It's just anaphylaxis

Specialties School

Published

I have ONE student's Epi-pen in my office, yet I have around 30 students with life-threatening allergies at my school, and I'm wondering how the rest of you get non-compliant parents to bring in critical medication or even just return paperwork.

Specializes in ICU CCU PACU.

So we are talking about school nurses here right. so go to the local pharmacy buy a vial of epi for $2 and a syringe. Or get a hospital ER, PARR or critical care nurse to bring you one home. You know how to draw up and give an injection . EpiPens are for amateurs. I give flu shots and have to have epi on hand. that's what we do, Cheaper to replace those every season.

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"At times I've also let parents and doctors know I'm documenting how many times I've requested this information in case something happens and i need to provide evidence for a Coroners Case…."

We so need to have a Like button for this!

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Specializes in med-surg, IMC, school nursing, NICU.
Admittedly, I'm naive. I'm not a school nurse, and I haven't quite finished my RN, although I'm a mother and grandmother of kids who have allergies. Isn't there a budget with which you can buy an emergency EpiPen to keep in your office to save a life? I agree some parents are the worst at sending necessary supplies for their kids, but if you make the case to your district, couldn't this be accomplished? I worked as a LPN at a summer camp and we had several EpiPens and Benadryl we sent on every trip off-site, along with the campers' own pens from home, in case we had an anaphylactic camper who didn't have a history or whose parents didn't send a Pen. We didn't have enough nurses to send one on every trip, so all staff were trained in proper use of the Pens. I know public school funding is very different, which is why I am asking.

In my district, each school has 4 EpiPens, 2 junior and 2 full strength. They are not purchased with my school-based health budget, the county provides them to us at the beginning of each year. However, like I said in my earlier post, these are more for students (or staff!) with unknown or new allergies who don't have Epi at school. It is always preferable to have a personal pen for each student for field trips, etc. When a child has a documented allergy, the medication order is often accompanied by an emergency action plan which is always helpful. It's dangerous to rely on stock epi that may or may not be available.

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So we are talking about school nurses here right. so go to the local pharmacy buy a vial of epi for $2 and a syringe. Or get a hospital ER, PARR or critical care nurse to bring you one home. You know how to draw up and give an injection . EpiPens are for amateurs. I give flu shots and have to have epi on hand. that's what we do, Cheaper to replace those every season.

Is there anywhere that epi is OTC? To have stock epi pens here we need to have a physician sign a blanket standing order.

Also, nurses are only site during school hours (and in some schools, not all day and not even everyday). A stock epi pen needs to be available for a lay person to use in case of emergency while the nurse is out of the building or during after school activities.

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Specializes in school nursing.
So we are talking about school nurses here right. so go to the local pharmacy buy a vial of epi for $2 and a syringe. Or get a hospital ER, PARR or critical care nurse to bring you one home. You know how to draw up and give an injection . EpiPens are for amateurs. I give flu shots and have to have epi on hand. that's what we do, Cheaper to replace those every season.

I think you are missing a couple key points to school nursing and nursing in general...

If I have no paperwork and no Drs note, I shouldn't be giving anything. I need a full prescription with all 6 rights of administration. I am a nurse, not a prescribing physician. It would be irresponsible of me to somehow obtain Epi and administer it willy-nilly.

If I have a student experiencing anaphylaxis without a documented allergy, I will use a stock EpiPen. I am to provide anything needed for unforeseen emergency situations. (I have a school-wide Doctors order for undocumented allergies and use of EpiPens).

With that being said, if a student has a KNOWN allergy, I fully expect them to have an EpiPen. Half of my job is teaching these children how to care for themselves, as well as educating parents. What would they do if I'm not here? They should always have an EpiPen on them, and if they don't understand that, it is my job as a nurse to educate them the importance.

Also, in school nursing, we may not see a child for several minutes after they've already ingested a known allergen and are experiencing symptoms. I need the fastest option available to care for these kids; a bottle of Epi and a syringe is not ideal. Sometimes I feel like even just taking the little blue tip off the EpiPen is eating up my precious time.

