Rectal Diastat

[Hilundlass]

Just curious about the views on administration of Valium rectally for seizures at school. Since I am subbing at different schools and grade levels, I'm finding general consensus that this is NOT a med to be given without some guidelines. Of course, it's given in the school setting at the discretion of the RN, but some nurses I know will not administer it unless EMS is on the way OR they have a doctor's office on the line.

Some daycares will not accept the responsibility for administering this medication at all, but would prefer to call EMS for prolonged seizures.

What to do when the school district has no policy except "use your own judgement" ? Then, of course, there are the pushy parents who insist on THEIR rules over the doctors.

A sticky spot to be sure. Comments?

[jidlr]

As our district's only school nurse (RN) if there's a doctor's order on file stating that rectal Diastat is to be given if a 'lesser' (ie. staring) seizure lasts X number of minutes or progresses to a grand mal (or initiates as grand mal) then I have no problem giving the Diastat and then calling the preferred ambulance company and the family. The superintendent has given me carte blanche to call the EMT's at any time I feel it's needed even if the parent's indicate they're coming and to wait for them to get there.... if I feel it's needed I'll call, as then, if somethng should happen, they can't blame me... and the doctor ordered medicine will also have been administered as ordered so I'm fully covered.

[Hilundlass]

Thanks for your comments. It really helps. In one school, the parent insisted that the Diastat be given at 5 minutes of ANYtype seizure and that the EMS not be called at all since she could get to the school quickly. She Also provided an oxygen tank and a pulse oximeter to be used for her three year old child who attends a half day special pre-K . The physician had ordered the med to be given only after 15 minutes of a seizure.

My thoughts are that if this mom has so many doubts about the fragility of her child's seizure status, and her "orders" conflict with the doc's, then perhaps the MOTHER is not ready for her child to be in a public school setting.

[Jeanine]

I have no problem giving the diastat if there is a specific doctor's order, with instructions just like any other med. We are required by law in NJ to have the MD signature, med, dose, specific reason, frequency, student, parent's signature, and possible side-effects. We also have an emergency care plan in place, sort of like an if:then flow chart that includes emergency #'s. I usually develop this with some input from the family. It cannot be given by anyone other than an RN or the parent (or paramedics if they've arrived). I can't use the O2 or pulse oximeter without the MD order, O2 is a drug. Good Luck!