Epi Question (new to school nursing)

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I'm new to school nursing, just working as a sub, and I am confused about something that was said by a nurse who was training me.

She was talking about having stock EpiPens on hand for emergencies and being able to use them on someone who has an unexpected anaphylactic reaction.

But then she said we can only do that if it's a previously unknown allergy. If there is a student who has a *known* allergy but their doctor has not prescribed epi, we can't give it--even if they are having an anaphylactic reaction.

For example, the student's paperwork says he has a mild food allergy and his MD has only written for Benadryl -- but one day he is exposed to the food and goes into severe anaphylaxis. This nurse said that a teacher or someone else could give that student epi, but my nursing license would be in jeopardy if I did it.

I'm confused. Is this a common policy that school nurses follow? I just can't imagine witnessing a kid in anaphylaxis, having EpiPens on hand, and saying "I can't give this because it's not ordered." Isn't that why we stock emergency EpiPens?

Can any experienced school nurses help me here? Thank you!

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I don't think that is correct. If a student has prescribed epi, it is ideal to give their own medication. But in an anaphylactic emergency, if the stock is closer- you can bet that's what I'm giving!

In one school I worked in, we had stock epi in both the health office and the lunch room. If I was walking through the lunch room and someone having a reaction, I would not waste time running to the office to get that child's epi pen. I'd grab from the stock and call 911.

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Thank you, kidzcare.

This situation would be for a kid who does not have their own EpiPen at all, but who has a known allergy. Like some students' allergy plans she showed me just said "avoid the allergen" (no meds ordered at all) or only had MD approval for Benadryl because the student had never had a serious reaction. So we know they have an allergy but I guess the MD did not write for epi for whatever reason...

It's these kids that she said my license does not cover me to give epi, even if they are in anaphylaxis.

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Specializes in pediatrics, school nursing.

I wouldn't hesitate to give the epi, personally... I Would fear for my license as a medical professional who just stood by and watched an anaphylactic reaction who could do something and didn't. I would ask the district nurse leader first or ask to review the written policy for the school/district and/or the standing orders that are prescribed for the nurses by the school/district physician (assuming there is one). If those cannot be procured, I would contact your state's DPH and the board of nursing for clarification.

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Thanks, jhunting. It did not sound right to me, but I wondered if I was missing something... She said it very matter-of-factly, even when I asked her to repeat/clarify.

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Just thinking... maybe the implication is that there could be something in the student's history that makes epi contraindicated, and that's why their MD would not have written it into their plan or prescribed it?

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Specializes in School Nurse, past Med Surge.

I would check the laws in your state, but I'm pretty certain she's wrong. Our protocol is written (and I assume it comes straight from the law) to cover those with known allergies in distress without their epi available, and those undiagnosed who have had a suspicious exposure now in distress.

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Specializes in kids.

I'll take my chances with giving the Epi six ways to Sunday! You are at that point using your nursing judgement.

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Specializes in pediatrics, school nursing.

If that was the case, that child should have specific MD orders stating that epi is contraindicated... Unless I have a medical reason not to give epi, i'm giving it...

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Thanks to all for your help. I appreciate it!

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If that was the case, that child should have specific MD orders stating that epi is contraindicated... Unless I have a medical reason not to give epi, i'm giving it...

Whatever condition that would contradict epinephrine in the setting of anaphylaxis (there is no such contraindication, btw) would itself be made insignificant by a precipitous and present life threatening condition.

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It's better to lose a job rather than lose your license

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