Need Advice - Seizure Issue!!

[uthscsa2011]

Hello everybody. I need some advice....

I am an elementary school RN, and yesterday we have an incident here that has upset a student and family. I thought I was acting in the best interest and safety of the student, but the family seems to think otherwise. Let me know if I did the wrong thing and what you would have done!.....

4th grade was headed on a field trip, including the functional resource kiddos. An hour before the field trip, a teacher comes to me and informs me one of his students apparently was RX'ed some "emergency medication" that she needs to have for the field trip. As usual, the parents did not come and inform me about this. So I immediately called the parent to bring this medication to the school. As usual, I had to leave a voicemail. 5 minutes before the buses take off, the parent dropped off the medication (of course, not to ME, but to the teacher, so i was not able to speak to the parent at all, why the office did not direct her to me, i have no clue). So i go to the front to fetch the medication, and see that it is Diazepam (rectal) for seizures. The bus is waiting on me to send the medication with the teacher and student, but I stop because there is no way I can teach the teacher or any other staff attending the field trip how to administer a rectal medication in 5 minutes. Nor did i feel safe delegating this task to anyone. I spoke with the principal and let her know my fears and concern for the student's safety and she agreed that we could not let the student go on the field trip. We would be to blame if she did seize and no one there knew how to administer the medication. So we kept the student, and at the end of the day the mother and grandma came and raised hell. They said the Dr told them "it does not have to be a RN to give the med" and that anyone on the bus could have given it to her....That was her argument...she wanted any untrained staff member to pull down her daughter's pants and administer this med in front of 30 other school kids. Seriously? I highly doubt the Dr said any person could give this med....

What do yall think?

[JustBeachyNurse, LPN]

Many districts in my area contract with pedi home health/private duty agencies for bus rides and field trips for students that require Diastat. No one but parent /guardian or licensed nurse (RN or LPN) can administer Diastat in my state. Most schools require neuro to write up a seizure action plan

Edited to add all districts require signed physician orders for ANY medication brought to school. If this parent showed up at school with Diastat the child would be excluded until signed orders received especially for seizure condition potentially requiring Diastat (also asthma requiring rescue inhalers and anaphylaxis requiring an epipen. )

[caregiver1977]

I absolutely AGREE with you, OP!!

I don't know why they would do that! There should be a plan with administering this medication, even to the point of how the medication can be administered with as much dignity as possible. I wouldn't care if grandma and such had SMOKE POURING out of their ears, you were right.

This medication isn't exactly Tylenol; people still have to be shown how to administer it.

Plus, doesn't a patient have to be specially monitored after receiving such medication? I could be wrong, but I thought their is a chance such medication could interfere with a person's breathing, especially if this is their first time using Diastat.

If the family was so upset, they should have accompained the child on the trip.

[JoAnnaSkewlRN, BSN, RN]

You were COMPLETELY in the right, and the principal made the call. In my state anyone can give the med as long as they are trained and it is not a case of delegation by the nurse (which is illegal in Virginia unless you have prescriptive authority) it is actually the principal who is delegating the task of med administration. Either way it would be a non-issue as the parents didn't follow what our med admin. policy is- ALL prescription medication must be brought by a parent or guardian to the school nurse with approprate administration documentation/orders, properly labeled container, signed parent permission. Funny but true story, a parent came into the clinic one time after her daughter was newly diagnosed with seizure disorder and said- " The ER doctor said when she starts twitching you squirt this in her mouth." Nice education from that doc-LOL

[nurs26]

In my county only nurses can give that medication. They should have gone on the field trip. You did the right thing.