The regulations allow registered schools, independent educational institutions and local authority nurseries to buy AAIs for emergency use, without a prescription.
Those institutions described in regulation 22 of the Human Medicines (No.2) Regulations 2014 may legally hold “spare” AAIs.
Nurseries and early childcare centres which are not funded by local authorities are not able to obtain “spare” AAIs under this legislation.
A number of different brands of AAIs are available in different doses, depending on the manufacturer.
Advice as to which brand to purchase, and which dose, can be found here. Schools may wish to purchase the brand most commonly prescribed to its pupils.
No. Schools should decide themselves whether they would like to purchase “spare” AAI(s) for emergency use.
If the club happens on school premises as part of official school activities, then there should be access to the school’s spare AAIs.
The change in legislation does not apply to other circumstances: children at risk of anaphylaxis should have their own prescribed AAI(s) with them in the event of a reaction.
Yes, this change covers all the devolved nations in the UK; the responsible departments have produced their own guidance documents, accessible via this link.
“Spare” AAIs can be obtained, without prescription, from a pharmacy in small quantities on an occasional, and not-for-profit basis. The school will need to give the pharmacy a written request signed by the principal or head teacher stating:
- the name of the school for which the product is required;
- the purpose for which that product is required, and
- the total quantity required.
A template letter which can be used for this purpose can be accessed here. A healthcare professional does not need to sign this letter.
Pharmacies are not required to provide AAIs free of charge, the school must pay for them as a retail item. Unfortunately, there are no funds held centrally or by local authorities to cover the cost.
The signed order needs to be retained for two years from the date of supply or an entry made into the Prescription-Only-Medicine (POM) register. Even where the signed order is retained it is good practice to make a record in the POM register for audit purposes. In line with normal record keeping requirement an entry in the POM register must include:
- Date the POM was supplied
- Name, quantity and where it is not apparent formulation and strength of POM supplied
- Name and address, trade, business or profession of the person to whom the medicine was supplied
The purpose for which it was sold or supplied.
Where can pharmacists locate information on a school, including head teacher/principal details if required?
There is no centralised database containing details of schools and head teachers across Great Britain. Possible sources of information would include:
- Department for Education’s register of educational establishments in England and Wales
- Ofsted reports
- Information on the individual school’s website
The school’s “spare” AAI(s) should only be used on pupils known to be at risk of anaphylaxis, and for whom both medical authorisation and written parental consent for use of the spare AAI has been provided. This includes children who have not been prescribed their own AAI, so long as the school has medical authorisation and parent/guardian consent.
The British Society for Allergy and Clinical Immunology (BSACI) has produced a range of Allergy Plans which can be used for this purpose, and can be downloaded here. All children with a diagnosis of food allergy and at risk of anaphylaxis should have a written Allergy Management Plan.
The school’s spare AAI(s) can be administered to a pupil whose own prescribed AAI cannot be given correctly without delay.
If a pupil has anaphylaxis but does not have the necessary approvals in place for them to receive the “spare” AAI:
- Immediately call 999 and seek advice
- If spare AAIs are available, tell this to the call handler/emergency medical dispatcher, as they can authorise use of the spare AAI if appropriate.
Any member of staff may volunteer to take on this role. In most schools, a number of staff members should be trained to administer AAIs, to avoid any delay in treatment and ensure cover when staff are on leave.
Staff should have appropriate training and support, relevant to their level of responsibility. This is a legal requirement.
Further information on staff training can be found here.
A number of different brands of AAIs are currently available in the UK, in different doses. Schools may wish to purchase the brand of AAI most commonly prescribed to its pupils, to reduce confusion and assist with training. The decision as to how many devices and which brands to purchase will depend on local circumstances, and is left to the discretion of the school. Schools may wish to seek appropriate medical advice when deciding which AAI device(s) are most appropriate.
Healthcare professionals prescribe AAIs according to each child’s individual weight. However, in the context of supplying schools with AAIs for emergency use (rather than for individuals), schools may wish to use the following guidance from the Department of Health:
|For children age under 6 years:||For children age 6-12 years:||For teenagers age 12+ years:|
|• Epipen Junior (0.15 mg)|
• Emerade 150 microgram
• Jext 150 microgram
|• Epipen (0.3 milligram)|
• Emerade 300 microgram
• Jext 300 microgram
|• Epipen (0.3 milligram)
• Emerade 300 microgram
• Emerade 500 microgram
• Jext 300 microgram
NB: These age-based dose recommendations are consistent with the UK Resuscitation Council guideline for the management of anaphylaxis by healthcare professionals.
No. The legislation only allows for the “spare” AAI(s) to be used in registered pupils, in whom both medical authorisation and parent/guardian consent have been obtained.
If an adult has anaphylaxis whilst on school premises, immediately call 999: if “spare” AAIs are available, tell this to the call handler/emergency medical dispatcher, as they can authorise use of the “spare” AAI if appropriate.