Ativan at School for Students Under 18

Jolie, BSN · Sep 19, 2015

Is it given IM to interrupt a seizure? What reason do the parents or prescribers give for changing from Diastat to Ativan for school use?

CASchoolNurse831 · Sep 21, 2015

Thank you for responding! It is actually given oral buccally. The parents are concerned about the student's privacy if he had a seizure in a public place they do not want it to me administered rectally. We have spoken to them at length and explained that we will ensure the most privacy possible if he was to seize in a public place but they refuse to change their minds.

We are trying to find out if we are legally allowed to not have a nurse on campus at all times and just instruct the school staff to call 911 if one of us in unavailable. This seems to be what other districts are doing but we do not know of any laws that would protect and support this.

Thanks!

Jory, MSN, APRN, CNM · Sep 21, 2015

I don't really see the rationale that the Ativan has to be given by the RN because it's not approved by the FDA for children under the age of 18. There is nothing in the nurse practice act that separates this between an RN and LPN.

Many medications are prescribed every day for children under 18 that are not FDA approved for that particular use. Whoever is making that decision should cough up evidence.

I also don't see the rationale in it being "illegal" to call 911 if a child is in trouble. That's kind is sickening that its even a question. Why do you need a document? To me this is a "duh".

Moving students is ridiculous.

Farawyn · Sep 21, 2015

Number 2 is indeed illegal, at least in NY. The school is REQUIRED to provide what the child needs medically for the student- not the parent, the school.

If the doctor's order says Ativan, then get the nurses there. That means field trips, town walks, everything.

I would talk to your superintendent.

Mods, can this thread be moved to the School Nurse Forum, please? There are very experienced SNs there that may have dealt with this. Thanks.

CASchoolNurse831 · Sep 21, 2015

No need to be rude, I think I may have not been clear with my question, and for that I apologize. I think that it is important that we keep this a positive place for nurses to help and support one another. We are all doing the best we can here.

That being said, of course we would call 911 in the event of an emergency. What I mean is, is it okay for a nurse (LVN or RN) to NOT be on campus full time when there is Ativan on campus? Currently our district is requiring an RN or LVN to be on campus in the event the student has a seizure emergency.

According to EdCode, NASN, and the BRN, medications that are not FDA approved for children under the age of 18 cannot be administered by anyone who is not a licensed professional in the public school setting.

My other question is, as long as the student has the option of going to a school within the district that has a nurse, then we are covered, correct? It was explained to me that nursing is a "service" like any other service (OT, PT, SLP etc.). Students who need specific services are placed at schools where there are service providers already available. If the parent declines to change schools, then they can sign off that a nurse will not always be there to administer a medication and that 911 will be called immediately. That is NOT to say that 911 would not be called regardless if a nurse was on campus or not.

CASchoolNurse831 · Sep 21, 2015

Thank you!

CASchoolNurse831 · Sep 21, 2015

Thank you Farawyn!

CASchoolNurse831 · Sep 21, 2015

Is NY one of the states that has a school nurse on every campus? Unfortunately here in CA we are severely understaffed. In this district alone, we have 25 schools - 4 RNs and 4 LVNs. We also have a program within the district that provides education to students K-22 year old with severe medical needs. We are also about to start district wide vision and hearing screenings that requires 3 RNs at a time. We are a busy bunch!

Flare, ASN, BSN · Sep 21, 2015

I can only really address solution #3 since in my state all schools require nurses. We enacted a policy that any time Diastat was given it would result in EMS transport for further eval. The parents are called too - if they choose to come and sign a RMA and take the child home with them, that is their right to do so, but I cannot properly monitor a child sleeping off Diastat (or more recently in my case, nasal midalozam) and keep track of the medical needs of the other 799 children in this building. It's a safety concern on both ends.

In my experience, the process at my school of calling for ems, having PD arrive, having EMS arrive, their assessment etc can take up to 20 minutes before they transport. So the parents, if they are close have a good shot of coming for their child (or having one of their emergency contacts coming too - but i don't think that an emergency contact would necessarily be able to sign the RMA form). And this is just in my area where the school is 3 minutes down the road from the closest hospital where the ambulance usually comes out of.

Farawyn · Sep 21, 2015

Is NY one of the states that has a school nurse on every campus? Unfortunately here in CA we are severely understaffed. In this district alone, we have 25 schools - 4 RNs and 4 LVNs. We also have a program within the district that provides education to students K-22 year old with severe medical needs. We are also about to start district wide vision and hearing screenings that requires 3 RNs at a time. We are a busy bunch!

Actually, no, there is no literature on this, that actually states a nurse must be present. However, there is mostly an RN on every campus. Much of the reason is due to meds like Diastat and Ativan that can only be administered by a nurse, and also much of the parents' groups specifically expect an RN.

Silverdragon102, BSN · Sep 21, 2015

Moved to the School Nurse forum