To say EpiPens are for amateurs is naive. Yes, I am a nurse and known how to give injections. But you would be very surprised that even after a 30 minute video, a quiz, and a demonstration to teachers and field trip staff, they are still using it incorrectly. It's not about just stabbing a child. It's about identifying the need for Epi, if the child is to receive benadryl first, what to do after administration, interpreting the Allergy Action Plan correctly, and all that's involved with an allergic reaction. I do not go on field trips, I am not at after school care. I need to ensure that these teachers are ready for anything. It's already hard enough, imagine if I handed them a vial and a syringe! :nailbiting:

It's my job to ensure that I have the safest and fastest means of providing them life-saving care. To me, just buying the Epi and a syringe and administering it with no paperwork seems neglectful. There are some students here that would go into cardiac arrest if I gave Epi without checking that their HR is within a range set by a physician. I would never know that if I didn't demand to have the proper paperwork.

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Specializes in Cardiology, School Nursing, General.

One of our admin is worried about getting other epi-pens because "who will make the call if this person is having an anaphylaxis and we should we inject them?" I'm a medical aide here and we do have epi-pens but for the students who are prescribed under, and no emergency ones.

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Specializes in IMC, school nursing.
Hi,

Just commenting from Australia so wish to acknowledge that my take on this may be different.

We have the same issue here but a few ways to address this with families.

If we have a documented student with anaphylaxis we expect all paperwork completed and epipens provided within one month of enrolling at the start of each year or within a month of diagnosis. If this doesn't occur it means no excursions- especially if it's a food or insect allergy, no purchases from the canteen if a food allergy, no participation in food technology (cooking) class if it's a food allergy, and sometimes kids have to sit outside my office to eat their lunch if they are potentially at risk. This is not to punish the kids but to make it as safe for them as possible. They often bring a friend with them so they aren't ostracised or isolated. The focus is on student safety and not punishment. These limitations often wear thin very quickly for the students and they seem to assist the parents to step up and provide documentation/ epipens really quickly..... Parents may choose to ignore me but they don't often get to ignore their child if they're missing out on something they want to do...

I also often scan/ email or fax the required paperwork directly to their doctor with a friendly cover letter requesting completion within a week. I resend this fortnightly until it's returned..... it seems to come back quite quickly. At times I've also let parents and doctors know I'm documenting how many times I've requested this information in case something happens and i need to provide evidence for a Coroners Case....

Compliance with providing required documents/ epipens/ inhalers at my school is around 90+%

LOVE IT!:up:

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Specializes in Peds, Neuro, Orthopedics.
in case we had an anaphylactic camper who didn't have a history...

If a nurse gives epi without an order, aren't we practicing medicine and breaking the nurse practice act? It's my understanding that we need an order to give any medication.

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Specializes in Psych, Addiction.
If a nurse gives epi without an order, aren't we practicing medicine and breaking the nurse practice act? It's my understanding that we need an order to give any medication.

At the camp I worked at, we had a book of standing orders for every OTC med we gave, as well as Epinephrine injections, just to CYA nursing staff. And careful documentation of symptoms and signs, as well as dosing criteria were always reviewed by our MD the very next shift, then signed by him or her.

I would be interested to know how other camps or schools handle this.

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If a nurse gives epi without an order, aren't we practicing medicine and breaking the nurse practice act? It's my understanding that we need an order to give any medication.

Not if standing orders are written.

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EpiPens are for amateurs.

QUOTE]

....nice. Make that a tee-shirt and I'm in...

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So we are talking about school nurses here right. so go to the local pharmacy buy a vial of epi for $2 and a syringe. Or get a hospital ER, PARR or critical care nurse to bring you one home. You know how to draw up and give an injection . EpiPens are for amateurs. I give flu shots and have to have epi on hand. that's what we do, Cheaper to replace those every season.

Didn't know you could buy epinephrine OTC. Or that it was right to ask hospital nurses to steal it and give it to you because parents are too irresponsible to supply epipens for their own children.

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