Diastat delegation

[ohiobobcat]

So there is a big to-do in my state over legislation that has been approved to move forward for consideration in the next legislative session.

This legislation will allow the school nurse to delegate the administration of Diastat to unlicensed personnel.

My state school nurse association is NOT impressed by this. They argue that "the act of assessing a seizure and determining the need for the administration of Diastat, and its effectiveness when used, is a nursing skill requiring nursing judgment, assessment, and knowledge."

I know there are school nurses here from all over the country. How do you handle the storage, assessment and delegation of administration of Diastat in your state/district/schools?

[Flare, ASN, BSN]

this isn't delegated yet in my state - thank God! Let's not give my brilliant legislators any ideas!!

[100kids, BSN, RN]

in NY Schools Diastat can only be administered by an RN or an LPN under the direction of an RN (requires that the RN can direct by phone and personally intervene in 15 minutes). Diastat is kept locked in my office.

[schooldistrictnurse]

hello friends,

although retired as of this year, I can't seem to break the habit of reading the school nurse topics! I can say that Diastat has been "delegat-able" in Wisconsin for many years. Staff are trained by the nurse and have annual refresher. Very specific parameters are set for each child and they are defined in an IHP. (This is the way to get around the assessment piece)

Educational aides have "medical procedures as required" in their job description so they cannot refuse. I always approached classroom teachers by saying "for your student's safety we want to have a large pool of trained personnel" and can't remember any saying no. Having the classroom teacher trained gave coverage for field trips. A small string bag with med, IHP, small blanket went out on any field trips.

[Jolie, BSN]

My answer probably won't be popular here, but it is honest.

I live in a state where the administration of Diastat (and almost any non-IV medication) can be, and often is, delegated to non-licensed personnel. Nebraska is largely a rural state, without adequate nursing personnel to staff every school. Without delegation, we would have students with no way to receive life-saving medications during the school day. As we all know, federal law prohibits schools from requiring parents to attend to their child's health needs during the school day in public schools. Laws mandating a nurse in every building are useless without adequate numbers of licensed staff willing to work there, and adequate funds to pay them, neither of which exist in many places any more.

By establishing a thorough program of selecting and training staff, well in advance of any known need, we are able to provide safe and effective medication administration to hundreds, if not thousands of children in our state alone. Keep in mind that like Epi-pens, Diastat is a product designed to be administered by non-healthcare personnel in stressful situations. I know of no one here who would object to teaching a parent, grandparent or regular daycare provider to administer emergency medications to a child with a known health condition. This is exactly what happens when we train our health assistants in our school district to administer Diastat.

Please know that unlike some jurisdictions that seem to allow "deputizing" just about anyone to hand a pill to a child, We follow guidelines similar to those regulating medication technicians in LTC, but more specific to the our population of school students. A number of health assistants are identified in each building, at least 5, but often as many as 10-15. These people attend multiple formal training sessions over a 2-3 week period, taught by nurses, RTs, pharmacists, and EMTs. They must become CPR certified, pass a written exam, pass practical exams, undergo observations by the district nurses and re-qualify every 2-3 years.

What may be the most critically important about these personnel is that they are the ones who spend the most time with the students in need. These teachers/assistants and support staff are far more familiar with these students' normal and abnormal behaviors and physical conditions than a nurse in the building 1-2 days per week could ever be. When the need for medication arises, they will always page the nurse, but if not present, will assess and give medications competently, just as the student's parents and grandparents do at home.

[Rubor]

My state allows delegation, I however, did not. There are some things I'm not comfort with.Access to a nurse or EMT is different for my rural community. Given a different situation my comfort level for the safety of the child and competence of staff could be different.

[Spidey's mom, ADN, BSN, RN]

Jolie - great post as usual.

In our state, we have had that law for years.

However, NO teacher or other staff will agree to be trained to administer PR meds in my district.

They are inundated with classes about inappropriate touch and can't even hug kids.

I haven't been able to train anyone; even if I wanted to.

[Rubor]

My rural community has EMT and fire department less than 3 blocks...lol. I'm sure my post makes no sense...

[SassyTachyRN]

We delegate that. The best people for us to train have been special Ed assistants as it is part of their job descriptions to assist students with medical procedures as trained by the nurse. We have to have a minimum of two people in our building trained in diastat. I have found teachers to be absolutely reluctant, and have never had one agree to be trained. The last few years I have had special Ed assistants and one of my secretaries volunteer for it. Field trips- we ask the parent or a family member to attend with the child.

[CalNevaMimi, LPN, LVN]

California districts delegate with parent consent. Unlicensed staff is trained by the RN. This is one of the many reasons I decided not to work as a district LVN anymore. More and more of my nursing duties were being delegated to unlicensed people. That speaks for itself. I work in schools through an agency now.