Say you had a student brought to your clinic w/what you think are the s/sx of anaphylaxis. Your med info sheet says student has no allergies. The students teacher, who brought the child up, said he'd thought he'd been gotten stung by a bee. 911 has been called. We do not have stock Epipens in the school. Would you use another student's Epipen on him? What would happen if the student wasn't in anaphylaxis - I know the epi wouldn't kill him, but then what? Administering medication without an order? or worse?

This is my biggest nightmare...

mc3:nurse:

Nope wouldn't do it at all. 911 was called, assess ABC's and continue down that path, administering breaths if needed, ect. Using someone else's epi-pen whether it is truly anaphalaxis or not without an order is a lawsuit waiting to happen- let alone anything else that can happen. EMS can administer epi on the ambulance if needed in our area. I'd allow them to do it.

Say you had a student brought to your clinic w/what you think are the s/sx of anaphylaxis. Your med info sheet says student has no allergies. The students teacher, who brought the child up, said he'd thought he'd been gotten stung by a bee. 911 has been called. We do not have stock Epipens in the school. Would you use another student's Epipen on him? What would happen if the student wasn't in anaphylaxis - I know the epi wouldn't kill him, but then what? Administering medication without an order? or worse?

This is my biggest nightmare...

mc3:nurse:

Nope. I'll pose a similar question: In the inpatient setting, would you administer medication (taken from another patient's Pyxis) that you believed would be potentially lifesaving despite having no order, because you believed that you could not get help fast enough?

As frightening and futile as a situation might seem, I am not trained to diagnose, do not have a license to prescribe, and have no legal standing to usurp a parents' authority to give or deny permission for a particular treatment.

That said, I am fortunate to live in a state where this will never be an issue:

See Appendix A at the end of this document.

http://www.education.ne.gov/legal/webrulespdf/RULE592006.pdf

That was a question/poll on NASN (National Association of School Nurses) recently - I think the majority said, yes, I'd save a life first before worrying about my license.

Me too.

We have a law here that says a physician can write an order for our own epi-pens . . . but you just can't get a physician to write that order. They fear liability as well.

The thing that would make this question unnecessary is if all schools could have stock epi-pens.

edited - I found this on NASN .. . .

Do you have stock epinephrine and/or a non-patient specific order for administration of epinephrine at your school?

Answer: Poll conducted during the weeks of June 13 - June 27, 2012

Do you have stock epinephrine and/or a non-patient specific order for administration of epinephrine at your school?

- Yes – stock epinephrine (67) 6%

- Yes – non-patient specific order (41) 3%

- Yes - both (502) 42%

- No (587) 49%

For more information, link to [COLOR=#0066cc]NASN Food Allergy Online Tool Kit. You can also read the [COLOR=#0066cc]School Access to Emergency Epinephrine Act (H.R. 3627 and S. 1884) to learn more.

Just a question, what would happen if you did use another student's epi-pen and then THAT student needed their pen?

Just a question, what would happen if you did use another student's epi-pen and then THAT student needed their pen?

That is one of the questions that did come up.

Concensus was . . .that is a rare event and the ambulance is already on it's way. Just make sure when you call that the ambulance has epi and can use it.

i'm lucky, i suppose because i have orders and stock epis. If i did not, i can't say that i'd use another student's epipen. to me, that's almost like using another student's inhaler on a student having a severe asthma attack. I suppose it's a you have to be there type call. I'd say the call for ems is first, and protect that airway!

Well of course call EMS first and protect the airway.

I wish I could get a local doc to give us an order for stock epi pens. That would solve the whole thing.

Stupid question here - how do you protect the airway once the throat/tongue is swelling without an ET tube or an ambu bag? Are you talking about tilting the head back so the tongue is not obstructing the airway?

I have stock epi-pens and I would use it if I felt it would open the child's airway. I'm not going to hurt them, it can only help. Call me crazy but I would risk my license to save the student's life. We have stock epi's for those students with unknown allergies who may have a reaction at school.

I have stock epi-pens and I would use it if I felt it would open the child's airway. I'm not going to hurt them, it can only help. Call me crazy but I would risk my license to save the student's life. We have stock epi's for those students with unknown allergies who may have a reaction at school.

I don't understand your post. If you have authorization to use stock Epi-pens for suspected allergic reactions, why would you be risking your license to use one?

for those rn's who don't have stock epi - I would risk my license and use another student's epi if my student's throat was closing up.

I have stock epi-pens and I would use it if I felt it would open the child's airway. I'm not going to hurt them, it can only help. Call me crazy but I would risk my license to save the student's life. We have stock epi's for those students with unknown allergies who may have a reaction at school.

Absolutely, I would too! Here in GA we do have some legislation that protects us. Unfortunately, we do not have an epi-pen stocked in every school. But we have a parent who has graciously allowed us to keep one of her epi-pens in the box where our AED is. If we have to use it, of course, the school will have to pay to replace it. But that's small potatoes, IMO