Confused about EpiPen administration in emergency situations outside of the hospital

[OctoberFoliage, LPN, LVN]

At a couple of my jobs in California (not a hospital) we had an EpiPen around in case any of our patients needed it. At my new job in NY (not a hospital), my boss has an EpiPen in her office but she said we actually can't use it if anyone has an anaphylactic reaction because we don't work with any doctors on our floor (our floor operates as a different program), so we just have to call 911. Seems strange.

I've been reading conflicting Good Samaritan articles on what the legal/right thing to do is as far as administration to someone without a rx or standing order. Can anyone shed some legal light?

Thanks. ?

[Asystole RN]

The basic rule of thumb is that you are a registered nurse no matter where you are and what the situation is.

If you are trained and knowledgeable in the rescue intervention then you can do it.

If you work L&D and try to intubate someone with a straw, not so much. Work in L&D and catch a baby in an elevator, OK.

[OldDude]

Since I have the knowledge and ability I would not hesitate to administer epi in an emergency instead of watching them die. As a school nurse, I have epipens on hand that are prescribed to certain students but we don't have stock epi on hand. I would even go so far as to use an epipen prescribed to another student if it would keep a child, or adult, from falling into the abyss. I answer to a higher authority that the Nurse Practice Act so I'd deal with whatever legal fallout afterwards. Watching someone die for fear of breaking some kind of "rule" would be a big burden to carry forever.

[OctoberFoliage, LPN, LVN]

9 minutes ago, OldDude said:

Since I have the knowledge and ability I would not hesitate to administer epi in an emergency instead of watching them die. As a school nurse, I have epipens on hand that are prescribed to certain students but we don't have stock epi on hand. I would even go so far as to use an epipen prescribed to another student if it would keep a child, or adult, from falling into the abyss. I answer to a higher authority that the Nurse Practice Act so I'd deal with whatever legal fallout afterwards. Watching someone die for fear of breaking some kind of "rule" would be a big burden to carry forever.

Yes, I hear you! I just felt like it could not be true that we would not be allowed to administer it in the event of an emergency, and that we could actually get in trouble for not doing so. Thanks for your guys' thoughts!

[ruby_jane, BSN, RN]

What does the hospital policy say about that EpiPen in the boss's office? Anyone can have it? Not those doctors, not that floor? It seems odd that a random EpiPen would be on a floor without a specific policy.

After you assess the policy, I'd say review what OldDude said (I agree).

[Jory, MSN, APRN, CNM]

I would rather stand in court defending giving an EpiPen to someone that survived and was fine with some dimwit DA arguing a technicality, than having to defend why I was on the phone with 911 and watched patient suffocate to death.

In a true, anaphylactic situation, the chances of an ambulance getting there fast enough is slim to none.

[Thanksforthedonuts, BSN, RN]

It would not fall under the Good Samaritan Act if you are a paid employee and they are on your unit. I was advised (we have a similar issue in Washington state regarding epipens and delegation) and the department of health recommended we "take a lunch break" during the time an epipen would be needed in an emergency. That way you fall under the Good Samaritan Act as you aren't a paid employee at the time. But honestly, I agree with everyone else, I doubt you will face negative consequences in court by saving someone when you have the knowledge to help them. I couldn't care less about a doctor's order at the moment in time. They'll be dead anyway so whatever you do won't aggravate the situation by giving epi.

[Guest219794]

8 hours ago, Thanksforthedonuts said:

It would not fall under the Good Samaritan Act if you are a paid employee and they are on your unit. I was advised (we have a similar issue in Washington state regarding epipens and delegation) and the department of health recommended we "take a lunch break" during the time an epipen would be needed in an emergency. That way you fall under the Good Samaritan Act as you aren't a paid employee at the time. But honestly, I agree with everyone else, I doubt you will face negative consequences in court by saving someone when you have the knowledge to help them. I couldn't care less about a doctor's order at the moment in time. They'll be dead anyway so whatever you do won't aggravate the situation by giving epi.

Highly unlikely that yelling the words "lunch break" before giving a medication will affect your legal status. It's a nice thought- if anybody ticks me off at work today, I'll just yell "lunch break" before I punch them.

[FolksBtrippin, BSN, RN]

I would not hesitate to break a policy to save a person's life.

I also would question any policy that puts a person's life below an imaginary need for an order.

I was taught in nursing school to always administer life saving interventions first and get the order later.

[Thanksforthedonuts, BSN, RN]

7 hours ago, hherrn said:

Highly unlikely that yelling the words "lunch break" before giving a medication will affect your legal status. It's a nice thought- if anybody ticks me off at work today, I'll just yell "lunch break" before I punch them.

I totally agree! It was probably the most stupid comment I heard from them. And for the particular situation I was asking for was in a community health setting where there is often only 1 employee on staff at a time. So in theory you can't "clock out" for your breaks. The caregiver would still be responsible for the residents (this was referring to delegation in the community health setting). The DOH is practically setting up people people for failure. At least, they realize there is a lapse in the wording of the law for epipens and the "intend" to work on it.