10 minutes and no emergency meds for seizure

[Vtachy1]

We have a kid that has had seizures all school year. He supposedly has a pediatric neurologist, but his seizure plan states that we are to call 911 for seizures lasting more than 10 minutes. Does this seem long to you? And odd that we don't have any meds for breakthrough seizures?

Its been a stress for all of us because he has a seizure daily. Mom is uncooperative in communicating diagnoses with us and care plans. She finally brought in the seizure action plan yesterday and we learned that he has a diagnosis of aspergers! Mom does not want EMS called. Would most schools put up with this? I am new to school nursing and don't know the norm!

[hsnurse1]

All of my seizure care plans state we will call EMS for seizures lasting more than 5 minutes or if seizures are successive in nature or severe in nature. I have one epileptic student with emergency medication, but my others do not have any. I think, personally, 10 minutes is a long time.

[flyingchange]

That does seem like a long time... Years ago I worked home care for a developmentally disables person with epilepsy. We were to call after 5 minutes. Can you clarify with the paediatrician? Mom doesn't sound very helpful.

[OldDude]

I haven't run across a seizure action plan that states to wait 10 minutes. I recommend getting that confirmed, in writing, by the prescribing physician. Watching a kid seize for 10 minutes seems excessive to me personally and I would be concerned that I may not be adhering to the "standard of care" one would expect with nursing care for someone with a seizure disorder. Please post what you find out because this kind of action plan would be a first for me.......

[Vtachy1]

The mom will not allow us to talk to any of the student's medical practitioners. Ughh. I think he should be kicked out of school since she won't communicate with us and we are not allowed to talk to his docs.

[JustBeachyNurse, LPN]

I've seen wait 10 minutes before calling 911 BUT we had orders Diastat at 5 min if seizure continues at the 10 min mark give Diastat #2 and call 911.

[OldDude]

If the parent won't let you update the seizure action plan with the prescribing physician I would abide by what the "industry standard" is in regard to seizure action plans; call 911 if the seizure lasts 5 minutes and have the child transported. To do otherwise,in my opinion, would enter the area of setting yourself up to be accused of professional negligence. For instance.....if a parent brought you a properly labeled prescription of Ritalin, to be given at Noon, to a 1st grader, and the dosage was, say... 60 mg tablet, give 2 tablets at noon, would you give that dosage without question? I know you would say "No" without confirmation from the physician that this "abnormal" order is accurate; patient advocacy is the heart of nursing; especailly in pediatrics where all the decisions for the patient are made by someone else. Also....I would inform the parent that, unless she allows you to confirm that this order, which deviates from the accepted standard of care for seizure action plans, is in fact accurate, you will active EMS and transport at 5 minutes of seizure activity.

[Artistyc1]

As it appears that there will be no cooperation from this mother, for whatever reason, you need to consider protecting the child, AND yourself. If I were to see seizures that did not appear to be stopping after a 5 minute period, 911 would be called, then the mother. If the mother does not like this, she can appear at the school when 911 arrives, and dismiss them herself. She cannot just dictate what will be done without a physician's input, and it is her choice to do so. Your main purpose is to protect this child.

[JustBeachyNurse, LPN]

Do you have standing protocols such as when to call 911 for a new onset seizure or seizure without an MD signed action plan?

[Psychcns]

Should child protective services be involved??

[squidbilly]

I have a student with a diagnosis of epilepsy, who has not had a seizure in 2 years. His care plan indicates that Diastat is to be administered (rectally) for any seizure lasting >5min. After Diastat administration, the parent has 30 min to come get their child, after which point EMS will be called. However, this parent has not provided Diastat to the school so I would call 911 for a seizure >5min. It may be wise to collaborate with your public health nurse to insure this child is receiving appropriate care, and together you may determine whether this is potentially a case of medical neglect and whether or not it warrants CPS involvement. Remember the student's safety is #1. And always cover your bum! Don't let this mother's lack of cooperation jeopardize your career.

[TraceyMarino]

Perhaps the reason the mom is reluctant is that this is not a seizure disorder at all. Perhaps the child has pseudo seizures---hence the lack of rescue medication, the 10 minute time frame for calling ems, the mom's unwillingness to cooperate. Some times there seems to be a stigma with pseudoseizure patients, and this mom is probably on the defensive. I would ask her point blank if these are pseudo seizures.