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Epi Pen Organization

Specializes in Pediatrics, Community, and School Health.

I am wondering what you do with your Epi pens. Are they always in your office? We are in a unique situation in that we are on two floors of a large public building, so I have the epi pens (and 2 diastat pens) in the class rooms specific to those students. I keep the emergency epi pens in my office and in the cafeteria. I am thinking I may change and keep them all in my office next year but not 100% yet.

What do you do with your and how do you store them? The nurse at our High School keeps them all in her office in a shoe organizer.

What grades do you have? We are a junior high school and our students all carry theirs. We do have backups for some of the kids that we keep in the clinic, just in case they forget theirs. We make sure they all know how to administer it, and the teachers are also instructed.

denstar

Specializes in School Nursing.

I am in a similar situation. My school is 5 floors and I fear if something happened in the classroom, it would take too long to get an epipen from my office there. Parents are made aware that if they provide just one epipen (or any emergency medication, such as an inhaler or diastat), that it is kept in the classroom with the teacher. If two are provided, I keep the spare here. Our stock epipens are in m office and any spares teachers give us. I go though the same thing every year - where is best? Not often, but every once in awhile a teacher will misplace a student's medication and we have to track it down. However, between how spread out our school is and that many of our classes travel off campus once a week (it would be a nightmare for me to organize, send out, and check back in the emergency meds for these classes each week), I always end up sticking with keeping them in the classrooms. I just feel it's the safest way to keep them close to the students that need them in our situation.

MHDNURSE, BSN, MSN, RN, NP

Specializes in Pediatrics, Community, and School Health.

What grades do you have? We are a junior high school and our students all carry theirs. We do have backups for some of the kids that we keep in the clinic, just in case they forget theirs. We make sure they all know how to administer it, and the teachers are also instructed.

We are K and 1 this year and next Fall will be K, 1 and 2 so they can't self-carry yet

I have a shoe holder hanging from a door in my office.

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

I have a wall hanging shoe organizer for them. But they are back-ups mainly for students that also self carry.

But, next year we are doing something very different. Using stock epi for everyone. We will no longer students to provide their own epi pen in school because are epi pens are identical (I work with the older kids, so no Epi-pens Jrs). A stock epi-pen will go on a field trip to cover diagnosed students. (Yes, orders for student with diagnosed life threatening allergies for said epi-pen will still be required.) Per my state, I will be the only one who can administer epi to a student with a new outset and previously undiagnosed food allergy presenting with anaphylaxis. Our school physician fully supports this.

I am actually excited about this, because Epi-pens can be expensive and getting a parent to send one is very hard; plus the darn things expire and have to be replaced, also something that isn't easy. And given the insurance climate, may or may not be easier depending on one's state. I do have several student with serious allergies that self carry, and they still will as they should as a rule in life for them.

I ran the numbers of administrations my school has had in the previous few school years (in MA, you actually have to fill out four pages of paperwork to report to the state every time an Epi-pen is used) and it is low enough for the school to support providing the Epi. We're starting with a free supply and supplementing as needed from there. The Epi-pens will stay in my office, in an easy to access place for admins as well in case of a rare emergency where I am not available.

denstar

Specializes in School Nursing.

Just to add - the medications I keep in my office are in clear plastic bins from the container store. For now, I put each student medication in it's own Ziploc bag, clearly labeled and have a grade or two in each bin (depending on how many there are). I then have a label on the outside of the bin indicating which grades and students have medications contained inside. In an emergency, would just have to grab the appropriate bin and should be easy/quick to get it out. All staff are aware of their location and I leave the cupboard unlocked for easy access.

If they don't self carry we keep personal EpiPens in the office in a filing cabinet like all the other meds. We also have stock EpiPen Jr's and adult EpiPens in the office (middle school). Both the care plans and the med cards have a post it listing which classroom the student is at each period. One of the high school nurses has a small emergency bag and one of the stock doses is kept in there at all times so she can grab and go. In an emergency campus supervisors will roll up to the office in a golf cart and drive me where I need to go instead of me attempting to run there.

I have a wall hanging shoe organizer for them. But they are back-ups mainly for students that also self carry.

But, next year we are doing something very different. Using stock epi for everyone. We will no longer students to provide their own epi pen in school because are epi pens are identical (I work with the older kids, so no Epi-pens Jrs). A stock epi-pen will go on a field trip to cover diagnosed students. (Yes, orders for student with diagnosed life threatening allergies for said epi-pen will still be required.) Per my state, I will be the only one who can administer epi to a student with a new outset and previously undiagnosed food allergy presenting with anaphylaxis. Our school physician fully supports this.

I am actually excited about this, because Epi-pens can be expensive and getting a parent to send one is very hard; plus the darn things expire and have to be replaced, also something that isn't easy. And given the insurance climate, may or may not be easier depending on one's state. I do have several student with serious allergies that self carry, and they still will as they should as a rule in life for them.

I ran the numbers of administrations my school has had in the previous few school years (in MA, you actually have to fill out four pages of paperwork to report to the state every time an Epi-pen is used) and it is low enough for the school to support providing the Epi. We're starting with a free supply and supplementing as needed from there. The Epi-pens will stay in my office, in an easy to access place for admins as well in case of a rare emergency where I am not available.

Jen, just curious, how many stock pens will you have? I have 2 twin packs and will send one out for field trips if a student with diagnosed allergy doesn't have any epi at school at all. But sometimes we have multiple field trips, or field trip in which the groups are really spread out ... there's my dilemma. So I tell my parents if their kid doesn't self-carry and I don't have their epi in my office, there will be none to send on trips.

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

Jen, just curious, how many stock pens will you have? I have 2 twin packs and will send one out for field trips if a student with diagnosed allergy doesn't have any epi at school at all. But sometimes we have multiple field trips, or field trip in which the groups are really spread out ... there's my dilemma. So I tell my parents if their kid doesn't self-carry and I don't have their epi in my office, there will be none to send on trips.

We are starting with the same stock; I am asking that students with severe allergies still self-carry on field trips vs sending a stock pen out for split up field trips. Or asking they provide the school with an Epi-pen designated specifically to go with their student on field trips.

MHDNURSE, BSN, MSN, RN, NP

Specializes in Pediatrics, Community, and School Health.

I have a wall hanging shoe organizer for them. But they are back-ups mainly for students that also self carry.

But, next year we are doing something very different. Using stock epi for everyone. We will no longer students to provide their own epi pen in school because are epi pens are identical (I work with the older kids, so no Epi-pens Jrs). A stock epi-pen will go on a field trip to cover diagnosed students. (Yes, orders for student with diagnosed life threatening allergies for said epi-pen will still be required.) Per my state, I will be the only one who can administer epi to a student with a new outset and previously undiagnosed food allergy presenting with anaphylaxis. Our school physician fully supports this.

I am actually excited about this, because Epi-pens can be expensive and getting a parent to send one is very hard; plus the darn things expire and have to be replaced, also something that isn't easy. And given the insurance climate, may or may not be easier depending on one's state. I do have several student with serious allergies that self carry, and they still will as they should as a rule in life for them.

I ran the numbers of administrations my school has had in the previous few school years (in MA, you actually have to fill out four pages of paperwork to report to the state every time an Epi-pen is used) and it is low enough for the school to support providing the Epi. We're starting with a free supply and supplementing as needed from there. The Epi-pens will stay in my office, in an easy to access place for admins as well in case of a rare emergency where I am not available.

This is AMAZING!! My husband is an allergist here in MA and totally asked me why we can't just do this instead of making them all bring one in- much easier. I am totally going to look into this! I am actually going to the Medication Administration and Delegation training next week which I am sure will help answer some questions I have.

We do have the stock epi- both junior and regular, I have two of each.

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

This is AMAZING!! My husband is an allergist here in MA and totally asked me why we can't just do this instead of making them all bring one in- much easier. I am totally going to look into this! I am actually going to the Medication Administration and Delegation training next week which I am sure will help answer some questions I have.

We do have the stock epi- both junior and regular, I have two of each.

The MA Medical Society recommended it and sent my school a letter about it, which is why I started exploring it. The more I thought about it, the more it made sense, especially when I looked back at Epi-pens administrations in the last 4 years.

Yes, food allergies are on the rise, but there is a much smaller subset of my student population that has experienced anaphylaxis with an allergy. I wanted to be prepared for that, but understood that my asking a parent to bring me an unexpired Epi-pen for their student who has never used it or experienced anaphylatic symptoms may feel like a tall order for some. I'm tired of chasing when this just makes it a more streamlined process.

But, next year we are doing something very different. Using stock epi for everyone. We will no longer students to provide their own epi pen in school because are epi pens are identical (I work with the older kids, so no Epi-pens Jrs). A stock epi-pen will go on a field trip to cover diagnosed students. (Yes, orders for student with diagnosed life threatening allergies for said epi-pen will still be required.) Per my state, I will be the only one who can administer epi to a student with a new outset and previously undiagnosed food allergy presenting with anaphylaxis. Our school physician fully supports this.

Will they still carry for after school activities (band, sports, etc.)?

in MA, you actually have to fill out four pages of paperwork to report to the state every time an Epi-pen is used
:wideyed::wideyed::wideyed::wideyed: O~M~G

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

Will they still carry for after school activities (band, sports, etc.)?

:wideyed::wideyed::wideyed::wideyed: O~M~G

Yep. We are the only state that tracks Epi-pen administration in the schools and it is very thorough. Thankfully it is now online and has some drop downs to help.

My school doesn't have band. Students with known allergies that plays sports, like field trips, will be required to self carry. (Like they do now; coaches aware of allergy and where epi is, typically in student's backpack or gym bag.) Only a school nurse can administer stock epi to a student with undiagnosed anaphylaxis and I do not go to sports practices or games. However, there are easily accessed emergency services at the off school site places in which games and practices do occur. (We don't currently have a gym.)

I work after school, so the building has me for activities that take place at school. I will be delegating a stock epi for use by teacher/admin at evening events at the school for a student with a diagnosed allergy. Part of the training for next year, when this will happen.

GetBackToClassRN

Specializes in Pediatrics, Hematology Oncology, School Nurse.

We have locked medication cabinets in our clinic. One cabinet is used for Allergy Medications (Epi-Pens and Benadryl), one cabinet is for our daily use medications and PRN oral medications, the third cabinet is for inhalers & nebulizer medications.

We do have some students (including my own child) that have gotten approval to self-carry their Epi-pens.

I asked our district nurse manager about ordering the stock Epi-pens and was discouraged from doing so. Our district is concerned about legal ramifications if the stock Epi-pens are used and later deemed that it was unnecessary.

This is my first year as a school nurse, so I don't have a lot of experience in this setting.

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

We have locked medication cabinets in our clinic. One cabinet is used for Allergy Medications (Epi-Pens and Benadryl), one cabinet is for our daily use medications and PRN oral medications, the third cabinet is for inhalers & nebulizer medications.

We do have some students (including my own child) that have gotten approval to self-carry their Epi-pens.

I asked our district nurse manager about ordering the stock Epi-pens and was discouraged from doing so. Our district is concerned about legal ramifications if the stock Epi-pens are used and later deemed that it was unnecessary.

This is my first year as a school nurse, so I don't have a lot of experience in this setting.

I'm less worried about giving Epi unnecessarily vs. not giving it when needed. Not giving it when needed can be fatal. The side effects of epi for a student without an underlying cardiac condition are very few.

I have read articles that talk about over-prescribing of Epi-pens. I have other read articles talking about patients with severe allergies and a history of anaphylaxis that are still afraid to use their Epi-pen if needed.

Students with a diagnosed allergy should have an allergy action plan with guidelines for using Epi. Stock epi should have guidelines for use as well; this is why only an RN can give to a student with undiagnosed anaphylaxis in my state.

If anyone is curious, check out the data from MA: Anaphylactic Events in School

Last report is from 2014, but ~24% of epi-pens administrations were to a student or staff member with no history of allergy, and 40% of administrations to those with no history of anaphylaxis.

I just like having access to epi if it is needed :).

Edited by JenTheSchoolRN

In case you weren't aware- Mylan gives epi-pens + epi-pen Jrs. to schools for free! That is how we got our stock supply. They give a twin pack of each and training info, as well as a big yellow case they can be stored in and wall mounted. If you end up using one you go to their site, fill out the paperwork and they send you another for free. As they outdate annually you just go and ask for new ones. Super simple. We keep them in the health office and one set in my ER Backpack that I can run with. They are only kept in the classroom for our kids with super severe allergies and this one is provided by the parent.

For field trips we require that parents provide one to take with; if they absolutely can't or forget, I send one with. It is very seldom that we have multiple kids/grades with allergies going to different sites during a day.

For the Epi-Pens for schools program check out here: EpiPen® (epinephrine injection, USP) and EpiPen Jr® (epinephrine injection, USP) Auto-Injectors

do you need prescriptions for each epipen kept at the school that you order?

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