Procedure

Asthma Management Procedure Council Early Years Services

Policy Number: D18-271113 Directorate: Community Services

Approval by: Manager Family and Children Services

Responsible Officer: Policy, Learning and Quality Officer

Approval Date: March 2017 Version Number: 1.

Review Date: 3 Years from Date of Approval 1. Purpose The aim of this procedure is to provide a clear set of guidelines to educators, staff and families regarding the management of Asthma in Council Approved Early Years Services to;

Respond appropriately to asthma by administering appropriate treatment. Support and document effective communication between families and educators regarding the

ongoing management of Asthma. Raise awareness of Asthma and its management at the service through education, and

implementation of this procedure. Promote children’s health and safety.

It also serves to inform other adults at the service such as volunteers, students and other professionals. 2. Context According to the Better Health Channel Asthma and Young children, every child’s asthma is different. Some children have mild occasional episodes while others can have continuous symptoms, which limit their daily activity. It is important to remember that a child can have a serious life threatening attack even if they generally have mild or occasional Asthma. Some of the common asthma symptoms and signs include coughing, wheezing, a feeling of tightness in the chest (often described as a sore tummy) or difficulty breathing. A child may have all of these symptoms or just a few. 3. Procedure This procedure will be required whether there is a child diagnosed with asthma enrolled at the service or not. 3.1 In Relation to Management of a Child with Asthma, Nominated Supervisors and Responsible persons will:

Provide at least one educator with current approved asthma management training (Appendix Six) that will be in attendance and immediately be available at all times the service is in operation. (National Regulations 136, 137)

Record all details of current, approved First Aid, Asthma and Anaphylaxis training as outlined on the ACECQA website, and document this in the educators/staff file. (National Regulations 146, 147)

Provide all educators, staff members, students, and volunteers with a copy of the Asthma Procedure and Medical Conditions Procedure. (National Regulations, 91)

Provide a clearly labelled ‘service name’ asthma puffer and spacer to be used in the case of an emergency only, which will be located in an easily accessible spot to adults (not locked away) but is inaccessible to children.

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3.1.1 In Relation to Management of a Child with Asthma, Nominated Supervisors, Responsible persons and educators will;

Provide the families of a child identified with asthma, with a copy of the Asthma Procedure and the Medical Conditions Procedure (National Regulation, 91)

Obtain the following documentation prior, to a child diagnosed with Asthma attending the service (National Regulation 162):

1. Asthma Action Plan (Appendix One) o An appropriate Asthma Action Plan will be completed and signed by the child’s Medical

Practitioner. 2. Asthma Communication Plan (Appendix Two)

o This will be used for documenting communication and partnership between the service and the family regarding the wellbeing of the child.

3. Risk Minimisation Plan for Asthma (Appendix Three) o This will be used to plan for, document and manage different risk exposures

(allergens/triggers) which might potentially arise during a child’s participation at the service.

In conjunction with families identify children with asthma during the enrolment process and complete all required documentation before the child commences and inform all other educators and staff at the service.

In conjunction with families, identify children diagnosed with asthma after enrolment, inform all other educators and staff, and complete all required documentation before the child’s next attendance at the service.

Place a copy of the child/ren’s Action Plan, Communication Plan and Risk Minimisation Plan; 1. In the individual child/ren’s enrolment record. 2. In the Emergency management kit. 3. With the child’s stored medication.

Check that Action Plans are updated as required. Display child/rens Asthma Action Plans in a key location at the service where the child is being

educated and cared for and is visible to educators and staff. Display the Asthma Foundation generic poster called ‘Asthma First Aid’ in a key location at the

service where the child is being educated and cared for and is visible to educators and staff. Recognise and treat symptoms of Asthma in accordance with the child’s asthma plan regardless of

whether the symptoms are mild, moderate or severe. Treatment must commence immediately as delay may increase risk to the child’s health and safety and wellbeing.

Complete regular checks, to maintain all asthma puffers and spacers in are current and in date. Check that the required Asthma puffer and spacer is stored in accordance with the Administration

of Medication Procedure in a location that is known to educators and staff; is easily accessible to adults (not locked away) but is inaccessible to children.

Take all medication needs for the child/ren during any activities outside of Council Approved Early Years Services as part of the services Emergency Kit.

Document any asthma incident that has occurred in Council Approved Early Years Services in the incident/injury/illness/trauma record and inform a parent as soon as practicable.

