School nurse delays giving epi pen

Updated:   Published

"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?

Specializes in School Nursing, Public Health Nurse.

I think this has to do more with education to the providers. Most of the allergist I speak to prefer Epi to Benadryl. I even went to a school nursing training last year and we had a pretty predominate allergist specialist speak to us about allergies and why Epinephrine is always the first line and how Benadryl can mostly fail to delay anaphylaxis. It was a great speech and changed a lot of people's mind about treating allergies.

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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. .

ABSOLUTELY!!!

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I think this has to do more with education to the providers. Most of the allergist I speak to prefer Epi to Benadryl. I even went to a school nursing training last year and we had a pretty predominate allergist specialist speak to us about allergies and why Epinephrine is always the first line and how Benadryl can mostly fail to delay anaphylaxis. It was a great speech and changed a lot of people's mind about treating allergies.

I agree and would love to see more physicians write their orders for school this way.

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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.

I think because the school cafeteria served her a turkey sandwich with hidden peanuts.

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Specializes in IMC, school nursing.
I think this has to do more with education to the providers. Most of the allergist I speak to prefer Epi to Benadryl. I even went to a school nursing training last year and we had a pretty predominate allergist specialist speak to us about allergies and why Epinephrine is always the first line and how Benadryl can mostly fail to delay anaphylaxis. It was a great speech and changed a lot of people's mind about treating allergies.

I agree that an ounce (or few cc's) of prevention is worth a pound of cure, but Benadryl may work and the child doesn't go to the ED, if you give epi, it's an ED visit. Not to mention they feel awful.

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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.

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.)

That's unfortunately a common mistake that needs to be changed.

I was involved with epi-pen education while a school nurse and I learned a lot about it that changed my perspective on what needed to be done.

Here's the video I used and have linked here before.

Always go with the epi first.

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Specializes in Telemetry, Gastroenterology, School Nrs.
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.

But it's not always the first line of defense. I have several students that, according to their Emergency plan, are to get Benadryl first. Obviously, that stands to go by the wayside, based on the symptoms and what the student is telling me. What seems crazy to me is the fact that this particular student's Emergency plan specifically (according to the article) states that she needs the EPI first and the nurse still chose to call mom to confirm, before allowing administration.

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I agree that an ounce (or few cc's) of prevention is worth a pound of cure, but Benadryl may work and the child doesn't go to the ED, if you give epi, it's an ED visit. Not to mention they feel awful.

Supernrse01 But it's not always the first line of defense. I have several students that, according to their Emergency plan, are to get Benadryl first. Obviously, that stands to go by the wayside, based on the symptoms and what the student is telling me. What seems crazy to me is the fact that this particular student's Emergency plan specifically (according to the article) states that she needs the EPI first and the nurse still chose to call mom to confirm, before allowing administration.

That is very dangerous.

http://www.stlallergy.com/pdfs/Children_and_Food_Allergies.pdf

...There are several KEY POINTS that need to be fully understood and have changed the way experts now approach food allergy patients since new Food Allergy Guidelines were published in the fall of 2010. Not all Emergency physicians or ambulance EMTs, doctors or nurses are yet aware of these changes in the updated Guidelines.

  1. If there has been a suspected INGESTION of a food to which your child is allergic and any body-wide (systemic) symptoms occur, Epi Pen or Epi Pen Jr should be given immediately without hesitation and then you should call 9-1-1!
  2. Benadryl is no longer recommended for allergic reactions due to food allergy INGESTIONS as it does NOT stop anaphylaxis (a potentially life threatening and rapidly progressive body-wide reaction).
  3. Benadryl may help a rash from a skin contact to a food allergen, but it takes 30 to 60minutes to begin working. Always wash off any area on the skin where a food allergen has contacted.
  4. There is NO HARM in giving an Epi Pen or Epi Pen Jr for a suspected food allergy reaction. Fast heart beat and shakiness are major side effects for about 15 to 20minutes, but failure to administer epinephrine injections or a delay has resulted in fatalities. .....

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Specializes in IMC, school nursing.

I drop pressure with epi eye drops, I can only imagine what IM would do to me. Respiratory arrest is definitely worse than that.

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Specializes in School Nurse.

My district nurses attended a FARE workshop last year and were introduced to this Emergency Care Plan:

http://www.foodallergy.org/file/emergency-care-plan.pdf

I really like this plan and encourage the families of all my students with EpiPen to have this completed by their Pediatrician, if they do not already provide it as a standard. This plan makes it very clear when EpiPen should be given immediately and when antihistamines are appropriate.

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Specializes in Telemetry, Gastroenterology, School Nrs.
That is very dangerous.

What is dangerous about following the emergency plan upon assessment? If a student came to me, telling me they had ingested an allergen and their plan and doctor's orders were to give Benadryl first, that is what I would do, unless their sx were indicative of anaphylaxis, OR, they were telling me they needed the Epi over the Benadryl. Actions need to be based on the assessment and the situation. I have one student with multiple, multiple, multiple food allergies. Some require Epi, some require Atarax. Each situation is different.

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Specializes in Peds, School Nurse, clinical instructor.

I realize we have not heard the nurses side to this story but if a student presents to me saying they need their epi pen, they get the epi pen. There would never be a reason to not give it.

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