School nurse delays giving epi pen

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"Officials at Township High School District 214 have apologized and agreed to pay the medical bills for a John Hersey High School freshman with a life-threatening peanut allergy, after a school nurse allegedly delayed her from using an EpiPen earlier this month."

District 214 apologizes after nurse allegedly delays student with peanut allergy from using EpiPen - Chicago Tribune

Thoughts?

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Specializes in Med-Surg, Oncology, School Nursing, OB.

I do not have one epi pen order that says give upon exposure. They all say give for anaphylaxis. Maybe she wasn't showing symptoms yet so the nurse wanted to clarify. This part abt the Benadryl "Lia refused, knowing from previous experience that her symptoms would be masked by the antihistamine, though the anaphylactic reaction would not be halted, and would continue to silently and dangerously escalate undetected," Sommer said. I've never heard of Benadryl masking anything while symptoms become more dangerous.?! We have a few kids that are prescribed Benadryl first and it will prevent a worse reaction so I questioned this but I could be wrong. I am surprised no one went with her but maybe no one was available and she did have paramedics with her so who knows.

I think this is a good reminder to make sure you get a full health history and specific orders. However, if I've always said if a student tells you they feel like they need it (whether you see symptoms or not)It's best to just give it. You aren't going to cause any long term harm but if you wait too long they can potentially die. After all we can see an itchy or swelling throat and I sure don't want to wait until they can't talk to give it.

It's not like the nurse completely refused to give the epipen. She wasn't sure so she reached the parent quickly to see what they normally did. The child lived and that's what is most important. I feel bad for the nurse who we know was just doing what she thought best!

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Specializes in School Nursing, Public Health Nurse.

I'm appalled the Nurse delayed the Epi-Pen and emergency services. Epi is always the first line for an allergic reaction. Benadryl is putting a band-aid on it. Our anaphylaxis procedure:

1) Epi-Pen

2) Call 911

3) Hook up to nebulizer if student in Health Center

4) Benadryl via liquid or IM.

Epinephrine is always the first line treatment. I don't care if you aren't sure if it's an allergic reaction or not. Give it.

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Any of our students with an epi-pen have a medical management plan filled out by their physician which specifically states when to use Bendaryl or epi-pen. Each one is just a little different, but I don't think a single one says to use pen upon exposure.

Last year we had a student who had been in ICU for an anaphylactic reaction. Came to school with a detailed plan. Came into the clinic with symptoms, doctor's orders said to give epi-pen for these sx. I gave the epi, rode with her to the hospital and got reamed out by the ER physician who didn't feel the epinephrine was called for in that situation. Too bad, I followed the orders and did my job. Girl was admitted for observation, but released the next morning. Mom was thankful that I gave the meds!

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The allergy action plans I have (are they universal?) have boxes to check for "give epi immediately if allergen is suspected to be ingested" and give epi immediately if allergen was definitely ingested"

I have several that say to give epi immediately if allergen was suspected to be ingested. I'd rather be cautious.

On the flip side, I had a student once tell her mom that she told me she needed epi and I refused. The student NEVER said that. I followed her action plan and did not give epi because I saw no signs of anaphylaxis. And her mom came to get her and they did not give epi at home either. I didn't get in any trouble since I had my charting to show that I followed her action plan but I was nervous because I was very new to school nursing and she was threatening to go to the school board to ask for my termination. Turns out, this student is a habitual liar (to teachers, principal). I did end up giving her epi the next time she was exposed. And that time mom sang my praises.

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It sounds like there is more to the story there. I can't imagine a nurse not following the direct orders from an MD. I'd like to get her side of the story, and maybe she did just mess up. Regardless, I hope they're able to change the process and procedures to facilitate better conversation and treatment.

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Specializes in IMC, school nursing.
I'm appalled the Nurse delayed the Epi-Pen and emergency services. Epi is always the first line for an allergic reaction. Benadryl is putting a band-aid on it. Our anaphylaxis procedure:

1) Epi-Pen

2) Call 911

3) Hook up to nebulizer if student in Health Center

4) Benadryl via liquid or IM.

Epinephrine is always the first line treatment. I don't care if you aren't sure if it's an allergic reaction or not. Give it.

All of my allergies say Benadryl followed by Epi as doctors orders and my protocol. Somehow I am thinking something was missed in transition between schools.

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I'm appalled the Nurse delayed the Epi-Pen and emergency services. Epi is always the first line for an allergic reaction. Benadryl is putting a band-aid on it. Our anaphylaxis procedure:

1) Epi-Pen

2) Call 911

3) Hook up to nebulizer if student in Health Center

4) Benadryl via liquid or IM.

Epinephrine is always the first line treatment. I don't care if you aren't sure if it's an allergic reaction or not. Give it.

Unfortunately I bet many of us have Doctor's orders for our students that say otherwise. Very few of my students with allergies have Epinephrine as the first line of treatment per their physician/allergist. I wish we knew more of the story but am so glad the girl survived!

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I'd say about half of my action plans state using Benadryl first for certain s/s and then progress to epipen jr. (I have all KG and first graders.)

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Specializes in school nursing, ortho, trauma.

Most of my orders say antihistamine is the allergen has been ingested but no symptoms. But if a student came to be saying that they ingested their allergen and felt they needed their epipen i would not debate it with them - i'd just give it to them. They probably feel things in their body that I could never visually assess and wouldn't want to take a chance.

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Specializes in Med-surg, school nursing..

The majority of mine say Benadryl first as well, then I have to hound the parents to send it.

Someone from the school should have definitely went with her. But as I think back to the two times I was transferred via EMS to the hospital, no one rode with me.

I am confused on why the school is paying her medical bills? Had the nurse given the epi-pen just a bit sooner the outcome would have been the same, no? Either way 911 would've been called and she would've ended up in the ER.

Using peanuts as a substitution?!?! The cafeteria should be in more trouble than the nurse in my opinion.

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I am confused on why the school is paying her medical bills? Had the nurse given the epi-pen just a bit sooner the outcome would have been the same, no? Either way 911 would've been called and she would've ended up in the ER.

Using peanuts as a substitution?!?! The cafeteria should be in more trouble than the nurse in my opinion.

Totally agree on the cafeteria thing! Why substitute peanuts????

On the other point- our school's insurance will pay the overage of anything not covered by insurance if the student was hurt during the school day (I don't know if that applies to school sponsored sports as well).

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