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3.2 Communication

The National Regulations 2011 require that a Communication Plan be in place where a child diagnosed at risk of Asthma is attending an early education and care service. The Communication will detail;

How Educators/staff are informed about the Asthma Management Procedures. How families might communicate changes to their child’s Risk Management Plan and Action Plan to

educators/staff, and; How Educators/staff continue to be informed and familiar with the plans for individual child/ren

diagnosed at risk of Asthma. 3.2.1 In Relation to Communication of a Child with Asthma Nominated Supervisors, Responsible person and Educators will:

Implement a communication plan and encourage ongoing communication between parent, educators /staff regarding the current status of the child’s Asthma.

Immediately communicate any concerns with parents regarding the management of children diagnosed at risk of Asthma attending the service.

Discuss and review the child’s plans as required in team meetings, or as changes occur to assess how practices in the service align with the requirements of the plans and communicate changes in practice with parent accordingly.

Ensure that the child’s Asthma Action Plan is specific to the brand of medication prescribed by the child’s medical practitioner.

Respond promptly to changes in the child’s condition when informed by parents (with an updated Action Plan signed by a Medical Practitioner) ensuring that other educators in the service are also informed in a timely manner of changes.

3.2.2 In Relation to Communication of a Child with Asthma Families will:

Work with the Responsible person and educators/staff to ensure the following documentation is complete and available prior to a child/ren attending the service.

1. Asthma Action Plan (Appendix One) o An appropriate Asthma Action Plan will be completed and signed by the child’s Medical

Practitioner. 2. Asthma Communication Plan (Appendix Two)

o This will be used for documenting communication and partnership between the service and the parent regarding the wellbeing of the child.

3. Risk Minimisation Plan (Appendix Three) o This will be used to plan for, document and manage different risk exposures which might

potentially arise during a child’s participation at the service. 3.3 Risk Minimisation:

The Education and Care Services National Regulations 2011 require that a Risk Minimisation Plan be in place where a child diagnosed at risk of Asthma is attending an early education and care service. The Risk Minimisation Plan will detail

How Educators/staff and families document and manage asthma risk exposures.

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3.3.1 In Relation to Risk Minimisation of a Child with Asthma Nominated Supervisors, Responsible Persons and Educators will:

Conduct an assessment for potential risk exposures (triggers/allergens) while child/ren with Asthma are in attendance at the service and develop a Risk Minimisation Plan for the service in consultation with educators and families of the child/ren.

Obtain information about identified asthma risk exposures (triggers/allergens) to which the child is sensitive to and take these into account while child/ren at risk of asthma are in attendance at the service.

Display the Asthma Foundation generic poster called ‘Asthma First Aid’ in a key location at the service.

Display ambulance contact details near all telephones. Check with families that children with known asthma have provided an asthma puffer and spacer

and where required a mask when in attendance at the service. Children will not be able to access the service until the families have provided the asthma puffer for the services to access in the case of an asthma attack.

3.3.2 In Relation to Risk Minimisation of a Child with Asthma Families Will:

Collaborate with educators/staff to develop the Risk Minimisation Plan. Regularly communicate with educators/staff in relation to their child’s risk exposures

(allergens/triggers) and Asthma Risk Minimisation Plan. Provided an asthma puffer and spacer and where required a mask when in attendance at the service

for their Child/ren. Children will not be able to access the service until the parents have provided the asthma puffer for the services to access in the case of an asthma attack.

3.4 Induction of Educators and Staff

Induction of educators/staff who are responsible for the education and care of a child diagnosed with Asthma who attends a Council Approved Early Years Service will include:

The provision of a copy of the Asthma Management Procedure and the Medical Conditions Procedure.

The location of the stored Asthma puffer, spacers and where applicable mask. Information about where the following documents are located:

1. Action Plan (signed by a Medical Practitioner) 2. Communication Plan 3. Risk Minimisation Plan for the management of Asthma

3.5 Education and Training of Educators and Staff

Council Approved Early Years Services recognise the importance of educators and staff, undertaking regular training and support educators to have opportunities for training that includes:

Support for educators/staff to gain an approved Asthma Management Training qualification (Appendix 6) every 3 years.

Note: All Knox City Council Early Years casual relieving educators are responsible to obtain and maintain current training in Asthma Management and be aware of symptoms of an Asthma attack and the location of Asthma Action Plans.

