right or wrong or in between?

[rdsxfnrn]

I am second guessing myself again! Would like opinions, pro or con. This is the scenario........ middle school student ingests a known allergen. I work 2 schools, middle and prek-5. They are approx. one minute from each other by car......

12:40- student brought to my office at m/s, c/o throat tightness, hard to breathe, etc. I did not know this student had allergies, and I KNEW FOR A FACT that I did not have any meds for him there. call dad to verify.... So I pop him in my car and fly to E/S. (where I have an abundance of meds)

12:50- administer 10 mls of Benadryl (which btw I do not have an order for)........ wait a few minutes to see if relieves symptoms, no it does not....... the student is not starving for air, however his throat is swollen. i make the decision to give epipen (which I never had before) and call dad to let know and tell him I am calling 911.... which hospital does he prefer?

1:09- epipen given (again no order) and 911 called... they arrive within 5 minutes and access the child, he is doing well and they praise me up and down :) they cart him of to the ED.......... later I found out he is doing well.

Here is my issue........ later I found out that school staff were ???? why I waited so long to call 911. I suppose to the untrained eye it does appear that way...... My ??? to you is......... would you have done anything differently? If so, please state rationale so I can learn from this....... thank you so much!

For backgrounds sake, I went straight from nsg school to school nsg, now yr 3. For reasons I will not go into, I AM THE ONLY MEDICAL PERSON at this school/district. There is NO ONE to call for advice. rdsxfn

[rdsxfnrn]

we have been very lucky to have good support from our allergy specialists over the last few years-the guidelines say epi and only epi (no benadryl) is to be given for any suspected case of anaphylaxis and to call 911. not beating up on you as i know how you feel. i have had to give it a few times and i swear there is more adrenaline in me then the kid after all is said and done but it felt good to be able to say this is why i did it. check your policy and procedures but here is the link..

http://www.niaid.nih.gov/topics/foodallergy/clinical/pages/patients.aspx

thank you for the link. good info.........

[Jolie, BSN]

Not trying to belabor a point, just trying to understand....

If your district has stock meds and standing orders, why were there no meds @ the middle school? Did the school fail to provide them? Had they already been used and not replaced? Were they out of date? This may be a key area for improvement.

Also, if your district has standing orders and stock meds, I'm also not understanding your comment that you gave meds without an order. Must parents agree in writing to allow staff to follow these standing orders? In our district, all students and adults are covered by standing orders. If a parent does not want their child to be medicated in an emergency, they must opt out.

[rdsxfnrn]

Not trying to belabor a point, just trying to understand....

If your district has stock meds and standing orders, why were there no meds @ the middle school? Did the school fail to provide them? Had they already been used and not replaced? Were they out of date? This may be a key area for improvement.

no stock meds at m/s was my fault, which i fixed today.

Also, if your district has standing orders and stock meds, I'm also not understanding your comment that you gave meds without an order. Must parents agree in writing to allow staff to follow these standing orders? In our district, all students and adults are covered by standing orders. If a parent does not want their child to be medicated in an emergency, they must opt out.

If you do not mind, I am gonna PM you about this. The info I provide could be key in identifying the school involved. rdsxfn

[rdsxfnrn]

I will pm you tomorrow. I am emotionally and mentally drained right now. It has been a very difficult 10 days, due to various other situations. I saw the young man today, and he is indeed fine. :) HOWEVER, there have been bad vibes all other the place today although no one said a word. I feel as though I should report myself to someone.....?????? We shall see what tomorrow brings......

[Kim O'Therapy, BSN, RN]

Hope you are feeling better soon. I sounds like you did the best you could under the circumstances. My district does not allow personal transportation or stock medications, so I would have had no other choice but to call 911.

Children who may need epi, have their own prescription with orders from a PCP; so, I don't have any liability in giving it. Unfortunately, I also have kids that need epi pens and don't have one in my clinic. I cannot even give Benadryl unless the parent brings their own OTC medication and signs a form giving me permission to give it.

[Kim O'Therapy, BSN, RN]

Don't be too hard on yourself. The child should not have exposed him/her self to a known allergen (if it was on purpose). Additionally, the parent should have had an allergy plan and medications on file with the clinic if this was a known allergen.

[missfixit]

I would have called 911, the parent and stayed put. But now that the situation is over, you don't need to focus on what you should have done. My advise is to focus on what you need to do to ensure this does not happen again. Cut yourself some slack and get your "ducks in a row" in case something similar happens again. Set up each school to run separately-- pretend they are 50 miles apart. Also, on a side note, if you do not already, you need to have ER teams trained in each building to handle ER situations in your absence.