Narcan for School Nurses?

Dogen · Nov 19, 2015

Oregon expanded the use of naloxone to non-medical people in 2013. They take a 15-minute training course in order to be eligible to receive a kit for either the IM or intranasal versions, so it's an easy med to give. People from clinics and shelters have been getting trained to administer, and in the first year that it was implemented opiate deaths dropped 44%. It's a good combination of safe, fast, and effective... especially compared to the alternative. It just gives EMS another ~15-30 between arriving "in time" and "not in time."

I can totally sympathize with the shock value of needing it in schools, though.

Farawyn · Nov 19, 2015

Oregon expanded the use of naloxone to non-medical people in 2013. They take a 15-minute training course in order to be eligible to receive a kit for either the IM or intranasal versions, so it's an easy med to give. People from clinics and shelters have been getting trained to administer, and in the first year that it was implemented opiate deaths dropped 44%. It's a good combination of safe, fast, and effective... especially compared to the alternative. It just gives EMS another ~15-30 between arriving "in time" and "not in time."
I can totally sympathize with the shock value of needing it in schools, though.

I'm not really scared of the med. It's the KIDS.

Mavrick, BSN, RN · Nov 20, 2015

I'm not really scared of the med. It's the KIDS.

Oh, yeah, when you suddenly reverse all that good stuff they come bouncing back with purpose and vengence!

Windchaser22 · Nov 20, 2015

Quiltynurse, we all have our medical alert list of kids so we know who has something going on. Plus I carry a walkie and get called for injuries. Additionally, many of us are on teams (I&RS, 504, IEP) that address various issues kids are having (attendance, behavior, etc). And like someone said...those pinpoint pupils.

Home Health Columnist / Guide · Nov 20, 2015

Hot off the press:

Oct 28, 2015 -News articles

Naloxone available to all Pennsylvanians with governor order

Overdose antidote available statewide

PA Dept of Health Regs:

STANDING ORDER DOH-002-201S NALOXONE PRESCRIPTION FOR OVERDOSE PREVENTION

Family members and friends can access this medication by obtaining a prescription from their family doctor
or by using the standing order
(a prescription written for the general public, rather than specifically for an individual) i
ssued by Rachel Levine, M.D., PA Physician General.

In addition to talking to your healthcare provider or the pharmacist about how to use naloxone, individuals giving this medication to someone should take the online training ahead of time. Training is available at one of the Department of Health approved training sites
www.getnaloxonenow.org
or
https://www.pavtn.net/act-139-training.
These easy to understand, brief trainings explain how to recognize the signs and symptoms of an opioid overdose, what to do in the event of an overdose, and instruct on how to give naloxone. While it is not necessary to obtain a training certificate in order to purchase naloxone, learning these important details will help you respond properly in the event of an overdose and also meet the immunity requirements of PA Act 139.

Adopted June 2015:

National Association of School Nurses (NASN) - Naloxone Use in the School Setting: The Role of the School Nurse

SUMMARY
It is the position of the National Association of School Nurses (NASN) that the safe and effective management of opioid pain reliever (OPR)-related overdose in schools be incorporated into the school emergency preparedness and response plan. The registered professional school nurse (hereinafter referred to as school nurse) provides leadership in all phases of emergency preparedness and response. When emergencies happen, including drug-related emergencies, managing incidents at school is vital to positive outcomes. The school nurse is an essential part of the school team responsible for developing emergency response procedures. School nurses in this role should facilitate access to naloxone for the management of OPR-related overdose in the school setting.

Farawyn · Nov 20, 2015

Thank you Karen.

Home Health Columnist / Guide · Nov 20, 2015

Your welcome!!... I learn alot reading this forum. Guess we will need a policy for our home health staff to be able to administer.

Farawyn · Nov 20, 2015

Your welcome!!... I learn alot reading this forum. Guess we will need a policy for our home health staff to be able to administer.

They are talking about it in HH as well. I work both. I am more comfortable with that.

NutmeggeRN, BSN · Nov 20, 2015

I think I'm maybe a bit nervous about this. What if I administer Narcan to a kid and I'm wrong?

In several conferences by EMS I have heard them quote it is essentially harmless if given and it is not needed. I would think if an assessment is done and it is given, the person administering would not be held liable.

allnurses Guide · Nov 20, 2015

More and more and more and more.
I *wish* this was a band aid pushing job.

But, ya know? We are NOT a trauma unit. We are a school.
I don't feel comfortable with the Narcan.
I need to research it more. This will be my project tonight. Last time I had a part in it was over 10 years ago, and a doc administered it.

