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: I'm just looking out for the safety of my patient and my license too. Is that a bad thing?
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.
Yikes! No way would I use "standing orders" for everybody. You don't know how a kid will respond to valium. It can severely depress respirations( has happened to my son) or cause vomiting and aspiration. They need to remain on their side while under the influence of Diastat/Valium and you cannot leave the child alone.
I'll tell you how they handle it in my area.
**If I child has never had a (known) seizure, it's an automatic 911 call.
**If the child has a known seizure disorder, no meds are given unless there are orders from the child's neurologist and medication available in the clinic. If the seizure is under 5 minutes with no complications, we manage the seizure and call parent. I always send kids home after any seizure.
**If a seizure goes 5min or more, or if a second seizure occurs,it's an automatic 911 call.
**If you give Diastat/Valium at school, it's automatic 911 call. Only an RN or paramedic is allowed to give Diastat/Valium. Send the empty Diastat syringe to the hospital with child.
**Parents are responsible for providing the original doctor's order AND the medication with original pharmacy label to the clinic.
Specializes in Med Office, Home Health, School Nurse.
In response to the OP, I wouldn't go NEAR that. Giving meds without an order is basically ASKING for trouble. I can't believe that the doctor doesn't understand that. Sounds like (as someone else said) there is something big time fishy here! It's completely irresponsible of them to expect you to do something like that. Stick to your gut instinct!
Can one of these Docs give you standing orders "in writing"? If they can't do that, forget it! You have to have an order to give it! If it is a true emergency, call 911!
In NYC Schools only an epipen order is a standing order that states that the school provided pen may be given in to anyone in the school in the event of an anaphylatic emergency and 911 must be called and the person must go to the hospital. Other than that, no order, no medication, period.
:confused:
mc3, ASN, RN
931 Posts
I wouldn't do it. Period. Who do you think it will fall on if something goes wrong?
mc3:nurse: