Question about students who self-carry medications for Anaphylaxis

[GetBackToClassRN]

In our school district, students are only permitted (with physician, parent, and student signature) to self-carry Asthma Inhalers, Diabetic Supplies and medications, Ephinephrine, and Pancreatic Enzymes).

My question is regarding the fact that some students have allergy plans from their physicians that indicate, if it appears to be a minor reaction like just a few hives, to give Benadryl or another antihistamine before giving Epinephrine. I understand the controversy over this issue as a lot of people have strong feelings that Epinephrine should always be given right away no matter how the reaction starts and others are more conservative about using the Epinephrine.

For those of you that have self-carry available as an option...do your students also carry Benadryl / other antihistamine or only the Epinephrine?

[JenTheSchoolRN, BSN, RN]

At my school, they only carry the Epi at school. If they need the benadryl, they see me. It allows me to assess. (Benadryl may travel depending on field trip, etc.)

My standing order for Epi/benadryl from my school physician is also benadryl first for mild skin reaction (a few hives).

[BeckyESRN]

Mine have always carried a single does of Benadryl with their Epi-Pens. Their allergy bag would have their Epi, a single dose of Benadryl (most used the fast melts because they are individually packaged), and a copy of their action plan.

[Farawyn]

At my school, they only carry the Epi at school. If they need the benadryl, they see me. It allows me to assess. (Benadryl may travel depending on field trip, etc.)

My standing order for Epi/benadryl from my school physician is also benadryl first for mild skin reaction (a few hives).

This.

[KeeperOfTheIceRN, ADN]

I currently have no Epi's on any of my campuses (we're relatively small), but in the past, I've had orders for Benadryl, as well as Prednisone, for minor reactions and parents supply all meds for me. They're allowed to carry their epi's on them, but I keep the Benadryl or other meds in the office. It all really depends on their Anaphylaxis plan that I require before meds can even be on campus.

[Supernrse01, BSN]

At our schools, the students only self-carry the Epi. If they have an order for Benadryl, that is kept in the clinic. The thinking is, the reaction isn't urgent enough to require the Epi, so they have time to get to the clinic, or the nurse to get to them to administer the Benadryl.

[plainfieldguy]

My students can self-carry the Epi-pen but not Benadryl. All PO meds are administered through the clinic. If their action plan says to first give Benadryl, then I make sure the parents supply that as well. I do have stock epi and Benadryl, however, just in case...

[BeckyESRN]

I guess I should clarify, all of my self-carry orders have specifically stated that the student should have both on their person at all times. They've all been highly reactive (like look at a peanut and get hives) type kids with orders for Epi first followed by Benadryl for suspected exposure. I have one kiddo now that has a red pack that he carries with him at all times, a medical pouch in his backpack, one in is spec. ed classroom, and one in my office- they all contain an Epi-Pen (backpack has 2) because they thinking is that I can be on site quickly enough to administer the 2nd dose if needed, a single dose of liquid zyrtec (he can't use benadryl) in a pre-measured tube, and his action plan adapted to fit on an index card and laminated. It's intense, he's 6 and has had over 20 life-threatening reactions before they discovered all of his allergens!

[ruby_jane, BSN, RN]

Most of the plans that I have this year have dispensed with the Benadryl and just direct the student to use the EpiPen.

Suppose the student uses the Benadryl and s/he "gets better" so s/he doesn't make the trip to the clinic. An hour later s/he gets on a bus and decompensates...Nope nope nope!!

It may be too late this year but you can consider whether you want to change up how things happen next year. You can't necessarily go against a doctor's order but you can document that you spoke to parent and student and student will immediately present to clinic for assessment and monitoring after dosing with Benadryl.

[100kids, BSN, RN]

At our schools, the students only self-carry the Epi. If they have an order for Benadryl, that is kept in the clinic. The thinking is, the reaction isn't urgent enough to require the Epi, so they have time to get to the clinic, or the nurse to get to them to administer the Benadryl.

YUP. This.

[Flare, ASN, BSN]

My students with proper order may carry their epi. I strongly encourage it once they enter middle school, given the sports, clubs or simply the tendency to want to go over one another's houses after school. I will gladly review epipen usage with any if my students that have a carry order whenever they need it. (they seldom ask, but from time to time i get a request, usually prompted by a parent before a trip ) I also have standing oders for unexpected allergic reactions for epi and benadryl.

[MrNurse(x2), ADN]

I currently have no Epi's on any of my campuses (we're relatively small), but in the past, I've had orders for Benadryl, as well as Prednisone, for minor reactions and parents supply all meds for me. They're allowed to carry their epi's on them, but I keep the Benadryl or other meds in the office. It all really depends on their Anaphylaxis plan that I require before meds can even be on campus.

Epipens for schools supplies pens to schools free. This is one thing I would suggest you do sooner than later. Maryland even has a standing order for all schools, public and private, so you don't need a prescription.