I am a school RN in California. My district has been getting a lot of students switching from Diastat to Ativan orders for seizures. We are able to train ULPs for Diastat with parental consent. Ativan, on the other hand, can ONLY be administered by an RN/LVN because it is not FDA approved for people under 18. We are having so many problems trying to figure out coverage for all of the Ativan scattered around our district!
My question is this, how are other schools (especially in CA) handling this? I see only three solutions:
1. We just hire more LVNs (obviously that is not even up to us and extremely difficult)
2. We tell the parents that their child can either move to a different school that already has a nurse (is that legal?)
3. Have some kind of LEGAL document that states the school will call 911 immediately at onset of seizure if nurse is not on campus. And is that even legal?
I would LOVE it if anyone has any legal documentation or resources regarding this issue.
What about Midazolam given intranasally? If that is given, they are transported , as well as if they get Diastat. As to the legal document, I think it would be in their seizure Action plan that an uncontrolled seizure would be an EMS call. Either way action plan or not (because the child without a diagnosis or new onset seizure would be transported anyway) if there is a medical need, they are evaluated by EMS.
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.
Farawyn my friend - You made me spit my coffee out while laughing . . .. . a nurse on every campus in California!
Most nurses here work part-time and there is not a nurse, for the most part, on every campus.
(There are 11 campuses in my district 20 miles apart).
We don't have any volunteers for diastat - there was a law passed a few years ago allowing lay-people to give it but there is not one teacher who will volunteer for that. They are bombarded with information regarding improper touching of students so you are not going to get many teachers willing to give rectal meds. Nor will a school secretary or principal. If you can't find a volunteer, it is my understanding that you as the nurse can't get into trouble for not being on campus to give the med.
Call 911 is what I tell folks.
We had one student who got Ativan for seizures - we had a doctor's order for it. As the school nurse, I made sure the order was correct and the meds were in a locked cabinet and trained the school secretaries but we've never had to use it and that student is now gone.
Specializes in family practice and school nursing.
In NY nurses can train volunteers to give epipens and glucagon and that is all. My school refuses to train people for glucagon. So if Diastat or Ativan is ordered for a student there must be a nurse available to administer it. This is the school's responsibility. This is why I rarely take time off...subs are few and far between and agency nurses are so expensive.
In NY nurses can train volunteers to give epipens and glucagon and that is all. My school refuses to train people for glucagon. So if Diastat or Ativan is ordered for a student there must be a nurse available to administer it. This is the school's responsibility. This is why I rarely take time off...subs are few and far between and agency nurses are so expensive.
Right, and this is how NYS gets around having and RN on campus- which both the schools and parents want, but is actually not legislated.
Thanks for this, bell1962. I'm still new as a SN and not completely sure.
we treated the midalozam the same as the diastat - actually, it may have been the tipping point in getting the student her own private duty nurse - not really the drug per se - just the student as a picture as a whole at the time (very long seizures, de-satting, long recovery from seizures in the am prior to school)
ER turned school nurse here: I read through the responses fairly fast, forgive me if this was covered. I thought the reason to give Diastat rectally was because of possible aspiration from giving anything orally. Plus a lot of times their jaws are clenched and you never put anything in someone's mouth while they are seizing. Is buccal Ativan a very small amount of liquid?
So the doctor is ordering something orally to stop a seizure in progress? In the ER we would never do this. IM or IV(if ya' got one) or rectally.
If it were me, since my license is on the line, I would not give any medication in a school setting that isn't FDA approved. It's not safe. End of story. It's our job to question MD orders for safety. Call the MD and question the order.
If the parents are so concerned about a seizure on a field trip, they should go on the field trip and administer the ativan if needed.
Otherwise rectal Diastat it is. It's safe and FDA approved. Do what's safe always.
Nope. If staff refuse to be trained, then we are covered from liability.
Same with the new epi-pen law.
NY will allow TRAINED lay people to administer EPI but only a nurse can administer diazepam pr.
So... if a student on diastat is there, I must be there. If the student stays after school they must let me stay OR hire an RN. They cannot tell the mom no, you have to pick her up, or no we have no nurse so we will call 911 (actually, 911 is step 2 in her care plan after the diastat) if it's in her care plan and is a dr order the nurse must be there.
I got lots of OT from my diastat student last year and now they changed the order because she has been grand mal seizure free.
coughdrop.2.go, BSN, RN
1 Article; 709 Posts
I recommend contacting the CSNO (California School Nurses Association) for guidance. Call, do not email. Leave a voice message if you need to.