Ethical question-WWYD?

[mmc51264]

This is NOT a hw question. It is an actual thing that happened:

I might should have put it in school nurses, but this could happen anywhere I guess. A person (not a child) is having a severe allergic reaction to something they did not know they were allergic to-having trouble breathing, etc. Person does not have an epipen but a parent who has a child with a severe allergy has one one their person. 911 has been called. Nurse has to decide whether to give someone else's epi to person.

Would the nurse lose his/her license for giving the epi? Do you let the non-nurse bystander give it? Wait for 911 and hope the person lives?

I think this episode has prompted the schools to have epi on hand in case of a new onset anaphalaxis, but I thought this was interesting case.

I have to carry glucagon for my T1 son. I don't know what would happen if I gave it to someone unresponsive d/t hypoglycemia.

[Ayvah, RN]

Just out of curiosity, if you were to call 911, would the operator tell you to administer someone else's epi? What is the 911 operator's scope in this situation?

[JustBeachyNurse, LPN]

Just out of curiosity, if you were to call 911, would the operator tell you to administer someone else's epi? What is the 911 operator's scope in this situation?

They are scripted and work of protocol (often state or county driven by a medical physician oversight) In most areas they would not likely ask if anyone had an EpiPen unlike asking every time "does anyone know CPR"

[ComeTogether, LPN]

So, just to be clear, some of you are actually saying you'd let a kid die to save your licence?

[PMFB-RN, RN]

So, just to be clear, some of you are actually saying you'd let a kid die to save your licence?

It does appear that some are saying that. However I want to give them the benifit of the doubt and let them answer your question themselves.

I don't know what other state boards of nursing would have to say about it, but in my state failure to rescue in the situation as described is far MORE likely to lead to action aginst an RN's license.

[Here.I.Stand, BSN, RN]

I'm sure the BON would look more kindly on practicing beyond my scope, than on failure to act as a prudent nurse.

But BON aside, I'd never be able to look myself in the mirror if I let a child asphyxiate because I was so worried about my license. Worst case scenario where my license is concerned, at least it will have died on a worthy hill.

[jadelpn, LPN, EMT-B]

I did not read all of the responses, however, my very first thought was that a pedi epi pen and an adult epi pen are 2 different doses. There are any number of emt's that carry and can give epi pens that they have on an ambulance--that is the right dose.

Going forward, a good policy to have in place for both the kids and adults who may be in the building. I would use this as a learning tool and to have a protocol in place for anaphylaxis. Your local emergency department can assist you in the creation of this.

And with the push on "tell us if anyone in your party has food allergies" and the limits on food brought to schools due to other's allergies, it is not far fetched to have a policy in place and meds on hand.

[blondy2061h, MSN, RN]

I'll have to research it a bit more, but I do think giving a child an adult epipen dose is still considered better than nothing in the event of true anaphylaxis with other options not imminent.

[2015]

Good Samaritan laws don't apply to us. I would give the epi if necessary. I'm in allergy/asthma so we have stock epi and many of our pts have their own EpiPen on hand. EpiPen, Jr. is for pts 33-66 pounds, EpiPen is for pts over 66#. The Epi Jr is 0.15, Epi is 0.3ml. The EpiPen, AdrenaClick, and Auvi-Q are designed for lay people to use so we can definitely use it with no problem. Yes, it might get tricky since you'd technically administer medication to a pt that wasn't ordered for that pt, but I couldn't live with myself if I didn't do what I could to save a life. Yes, most people do carry a 2-pack EpiPen, as they should, in the event both devices are needed... Whether you use one or two devices the pt is going to the ER anyway.

I have learned a lot in this thread about Epi pens. You nurses are great. Very healthy informative debate we have here.

[Here.I.Stand, BSN, RN]

Re: Good Samaritan laws; nurses are protected by them so long as 1) it's an emergent situation (BLS-protected; suture the neighbor kid's knee lac-not protected), 2) we're not getting paid for our services, 3) we're outside of a healthcare facility (inside, a hospital-pt relationship is implied, and we're bound to the facility's P&P), 4) we're not acting in gross negligence. (I think it was here on AN, but I remember hearing a story where an injured person was face down in a big puddle of water. A nurse-bystander yelled not to move him because he could have injured his neck. Uhhh...he's face down in a puddle of water. Why are we worried about his neck if he's going to drown?? That's basic BLS.)

One of my instructors from nursing school was a legal nurse consultant on the side. She advised us that although we have Good Samaritan laws, there are people who will jump at the chance to sue. And that we NOT do like in the movies, "I'm a doctor!" as the bystander rushes in to save the day. Don't say "I'm a nurse," say "I'm going to help you."

I once took care of a very young man (like 18 or 19 yrs old) whose car had been T-boned by a very large vehicle. He literally came within an inch of internal decapitation, but what saved him was a Good Samaritan got in the car with him, held C-spines and kept him calm until EMS arrived.

Now I realize being a school nurse in the school is a little different than an off-duty RN being in the middle of the community...but still, in my view when a life is at stake, the moral duty to act trumps the potential for legal repercussions. Worst case scenario, we can get a new job or enter a new line of work. That child can't get a new life and those parents can't get a new (replacement) child.

[myrachandler]

I use the Epi pen.

[ThePrincessBride, MSN, RN, NP]

I'd give the epipen to save the kid now and get a good lawyer to defend my license later.

[Graduatenurse14]

I would use the Epipen and let the chips fall where they may.