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Hospital Stays

Introduction:

An admission to hospital can be a confusing and frightening experience. This help sheet has been developed to assist you in preparing for this process, in particular for the management of your food allergy.

Managing food allergies can be difficult, especially when a person has multiple food allergies or severe reactions to foods. Don’t assume that hospitals are any better at catering for severe food allergies than any other food provider. Despite the increase in allergies, many hospitals may not have robust processes in place for providing appropriate foods to patients with food allergy. It is important to remain ever- vigilant with all foods consumed, even when in hospital. Ask about content of every meal or snack if the food is not packaged and you cannot read content for yourself.

Reason for hospital admission

There are two types of hospital admission; emergency or elective:

An emergency admission occurs through the Emergency Department of a hospital. In this case you may arrive via ambulance, or you may attend as a result of an ‘emergency’ situation (e.g. injury, sudden serious illness). This situation does not necessarily allow for planning or preparation at the time, but you can plan for this ahead of time to assist you (e.g. have a list of/packaged food that is appropriate ready just in case, have a trusted family member bring food in each day). If you have severe food allergies/anaphylaxis your visit may be as a result of a reaction or unrelated. Either way this can often involve several hours in hospital, waiting and being treated. It is likely at some point you will need to eat or drink.

An elective admission or direct admission is planned ahead of time and will occur via an admissions department rather than though an emergency department. This usually occurs at a more convenient time and may allow for a planned/prepared approach. It may involve just a day procedure or could involve a longer stay, so you should take the opportunity to think ahead and plan how to manage your needs during your stay.

Whatever the reason for your hospital admission, if you have a food allergy you should have a coloured (usually red) wristband placed on your arm/leg. If the allergy alert band lists your food allergens, make sure the wording is correct. Many hospitals also identify the patient as having an allergy by way of a bed card placed above their bed. When being admitted, ask how the hospital identifies patients with food allergy and check that the protocol is carried out and that information communicated is correct.

Things to consider

What is your normal routine for managing your food allergies? Just as you would plan for a holiday or your regular day at school or work, it is important to plan for a potential trip to hospital. Food allergy management can be complex and involved and it is important to prepare as thoroughly as you would for any other eating out experience.

Communicate: If you know you or your child will be requiring a hospital admission there is time to do preparations. Contact the hospital ahead of time (as you would a restaurant or child care facility). Explain what food restrictions are required and find out if the menu can accommodate these needs. Find out how much, if any notice they will need to be able to provide safe meals. Ask questions. How will they prepare, label, package and deliver the food? Where is it prepared? How do medical staff communicate your food allergies to the catering staff? Do they have paperwork that you can fill in ahead of time to advise exactly what the restrictions are? Do they have sample menus? Do they list all the ingredients? How will your food be delivered/packaged so that you can check it? The answers to these questions will help you make an informed decision whether you can be catered for safely.

Remember that not all staff will be able to answer your questions immediately and not all hospitals will have had experience in managing severe food allergies. There may not necessarily be systems in place to manage or provide meals during your stay. If in doubt, plan to bring your own meals or have your meals brought in for you.

BYO: If you decide to bring your own meals find out what facilities are available to you to store and heat your food. Do they have a fridge/freezer available? How will you label or store your food to alert others and ensure it is not contaminated by others?

Things to find out on arrival to the emergency department or ward

  • How to get assistance if required? How do you use the assist/emergency bell system? How do you alert staff if urgent assistance is required?
  • Where to store the adrenaline (epinephrine) injector (such as EpiPen®, Anapen®) during your stay. Ensure that it is easily accessible to you and not locked away so that you can easily access and administer if needed. If you need to administer your own adrenaline injector, immediately notify staff that you have done this. Press your assist/emergency bell - do not stand or walk to the nurses’ station. Follow instructions on your ASCIA Action Plan. Being in hospital does not mean you manage anaphylaxis differently.
  • Who is writing up medications? Ensure that all medications including the adrenaline injector are put on the medication chart so nursing staff can administer the adrenaline injector immediately and then call a ward emergency requiring a medical team. The patient’s already prescribed adrenaline injector should be written up as an ‘as required’ or PRN medication on admission. This will ensure that should adrenaline be required, the adrenaline injector can be administered promptly before calling a medical emergency. Be aware that medical staff do NOT generally know how to use an adrenaline injector as the device is generally prescribed for use in the community setting. On admission to hospital, discuss with your doctor if you should have a copy of your ASCIA Action Plan for Anaphylaxis on your bed notes. The doctor should also write up a dose of adrenaline (in addition to the adrenaline injector) so nursing staff can draw up a dose using ampoules/vials, needles and syringes and administer the dose of adrenaline prior to a doctor arriving at the scene of the medical emergency should a severe allergic reaction occur.

Age related considerations

Where a child is being admitted to hospital, consider a plan to manage their supervision. Hospitals are very busy environments and nursing staff are often responsible for the management of many patients. This means that you must think through and communicate with staff on allergy management during your child’s hospital stay. Consider how frequently food is provided to patients, and have a plan to ensure that supervision can occur at all times, in particular around all meal/snack times. This may require you to use the call bell to get a nurse to attend your child while you use the rest rooms. Plan also for your own meals whilst you are caring for your child.

If child is young:

Educate your child with food allergy at an age appropriate level.

If you are in a shared room, tell other parents/carers in the room that your child has food allergy and not to offer them any food.

If children are encouraged to eat at a table with other children, be aware of what children next to your child are eating.

Teens and adults:

Everyone, including teens and adults with food allergy needs extra care in a hospital setting.

People may be too embarrassed or feel awkward about questioning busy staff about ingredients in hospital food they are served. It is important to know that hospital staff should be able to access an ingredient list of your hospital meal/snack when you ask about content.

If the person has undergone surgery or is on medication, their thought process can be altered. Ensure hospital staff check the food is appropriate.

Medical history

It is important to provide an accurate and thorough medical history to the hospital staff. This may include doctors, nurses, dietitians, various other health professionals and administration staff. Always disclose food allergies to all staff even if they only ask about medication allergies. Never assume that all staff will be aware of previous information you have provided as not all assessments are shared. Often you will be required to repeat information to a number of different people. Consider how you can make this easier. Keeping a folder of any relevant medical information including any test results, may be of assistance – even if you do this, you must still verbally communicate your food allergy.

Also ensure that you take an up to date “ASCIA Action Plan for Anaphylaxis” or “ASCIA Action Plan for Allergic Reactions” as a quick reference for staff. You may wish to make copies. You may also want to take information regarding previous reactions if relevant, such as the ‘ASCIA event record allergic reactions’ forms if completed from any prior reactions (www.allergy.org.au/hp/anaphylaxis-resources/anaphylaxis-event-record).

If possible, provide written information, including letters from specialists, or health summaries. If you don’t have these, make a list of any information you do have and make copies that you can provide to the staff.

A&AA© 2016

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IN AN EMERGENCY

If you are having an allergic reaction follow advice on your ASCIA Action Plan.

If in doubt, give the Anapen® or EpiPen®.

Do not call us for emergency advice.

If you do not have an ASCIA Action Plan and/or an Anapen® or EpiPen® call triple zero (000) for an ambulance.