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3.6 First or Unknown Attack

If a child suddenly develops or complains of difficulty in breathing and/or has an incessant cough or wheeze, appropriate care must be given immediately, WHETHER OR NOT the child is known to have Asthma (i.e. Apply Asthma first aid procedures as per the Asthma First Aid poster (Appendix 8), and

Call an ambulance immediately (dial 000) and state that the child is having breathing difficulty. Follow the direction of the emergency services.

If medication is administered under this scenario, parents must be notified as soon as practical (National Regulations, 94).

3.7 Provision and Cleaning of Devices

Asthma devices are considered ‘single-person use only’. This means that once a spacer has been used by a child it must be discarded or given to that child for their exclusive use. Spacers are not to be shared between children. If a puffer has been used directly in the mouth of a child, it is to be treated in the same manner:

A small mask will also be available as not all small children have the ability to close their mouth around the mouthpiece of a spacer.

If puffers are attached to spacers every time they are used, then only the spacer is to be discarded. Puffers may be cleaned by removing the medication canister, rinsing the outer plastic casing with

warm soapy water, allowing to air dry then replacing the medication canister inside the plastic casing ready for further use. (Appendix 7)

It is essential that if a spacer is used and discarded (or given to a child) from the services first aid or emergency evacuation kit that it is replaced as soon as possible. Personal spacers belonging to children do not need to be discarded after use.

4. References 4.1 Community & Council Plan 2017-2021

We are a healthy, happy and well We have confidence in decision making

4.2 Relevant Legislation ACECQA Three – Guide to the National Quality Standard, (January 2018). Quality Area 2: Childrens Health

and Safety Child Safe Standards Child Wellbeing and Safety Amendment (Child Safe Standards) Act 2015 No.63 of 2015 Child Wellbeing and Safety Act 2005 (Vic) Education and Care Services National Law Act 2010 Education and Care Services National Regulations 2011: Regulation 90-92,94,136,137,146,147,162 & 247 Health Records Act 2001 Information Privacy Act 2014 (Vic)

4.3 Charter of Human Rights This policy has been assessed against and complies with the charter of Human Rights.

4.4 Related Council Policies & Procedures Nil

4.5 Related Family & Children’s Services Procedures Medical Conditions Procedure Anaphylaxis Procedure Incident, Injury, Trauma and Illness Procedure Administration of Medication Procedure Children’s Health, Well-Being & Safety Policy

4.6 Relevant Sources Asthma Australia www.asthmaaustralia.org.au

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Asthma Australia -Asthma Action Plan and Asthma First Aid Poster https://www.asthmaaustralia.org.au/vic/education-and-training/for-children-s-services/children-s-services-resources/copy-of-school-resources

Asthma Management Handbook, National Asthma Council Australia https://www.asthmahandbook.org.au

Asthma Foundation www.asthmaaustralia.org.au Better Health Channel https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/asthma-

and-young-children 5. Definitions

Council means Knox City Council, whether constituted before or after the commencement of this Policy.

Approved Provider Someone with management or control that will operate the education and care service; this can be an individual, an organisation or a company.

Early Years Service Refers to Long Day Care, Occasional Care, Preschool and Maternal Child Health Service unless otherwise specified.

Educator: These are staff employed to care and educate children enrolled in the Early Years’ Service. This may include but is not limited to an Approved Provider, Responsible Person, Nominated Supervisor Person In Day-to-Day Charge and Educational Leader.

Responsible Person Must be present at all times at a centre based service who is educating and caring for children. A responsible person can be one of the following (section 162):

The approved provider or a person with management or control The nominated person of the service A person who has been placed in day-to-day charge of the service.

Parent The term ‘parent’ includes a child’s legal guardian. It does not include a parent who is prohibited by a court order from having contact with the child.

Staff Refers to staff inclusive of but not limited to, Maternal Child Health Nurses, Mental Health Nurses, Parenting Support Workers, Maternal Child Health Students, Supported Playgroup Facilitators, Early Years Consultants, Cooks and Program Support Officers.

6. Administrative Updates From time to time, circumstances may change leading to the need for minor administrative changes to this procedure. Where an update does not materially alter this policy, such a change may be made administratively. Examples of minor administrative changes include changes to names of Council departments or positions, change to names of Federal or State Government departments or a minor amendment to legislation that does not have material impact. Where any change or update may materially change the intent of this policy, it must be considered by Council.

