My question is: Under an emergency situation, (ie. asthmatic attack) can a nebulizer treatment be administered without an order? I have searched high and low and can't find an answer. Also tried the Nurse Practice Act, which doesn't address it. How about an anaphylactic reaction (ie. bee sting)? Can an Epi pen be used without an order? I feel the answers to these questions are both no and call 911, but really need input... Any sources? I really appreciate any help!!
Last edit by sirI on May 3, '12
May 3, '12
by tnbutterfly, BSN, RN Admin
Moved to School Nursing
for more response.
You should have a school or district medical director, check with them. At this time, we do not have any non pt specific meds at my school.
You would need to have non patient specific standing orders from your school Dr to do this.
My district has no standing orders and no school-provided meds. Any meds must be provided by the parent and be accompanied by a valid physician's order. This does vary widely across the US, so definitely check out the policy for your district.
Can you tell us your state?
In Nebraska, there is a state law requiring every school (public or private) to have a physician sign a protocol for the emergency management of presumed severe asthma or anaphylaxis invloving a student, staff member or visitor. This includes stocking a list of meds and equipment (nebulizer, albuterol, Epi pen Jr and Epi pen) and training of multiple staff members as responders. Parents must OPT OUT if they do not wish for their child to be subject to the protocol.
I know that we are not the only state with such a protocol, but I'm not sure which other states have similar laws.
See:Annals of Allergy, Asthma & Immunology Nebraska Rule 59 protocol - a treatment model for school-based programs!
You need an order to give anything in my state. This even includes over the counter meds. Students can carry and self administer epipens and inhalers if signed off by a doctor and parent. So that being said, I guarantee that of my 850 students there is probably at least half a dozen or so that are carrying inhalers i don't know about (and don't have orders for). If a student came to me in distress and fessed up that they had their inhaler, would i administer it? Most likely, with a follow up earful for the parent and the student to get me the proper orders - TODAY. The threat would be that the administrators would get notified and the protocol for possession of a substance would be followed - even if that substance was "just an albuterol inhaler'.
We have a standing order for epipen only. any other emergency, I call 911.
Would I administer, I would have to say, probably not. What if the student has an allergic reaction to the med you gave her? How do you answer the famous attorney question on the stand...who gave you orders to do this? the family did NOT provide the required paperwork, required medication for you to do your job. I hate to put the child at risk, but if I can provide everything my kids' school nurse needs, why can't other parents?
sorry this is a huge issue for me.
Epi only (bystate law we are allowed to have it in our office) and 911 otherwise. Parents need to parent otherwise EMS needs to be called.
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