Stock epinephrine is an epinephrine auto-injector (e.g. EpiPen®) that is not prescribed to a specific person and can be used in an emergency. The University of Victoria (UVic) launched its stock epinephrine program in July 2018. We spoke to Nicole Fetterly, RD, Coordinator, Nutrition Programming & Services about the new program.
Q. How did this program get started?
A. After learning from Food Allergy Canada that stock epinephrine is a recommended practice for keeping our customers with food allergies safe, I proposed this program to Student Health and Campus Security. As the campus dietitian, one of my primary responsibilities is helping to manage our food allergy labelling and communications as well as supporting our students with food allergies in navigating our menus. It seemed only fitting to advocate for a stock epinephrine program to help manage an anaphylactic reaction on our campus. We had also started a stock naloxone program in 2017 so we had a precedent for having life-saving stock medications available to our Campus Security first responders.
Q. What factors were taken into consideration?
A. We factored in the cost of the program, the training needs and the need to develop a protocol and procedure. We looked at owning the program entirely within Food Services but with 600 employees, training would’ve been challenging. We also considered other factors such as insect sting allergy, children attending summer camps on campus as well as people eating food outside of a foodservice setting as reasons for this to be at a more institutional, not departmental level. Campus Security team members are all certified in Occupational First Aid Level 2/Intermediate training which covers anaphylaxis and epinephrine, so it made sense to have them involved in the administration of stock epinephrine.
Q. What internal/external stakeholders were involved?
A. Internally, the program is managed by three departments – Food Services, Student Health and Campus Security. Externally, we consulted with Worksafe BC, Vancouver Island Health Authority (VIHA) and the Provincial Health Services Authority (PHSA).
Q. Were there any challenges in putting together the program?
A. There was initially some discussion about who would fund the cost of the EpiPens. With Food Services being the only one of the three departments that generates revenue, it made sense for them to cover the cost. Only one Campus Security team member was concerned about his personal liability if he administered epinephrine and it was contraindicated. After reviewing the Worksafe and VIHA communications, we determined that this could very much be a part of our Security Team members’ jobs as they are trained in Level 2 First Aid which covers treatment of anaphylaxis. As long as we had a protocol and procedure as well as training, they would be covered in performing this duty.
Training was somewhat challenging as the Campus Security team members had to be trained in small groups while on shift. This meant conducting multiple trainings and occasional delays due to team members attending to emergency calls.
Q. Can you describe the basics of the program?
A. Our Campus Security team now has access to 6 EpiPens (3 adult, 3 junior doses) and they have all been trained on how to recognize anaphylaxis and administer or encourage epinephrine as the best practice in treating anaphylaxis. The training is managed by a Registered Nurse from Student Health; and it will be repeated yearly but might be done by the Level 2 First Aid recertification instructor. In the event of an incident involving anaphylaxis, the three departments will meet to debrief on why the incident occurred (in case any action needs to result on the part of Food Services) and how it was managed (e.g. has the training given been sufficient).
Q. Do you have any advice for other institutions considering a program?
A. Go for it! All of those involved in initiating and participating in this program at UVic are extremely supportive of its need and the ability for our Campus Security team members to potentially save a life. Our first-year students with food allergies are especially vulnerable as they are managing their allergy and its treatment on their own for the first time while also navigating a new living and social situation, intense post-secondary courses, not to mention eating out three or four times a day on a meal plan. It’s easy for them to forget their EpiPen, fail to identify their allergy to others and/or be exposed to food that has been cross-contaminated with their allergen. But it also goes beyond food-related reactions to those resulting from insect stings or medications and that is why it makes sense to have the program at the institutional level, not just within Food Services.
Students with potentially life-threatening allergies should always carry their epinephrine auto-injectors. Stock epinephrine does not replace the need for students to do so.
View the Managing Food Allergies and Anaphylaxis guide for additional considerations regarding the use of stock epinephrine in post-secondary institutions.