Interesting that NASN came out in favor but the agenda there is to get a school nurse in every school so the more medical things that are mandated, the more the schools will feel the pressure and will have to acquiesce and hire more nurses full time on every campus.

My issue here on the West Coast is for the most part we don't have full time school nurses or even health aides on every campus. As you all have heard me say many times, in this district there are 11 campuses from pre-K to high school, including Continuation and Community Day Schools. The school nurse works three days a week.

Our state passed the stock epi pen law a year ago. It took us forever to find a doc to write a prescription though. And some of the local docs at our ER are not happy about that.

The problem if you don't have a nurse on each campus full time is you have to train the staff to administer these drugs.

For the epi pen law, the superintendent has to ASK for VOLUNTEERS to learn to administer epi. Only two takers. We finally decided that we would simply train all office staff because that's where the kids come for medical care anyway. The office staff did so begrudgingly. They are so busy with their real jobs and they feel very conflicted about being the "medical authority" on campus. We have had a law here for a few years about rectal valium but no one will be trained for that. Teachers are constantly attending trainings about keeping physical (and emotional) boundaries with students and so no one will consent to placing medication rectally even in an emergency.

There's the rub for me . . . we pass these laws without considering how it is going to work. The epi pen law was passed even though the AMA was against it for a long time and there was no stipulation in the law for how the districts were supposed to get the medication. We also don't have the medical staff on each campus to do what the legislation entails.

And now Narcan.

The educational staff are getting pretty darn tired of this and the reason I know is I had to train them to give epi.

Makes me glad I retired a couple of weeks ago.

akulahawkRN, ADN, RN, EMT-P · Nov 20, 2015

In several conferences by EMS I have heard them quote it is essentially harmless if given and it is not needed. I would think if an assessment is done and it is given, the person administering would not be held liable.

I've given naloxone many times in the past and the major danger with it is simply reversing the opiate too quickly. IM and/or IN routes are reasonably good for bringing people up and out of respiratory depression without ruining their high so quickly that they experience instant withdrawl symptoms... and they know. Quite honestly, opiate OD cases are usually VERY obvious. Pinpoint pupils, altered level of consciousness, and respiratory depression usually = opiate OD. So you give naloxone (do it very, very slowly if IV) and watch for the respiratory rate and depth to increase. If the patient doesn't respond to the naloxone, then the chances of an opiate OD being the cause of the problem are about zero and in those instances, the side effects of naloxone are also about zero... except that you can't give an opiate for pain control for a while. In the school setting, that's a non-issue, but Field EMS, the ED, and elsewhere you'd normally give opiates for pain control, that can be an issue.

Seriously, naloxone is a generally benign drug if there's no opiate on board for it to reverse.

NutmeggeRN, BSN · Nov 20, 2015

Interesting that NASN came out in favor but the agenda there is to get a school nurse in every school so the more medical things that are mandated, the more the schools will feel the pressure and will have to acquiesce and hire more nurses full time on every campus.
My issue here on the West Coast is for the most part we don't have full time school nurses or even health aides on every campus. As you all have heard me say many times, in this district there are 11 campuses from pre-K to high school, including Continuation and Community Day Schools. The school nurse works three days a week.
Our state passed the stock epi pen law a year ago. It took us forever to find a doc to write a prescription though. And some of the local docs at our ER are not happy about that.
The problem if you don't have a nurse on each campus full time is you have to train the staff to administer these drugs.
For the epi pen law, the superintendent has to ASK for VOLUNTEERS to learn to administer epi. Only two takers. We finally decided that we would simply train all office staff because that's where the kids come for medical care anyway. The office staff did so begrudgingly. They are so busy with their real jobs and they feel very conflicted about being the "medical authority" on campus. We have had a law here for a few years about rectal valium but no one will be trained for that. Teachers are constantly attending trainings about keeping physical (and emotional) boundaries with students and so no one will consent to placing medication rectally even in an emergency.
There's the rub for me . . . we pass these laws without considering how it is going to work. The epi pen law was passed even though the AMA was against it for a long time and there was no stipulation in the law for how the districts were supposed to get the medication. We also don't have the medical staff on each campus to do what the legislation entails.
And now Narcan.
The educational staff are getting pretty darn tired of this and the reason I know is I had to train them to give epi.
Makes me glad I retired a couple of weeks ago.

NASN has not legislated it, it supports those schools who do choose and encourages all.

In NH, EVERYTHING is local control, so it will be up to each district.....will be very interesting.

In RI it is mandated for every middle and high school.