Incoming Seizure Disorder

[KeeperOfTheIceRN, ADN]

Hello everyone! I hope you're enjoying your Summer so far. Ya know, considering the current state of the world ?

Anywho, I have a new student that will be starting in the fall who has a "significant" seizure disorder. I have not seen any paperwork or MD orders yet, but we have a meeting coming up that I am gathering all of my pertinent info for. My only hang up is the possible administration of Diastat. I'm assuming this will be the medication (again, I haven't received any paperwork yet) that they will have on campus for this student and I do not have any personal experience with it. Specifically, IF I can delegate the administration of the med and WHO (any staff, administration only, etc. etc.) I can delegate it to. I've tried to find guidance on it through my BON and DSHS but I haven't found anything that specifically states what the guidelines for Diastat administration are. Any help or links to governing documents will be greatly appreciated!! Thank you!

Oh! I'm located in Texas, by the way ?

[k1p1ssk, BSN, RN]

In Massachusetts, Diastat cannot be delegated as it is technically a controlled substance (Valium) and in order to administer, there is not only the need for training on HOW to admin, but when. With all this said, all faculty/staff that would have frequent contact with the student should have seizure recognition training and you should have a plan in place for what staff should do should they witness a seizure.

I would want to know from the MD/Family when they want 911 called (I.e. EVERY seizure, or only seizures involving certain behaviors, or only seizures that last a certain amt of time, or only if Diastat needs to be given, etc.)

The student should have an IHP / EHCP and depending on the severity/frequency/triggers of the seizures, a 504.

[Flare, ASN, BSN]

In NJ we can't delegate diastat. Unfortunately, I am not certain what TX laws are, but we have a few TX school nurses here. Hopefully they will weigh in. If you don't have a seizure action plan form, I'd suggest that you use the one from the epilepsy foundation:

https://www.epilepsy.com/sites/core/files/atoms/files/SCHOOL Seizure Action Plan 2020-April7_FILLABLE.pdf

Also, I'd imagine you do seizure training as well, for the staff. I tried using a Google classroom type thing to get the info out to my staff. I put together a few quick you tubes, a slide show type thing and then a short quiz.

[shark_nurse14, BSN, RN]

I would have a very honest conversation with the family before the start of school regarding EVERYTHING they want the school to do in response to a seizure and have it included in an EAP with nurse/parent/doctor signature. I've had some students who we were to call 911 with every seizure, and others who were to rest in the nurses office x30 minutes and then return to class. Every seizure disorder is definitely unique. I also have a few questions before I could offer more advice regarding the delegation of emergency meds:

Is there a full time nurse at the school?

Is there a possibility for the prescription/administration of nasal Midazolam instead of rectal Diastat?

When was this students last active seizure/how long/last time they received emergency med?

As for the delegation, I'm unsure about Texas. I practice in MA, and Diastat cannot be delegated. Also, you mentioned the student will be on "campus". Is this a single school or multiple schools in close proximity? If the latter, could there be the possibility of a nurse being able to arrive at the school within the timeframe of med admin (usually 5-10 minutes) to administer so no UAP is necessary? Just a thought! Good luck!