advice received from the health professionals in summoning the emergency services as appropriate.
copies held by parent/carer and head teacher.
City of Edinburgh Council and NHS Lothian Page 6 of 6
Form 9: School Health Care Plan
Severe Allergies
and its contents agreed by the undersigned.
Parent/carerI wish my child to have the care detailed in this plan and I accept that the emergency services will be summoned as required in the event that the school staff are unable to administer the plan at any time where appropriate.
Pupil (if appropriate) I agree to the care arrangements as detailed in this plan.
The head teacher/designated member of staff I agree to the procedures detailed in this plan being administered in school in the event that these procedures cannot be implemented at any time the school will follow advice received from the health professionals in summoning the emergency services where appropriate.
copies held by parent/carer and head teacher.
City of Edinburgh Council and NHS Lothian Symptom and Action Flowchart for Severe Allergic Reaction
(Anaphylaxis) Using an Adrenaline Pen
Refer to School Health Care Plan and medication container for dosages.
• Change in colour, pale, clammy• Feeling faint• Deteriorating consciousness• Collapse Lie pupil down and raise pupil’s feet if (2 puffs). Another 8 puffs, 1 puff per minute, can be given.
3 Contact parent/carer.
4 Stay with pupil.
5 Give adrenaline pen to ambulance City of Edinburgh Council and NHS Lothian Action Symptom and Action Flowchart for Severe Allergic Reaction
(Anaphylaxis) WITHOUT Using an Adrenaline Pen
Refer to School Health Care Plan and medication container for dosages.
• Change in colour, pale, clammy• Feeling faint• Deteriorating consciousness• Collapse Lie pupil down and raise pupil’s feet if City of Edinburgh Council and NHS Lothian

Source: http://www.sciennes.ik.org/attachments/HSP4_App14_Form9_SHCP_Severe_allergies.pdf