Need Advice - Seizure Issue!!

[uthscsa2011]

Hello everybody. I need some advice....

I am an elementary school RN, and yesterday we have an incident here that has upset a student and family. I thought I was acting in the best interest and safety of the student, but the family seems to think otherwise. Let me know if I did the wrong thing and what you would have done!.....

4th grade was headed on a field trip, including the functional resource kiddos. An hour before the field trip, a teacher comes to me and informs me one of his students apparently was RX'ed some "emergency medication" that she needs to have for the field trip. As usual, the parents did not come and inform me about this. So I immediately called the parent to bring this medication to the school. As usual, I had to leave a voicemail. 5 minutes before the buses take off, the parent dropped off the medication (of course, not to ME, but to the teacher, so i was not able to speak to the parent at all, why the office did not direct her to me, i have no clue). So i go to the front to fetch the medication, and see that it is Diazepam (rectal) for seizures. The bus is waiting on me to send the medication with the teacher and student, but I stop because there is no way I can teach the teacher or any other staff attending the field trip how to administer a rectal medication in 5 minutes. Nor did i feel safe delegating this task to anyone. I spoke with the principal and let her know my fears and concern for the student's safety and she agreed that we could not let the student go on the field trip. We would be to blame if she did seize and no one there knew how to administer the medication. So we kept the student, and at the end of the day the mother and grandma came and raised hell. They said the Dr told them "it does not have to be a RN to give the med" and that anyone on the bus could have given it to her....That was her argument...she wanted any untrained staff member to pull down her daughter's pants and administer this med in front of 30 other school kids. Seriously? I highly doubt the Dr said any person could give this med....

What do yall think?

[Morganalefey]

You were right. They can be upset if they want.

Our district has a procedure for medications, and bringing it in 5 minutes before a field trip isn't part of it. There is paperwork, the Dr. has to sign it, etc, etc.

They maybe should have thought ahead a little bit more.

Let the principal handle this.

[JustBeachyNurse, LPN]

Not a school nurse, but I do pediatric private duty/home health. My agency will send nurses (by contract) on bus runs and field trips for students with seizure d/o who require emergency Diastat. One local district has their own team of "private nurses" (part time/per diem school nurses employed by the district) for in class support and field trips for seizure d/o with diastat, asthmatics or allergic children not capable for self-administration of epi-pens or MDI's, and IDDM students with coverage or insulin pumps and any other medication that requires additional training or nurse judgement.

As a parent and a nurse that works with children just like this, I think you made a prudent decision in conjunction with school administration. In my state written action plan and medication orders signed by the treating physician are required before a nurse can accept medication for use at school. Mom dropping off medication 5 minutes before a trip puts the school in a precarious position and was beyond unfair to her child. There wasn't even sufficient time to verify the order with the treating physician!

Perhaps the physician said that it doesn't have to be an RN meaning that parent/caregiver or an LPN can administer the medication I seriously doubt that s/he meant any random stranger can administer an invasive, parenteral controlled substance!

ETA: Plus I can pretty much guarantee that the child was not just prescribed DiaStat so the onus was really on the parent to follow up and be forthcoming.

[CodeteamB]

I think you did the right thing. Asking the teacher to take responsibility for emergency administration of a suppository is totally unreasonable, and there was obviously a strong concern that this child might seize. Also, by getting your principal involved you covered all your bases.

Perhaps this student needs a healthcare aide to travel with her if this is going to be a concern (that is how it would be handled by the school board where I live).

The student was probably really upset to miss a field trip, and that can be hard to see as a parent, so I'm not surprised you got a big reaction, however, you made the right call!

I hope a good solution can be found for this child to get appropriate care and be able to participate in school activities.

[bell1962]

In NYS only a school nurse can administer a med to a student . The exceptions are: Parents may come on field trips or designate someone else(not a school employee) to gave their child the med. Any TRAINED person can administer an epipen or give glucagon. Teachers may supervise a SELF DIRECTED student taking his own medication. That is it. Otherwise it must be administered by a nurse. OP you most definitely did the right thing.

[schooldistrictnurse]

In my state this can be delegated and we have many UAP trained to give diastat. They are not trained, however, on a 5 minute schedule with bus fumes in their faces!!! You made the absolute right call. The only other option would be for you to go on the field trip if you could be away from your building for that amount of time. The only thing I would have done differently would have been to ask the principal to call the parent as soon as possible to inform the parent that the child was held back from the field trip. Be sure your principal understands your state laws regarding delegation and he/she will stand with you. Good luck!

[NutmeggeRN, BSN]

Cannot delegate that in NH, either way that sticks there was no knowlwedge of the issue/med prior to that...grrrr:mad:. They (the parents)were WAY WRONG!

You did just what you should have.

[BSNbeauty, BSN, RN]

You did the right thing! 1) you had NO orders, you couldn't have delegated this even if you wanted too. 2) Usually in this situation were an emergency med has to be given a private nurse or parent is to accompany the child on the trip. The parents should have went with the child if they really wanted him to go. 3) Who cares if the family is upset? You did exactly what you were supposed to do.

[Flare, ASN, BSN]

In my state nobody but a nurse or a parent would be permitted to give Diastat on school grounds (ok, i suppose the school MD, like the school MD is ever really present). Even if your state has more leeway, you're absolutely right - it takes more than 5 minutes of training for a staff member to take on a delegation task (which i don't think i'd be entirely comfortable with if that were permitted in my state). You made the right call.

[mc3, ASN, RN]

You absolutely did the right thing. In our school, only an RN or LPN can administer the Diastat, no UAP's. It's really the parent's fault for not bringing this to the school's attention sooner. Unless they just found this out yesterday, they must have known they needed to let the school know. What if the child had a seizure at school???? I am amazed at the number of parents that check off their child has an anaphylactic reaction to bee stings, but then don't bring anything to school. I've been told, "well, it happened a long time ago" and "they know to stay away from bees", or peanuts etc. etc. I document my heart out on those ones, and pray nothing happens. I tell the parents 911 will be called first, parents second, if an anaphylaxis reaction does occur. Actually, protocol calls for me to do that anyway, even if I do have an Epipen...... I find parents get angry at so many things we do at school. They do not understand that their child's welfare is first and foremost in any school situation - I swear I think they believe we are out to do nothing but cause them aggravation. Sometimes, I feel like I have a big target on my back because I work in the school system!! mc3:cat:

[KelRN215, BSN, RN]

Does your district not require a nurse to accompany students on a field trip? As far as I know, that's a requirement around here.

I worked in pediatric neurology for 5 years and I believe that the MD told the parents that it didn't need to be a nurse who gave the med... presumably the parents were taught to administer it and they would be expected to teach others (grandparents, aunts/uncles who the child may spend a night with, day care providers, etc) to administer it as well. It is, however, the parents' responsibility (and the neurologist's) to inform the school nurse of the child's diagnosis and medical needs in the event of an emergency.

[tjlemons]

You can't make everyone happy all the time. Our school has a Diastat policy that only the licensed nurse can administer the medication. This policy has both upset and pleased many staff and parents. You were in the right and the parents would have know that if they would have talked to you about it before waiting til the last minute.