Administering emergency medicine

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Specializes in School Nursing and Sports Medicine.

We had a case of seizure last week and the student/parents failed to inform us that she has a previous history of seizure (7 years ago - no known cause since she didn't undergo any diagnostic test). After the incident, our doctor and head nurse wants to implement a protocol that we can give emergency medicine without doctor's order. For example: after a seizure episode, we need to monitor the student for 2 mins then give diazepam (therapeutic dose must be calculated), if another episode occurs give another dose of diazepam with a 5 mins interval from the first dose.

I told them that I don't think this is a good idea but the doctor insist that it's ok for us nurses to do it even without an order/standing order since it is an emergency. My concerns are: Why wait for 2 mins after the episode if you intend to give diazepam regardless of what findings you get? What if the student with no previous history of seizure happens to be allergic to diazepam and because of this protocol you caused more harm than good. Who will be held liable if something untowards incident happens? I know for a fact that administering a medicine without an order can be categorized as malpractice for us nurses.

I've tried talking to them about it (even with the other nurses) and they all agree to do it. I said can we put this into writing since you want it to be a protocol. The doctor said, we don't need to put it into writing since it's a known protocol that if it's an emergency you need to give emergency medicine. I didn't say anything after because I felt that it was pointless.

The sad part is just because I want to make things clear and to cover every possible issue that may arise, I am considered being difficult and have no guts to do it (administering medicine without orders). :confused::confused::confused: I'm just looking out for the safety of my patient and my license too. Is that a bad thing? :confused:

What is your school's protocol in emergency medicine? Do you have any experience concerning this issue? I heard one story about a ER nurse. He is a doctor in the Philippines and pursued nursing to work in the U.S. A patient who was experiencing MI was brought in the ER. Knowing what to do, he ordered medicine and was able to make the patient stable. After the incident, despite saving the life of the patient, the nurse was filed with malpractice and was deported to the Philippines.

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no order, no med, real simple. and why are the other nurses not clear on this?

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Specializes in Nephrology, Cardiology, ER, ICU.

OMG - are you guys looking for a lawsuit???

What about 911?

Last I heard a school wasn't an ER. Are you going to have a readily available ambu bag/oxygen, cardiac monitor too?

Absolutely not!

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Specializes in school nursing, ortho, trauma.

No way. I have had scads of students with seizure disorders over the years and can count on one hand the amount of times it was actually medically necessary to give diazepam. If I am reading your post correctly, it looks like the diazepam would be given after ANY type of seizure activity. The concerns that you voice in your post are all viable, realistic concerns.

I am guessing that you are localed in the Philippines - i don't know your laws, but i am betting that they are similar to the US that even emergency meds need an order or standing order written for a facility.

You are completely in the right.

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OMG - are you guys looking for a lawsuit???

What about 911?

Last I heard a school wasn't an ER. Are you going to have a readily available ambu bag/oxygen, cardiac monitor too?

Absolutely not!

thank you

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Specializes in Maternal - Child Health.

I live in a state where schools are required by law to follow a state-developed and approved protocol to administer emergency meds in the event of a severe asthma attack or anaphylaxis.

The protocol was developed at the state level, passed into law, and every school or district must partner with a physician who signs the protocol for that school.

Parents are informed of this protocol and may opt out of it (in writing) if they wish.

Unless a parent deliberately opts out, the protocol is implemented by a trained team in an emergency.

This works very well in our rural state where EMS can be too far away to provide emergency care in a life-threatening airway emergency.

But it is a well-defined protocol, and a very far cry from what your district is discussing. I wouldn't touch that with a 10-foot pole.

As for students with known seizure disorders, we do have some with orders for Diastat at school. Any other student experiencing a seizure for the first time needs medical evaluation, not a poorly defined medication protocol.

