Epi Question (new to school nursing)

[Back2workRN]

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!

[AdobeRN]

Our stock epi is for anyone and everyone, from students to staff to the UPS guy. If someone is having anaphylaxis then we are allowed to use the stock epi.

Same here.

[Amethya]

You'd lose both in my district if push came to shove.

I honestly would rather save the child than stand there and not help them because of paperwork.

[MrNurse(x2), ADN]

We are not approved to give epi on our own authority. Either we have to have a physician's consent already or we have to obtain one over the phone. In practice, we call 911. Fortunately, we have one of the best EMS systems in the country in our county, and the paremedics carry and are authorized to administer.

I hope I'm never in the situation where I have to decide if I need to go outside the scope of my authority to administer a life-saving drug. Fortunately, it has not occurred.

I believe that our state health department covers giving it without orders. We can even order it from epipens 4 schools without a prescription. State law says epipens must be available to be used in all schools. We were one of the first states to mandate back in 2012.

[KatiejonD, RN]

I recommend you dig a little about what's allowed in your state. Maybe start with the local Pediatrician? I had 'house stock' epipens. The school staff were only permitted to administer an epipen to the students that had diagnosis of anaphylaxis *and* where the MD had written a script for it. But as an RN, I was able to administer it per Nursing judgement, on any student who was presenting as being in anaphylaxis - whether they had any history of an allergy or not. I was never in that situation, but it was an option if ever needed.

[Back2workRN]

Thanks, everyone! I appreciate your responses.

[rnprincesstlo]

Most districts in Ca have a stock epi pen for those who are not know to have an allergic reaction. Additionally, any student who does have a known allergy requiring epi must have their own pen. This goes with them on field trips while the stock stays at school. The nurses are trained that this is the one and only medication ever allowed to be given in an emergency situation, even without an order and parent consent. Of course each district does have a physician order to administer the epi in case of anaphylaxis (for anyone in the school).

Law section.

[beachynurse, ASN, BSN]

There should be a standing order available that spells out exactly what you can do with stock epi. We ahve stock epi here. and I can give it to anyone having an anaphyllactic reaction, student, staff or visitor. I have a written standing order from an MD from our local health department as we do not have MD's on staff, and it is available for all substitute nurses to review.