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Appendix 1: Asthma Action Plan Example of an Asthma Action Plan

Click here for Asthma Action Plan (Asthma Care Plan Link) https://www.asthmaaustralia.org.au/vic/education-and-training/for-children-s-services/children-s-services-resources/copy-of-school-resources

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Appendix 2: Asthma Communication Plan

Record when parent is provided with a copy of the KCC Early Years Service Asthma Procedure for ‘an at risk child’. Parent Name: Signature: Date: Educators Name: Signature: Date:

Record when parent provides Asthma puffer and spacer Educators Name: Signature: Date:

All Educators/staff know the location of the ‘at risk child/ren’s Asthma puffer and spacer Educators Name: Signature: Date: Educators Name: Signature: Date: Educators Name: Signature: Date:

(Preschool Only) Action Plans are provided in the Casual Reliever’s green folder regarding the ‘at risk child/ren and information re: the location of puffers and spacers and procedures.

Regular checks are completed of the expiry dates of the asthma medications Parent Name: Signature: Date: Educators Name: Signature: Date:

Parents will immediately inform Educators/staff if allergens/triggers change and the Risk Minimisation Plan will be updated as soon as practicable. Parent Name: Signature: Date: Educators Name: Signature: Date:

Parents are aware of the procedure whereby no child/ren who has been prescribed Asthma medication is permitted to attend the service without it. Parent Name: Signature: Date: Educators Name: Signature: Date:

Early Years Service’s will display the Asthma Australia Action Plan for Asthma on the first aid cupboard and completed ambulance details are located by the telephones. Parent Name: Signature: Date: Educators Name: Signature: Date:

The Asthma medication including spacer will be provided for all excursions attended by the ‘at risk child/ren. Parent Name: Signature: Date: Educators Name: Signature: Date:

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Appendix 3: Asthma Risk Minimisation Plan

Review risk minimisation plan with family (minimum of annually, but always upon enrolment of ‘at risk’ child and after any incident or accidental exposure or change in known allergens/triggers). Parent Name: Signature: ECE/Staff Name: Signature: Date:

Child’s Name:

Date of Birth:

Predominant Asthma Trigger/s:

Other Asthma Triggers:

Risk (suggested risks Listed in Appendix Four

Strategy Who is Responsible?

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Appendix 4: Examples to Consider

Examples of Risks, Situations, Concepts to Consider When Completing the Asthma Risk Minimisation Plan

Who are the children and what are the asthma triggers (is information provided on their Asthma Action Plan)?

What and where are the potential sources of exposure to their asthma triggers? Do plants around the service attract bees, wasps or ants? Have you considered planting a low-allergen garden? Do your cleaners use products that leave a strong smell? Do Educators/staff use heavy perfumes or spray aerosol deodorants while at work? Are you in a bushfire-prone area where controlled burning may occur? What special activities do you have planned that may introduce children to asthma triggers? Are you aware of the pollen count site? http://www.melbournepollen.com.au/ Have you considered protection from insect bite allergies?

Appendix 5: Enrolment Checklist

Enrolment Checklist for Chidren ‘At Risk’ of Asthma

Educator/Staff Name: Educator/Staff Signature:

Date:

Appendix 6: List of Approved Asthma and First Aid Training Qualifications Australian Children’s Education and Care Quality Authority First Aid Qualifications and Training http://www.acecqa.gov.au/First-aid-qualifications-and-training

☐ Asthma Action Plan signed by a Medical Practitioner giving consent to use the asthma medication in line with this action plan complete, labelled medication.

☐ Signed Asthma Communication Plan with the service that is completed in conjunction with Educators/staff and parent.

☐ Signed Asthma Risk Minimisation Plan with the service that is completed in conjunction with Educators/staff and parent

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Appendix 7: How to Clean a Puffer How to clean a puffer Blue/grey reliever puffers require cleaning every week to prevent blockage from a build-up of medication. Intal Forte and Tilade puffers should be washed every day and allowed to dry for more than 24 hours before re-use. Alternate between the two mouthpieces provided by the pharmacist. All other preventer and combination puffers must never be wet or washed: they should only be wiped with a dry tissue.

For puffers that require washing (reliever puffers, Intal Forte and Tilade)

1 Remove metal canister. Do not place in water

2 Wash the plastic casing only. Rinse mouthpiece through top and bottom under warm running water for at least 30 seconds. Wash mouthpiece cover

3 Allow to air dry

4 Reassemble

Asthma Medication and Devices pg 18 – Asthma Australia

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Appendix 8: Asthma First Aid

Note: This poster is from the Asthma Foundation Website, please check the website annually for updated versions to display. http://www.asthmaaustralia.org.au/vic/education-and-training/for-children-s-services/childrens-services-resources