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Specializes in School Nursing and Sports Medicine.
no order, no med, real simple. and why are the other nurses not clear on this?

exactly. sigh.. I've asked them straight forward "In case this happens again and the doctor is not around. would you administer the medicine?" Without even thinking, she said yes because it's an emergency and life threatening. Bonus points: This particular nurse can't even do a skin test! sigh..

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Specializes in School Nursing.

It seems fishy that the docs are not willing to write standing orders/protocols for this. Maybe they are trying to avoid malpractice if something goes wrong? I just have a funny feeling that you all are going to get scapegoated if something goes wrong.

If this were my district, I would put my concerns in writing, and state that I am unwilling to administer any med without an order. I would cc the BON on that letter and contact them by phone as well. This is way out of scope of practice!

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Specializes in School Nursing and Sports Medicine.
OMG - are you guys looking for a lawsuit???

What about 911?

Last I heard a school wasn't an ER. Are you going to have a readily available ambu bag/oxygen, cardiac monitor too?

Absolutely not!

I've been telling them that too. apparently we have an ambu bag, oxygen, defib, and an ambulance. We don't have a cardiac monitor but they are planning to buy a portable pulse oximeter. Maybe that's why they feel like an ER. :uhoh3: At the end of the day I'll still follow my guts. I just hope they won't harm a patient (I'm in a separate building and I usually hear about the news when it's over).

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Specializes in School Nursing and Sports Medicine.
No way. I have had scads of students with seizure disorders over the years and can count on one hand the amount of times it was actually medically necessary to give diazepam. If I am reading your post correctly, it looks like the diazepam would be given after ANY type of seizure activity. The concerns that you voice in your post are all viable, realistic concerns.

I am guessing that you are localed in the Philippines - i don't know your laws, but i am betting that they are similar to the US that even emergency meds need an order or standing order written for a facility.

You are completely in the right.

Yes, they want to give it in any type of seizure activity. I've been telling them that too. It's me against 2 doctors and 3 nurses and none of them gets my point. In general, any concern I have is considered invalid. I'm located in the Philippines and our standards are the same with the US. I'm working in an International school and i'm sure parents are aware of the law and won't think twice to use it. Sometimes i feel like talking to the school adminstration and letting them know about this things. i just don't know how to because it might come across to them as by passing the head nurse and the doctors.

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Specializes in School Nursing and Sports Medicine.
I live in a state where schools are required by law to follow a state-developed and approved protocol to administer emergency meds in the event of a severe asthma attack or anaphylaxis.

The protocol was developed at the state level, passed into law, and every school or district must partner with a physician who signs the protocol for that school.

Parents are informed of this protocol and may opt out of it (in writing) if they wish.

Unless a parent deliberately opts out, the protocol is implemented by a trained team in an emergency.

This works very well in our rural state where EMS can be too far away to provide emergency care in a life-threatening airway emergency.

But it is a well-defined protocol, and a very far cry from what your district is discussing. I wouldn't touch that with a 10-foot pole.

As for students with known seizure disorders, we do have some with orders for Diastat at school. Any other student experiencing a seizure for the first time needs medical evaluation, not a poorly defined medication protocol.

I've been reading manuals about school nursing in the US and I do admire the structure. I wish we have it here in the Philippines too. We do have a written consent and standing orders for students who have known seizure. disorders.

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Specializes in School Nursing and Sports Medicine.
It seems fishy that the docs are not willing to write standing orders/protocols for this. Maybe they are trying to avoid malpractice if something goes wrong? I just have a funny feeling that you all are going to get scapegoated if something goes wrong.

If this were my district, I would put my concerns in writing, and state that I am unwilling to administer any med without an order. I would cc the BON on that letter and contact them by phone as well. This is way out of scope of practice!

I felt the same way too. They've been shrugging off the topic after I told them my concerns. I even showed them a book about the law governing us nurses and instead of reading it they just stood by their opinions and repeat everything they said as if i'm the one being irrational. hmmm.. That's a good idea. I think i can contact the BON and ask for assistance. Thanks! :)

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