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Discussion

Ativan Administration at School

I work in a California school district that is fortunate to have both LVNs and RNs, but we are spread thin to provide necessary coverage. School sites will have their own LVN if there is one or more students who require a licensed medical person to administer a medication. We've had parents who refuse to allow an unlicensed person to administer emergency Diastat, for example, or nobody on campus would agree to be trained to give it. Bingo, that school gets their own LVN. We have at least one school with a student that has emergency Ativan for seizures and an LVN or RN is always there. Our district nurses would like to know how other schools handle that situation. Is it legally necessary for a licensed medical person to be on campus at all times in case the Ativan needs to be given? Just wondering what other districts are doing.

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    My school district had one RN who made the rounds between several schools. When she was not there, they would call her for instructions, send the kid home, or call 911, if necessary. One child had a home health agency provide an LVN to be with that child during the school day. I would assume that it would be up to the parents to get their doctor to get them in a program to pay for an agency nurse to take care of their child during the school day. For my child it was safety reasons. They needed constant stand-by monitoring and would not have been able to attend school without their own companion.

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    Wouldn't the use of a PRN dose of Ativan need a nursing assessment? That to me seems to require a license. I think it is different (although IMHO not ideal) to delegate EPI, as an reaction will be pretty evident, and there should be an ECP that specifically defines what symptoms require what action. I think the assessment for the need of Ativan would be more difficult as there are more nuances to an episode of agitation.

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    Wouldn't the use of a PRN dose of Ativan need a nursing assessment? That to me seems to require a license. I think it is different (although IMHO not ideal) to delegate EPI, as an reaction will be pretty evident, and there should be an ECP that specifically defines what symptoms require what action. I think the assessment for the need of Ativan would be more difficult as there are more nuances to an episode of agitation.

    In NYS only an RN can administer meds to a student... the only exceptions are epipens and glucagon which can be administered by trained staff in emergency situations. The Ativan for seizures has to be adminstered by a nurse after an assessment is made.

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    In Massachusetts, Diastat can only be administered by a registered nurse. I have a student with a Diastat order. I have to go everywhere he goes – meaning, if the school walks to the neighboring school for buddy reading – I have to go. If parent can not go on a field trip with him – I have to go. When his class walks to deliver food for a food-a-thon – I have to go. We have a Halloween walk around the square – I have to go. Yas, no one but a registered nurse can give Diastat, insulin, benadryl (allergic reactions) and EpiPen for undiagnosed students. Trained staff can give EpiPen to students who have an order, but not to students who are undiagnosed. I can't designate staff to give benadryl for allergic reactions as it takes assessment (per DPH). We have to take a med delegation course and renew it every two years in order for us to train and delegate Epipen, medications, and inhalers to staff for field trips.

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    We train unlicensed personnel and if parent not willing then they have the option to send their child to one of the other schools in the district that does have a full time nurse. The only schools that get an RN every day are those that have students who need insulin due to state regulations that an RN only must give.

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    I work in FL. In my district every school has an LPN regardless of what meds need to be given.

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