School nurse delays giving epi pen

Supernrse01, BSN · Sep 22, 2016

It is dangerous because these orders are not the protocol anymore and many docs have missed that memo.
I tend to think that the danger comes when we start practicing strictly by the black and white/protocol and we leave our assessment skills behind. I understand what you are saying and agree that we all need to be up-to-date on new findings and practices, but I also think that each situation is unique and we have to use what we are seeing at that given time to make the decisions on what the next step needs to be. That allergic reaction, heart attack, asthma attack, seizure, etc... isn't always going to go by the classic presentation.

KeeperOfTheIceRN, ADN · Sep 22, 2016

I feel sorry for the nurse, but at the same time, the article says her medical forms say "give epi-pen first". She should have followed the forms that were given to her since that is what they're for. Also, I kind of feel the student is old enough to carry her own epi on her person. Unless its just against NY policy for them to carry it with them. I feel she should keep it in her purse or back pack. I have several students on my campus who have epipens that they keep with them as well as those with inhalers. Naturally, we have a medication form on file with their doctor signature signing off on whether they've been educated on it. I follow up on it as well and once they show they can administer it correctly, they keep it with them. But 15....I think she should be allowed to start taking ownership of her allergy and carry her epi on her. But this is just my opinion.

allnurses Guide · Sep 22, 2016

I tend to think that the danger comes when we start practicing strictly by the black and white/protocol and we leave our assessment skills behind. I understand what you are saying and agree that we all need to be up-to-date on new findings and practices, but I also think that each situation is unique and we have to use what we are seeing at that given time to make the decisions on what the next step needs to be. That allergic reaction, heart attack, asthma attack, seizure, etc... isn't always going to go by the classic presentation.

No one is saying don't immediately assess. I doubt that a school-age student would be having a heart attack unless there is an already diagnosed heart condition or one that hasn't been diagnosed yet. That is rare though.

Asthma attack in a student with a history of asthma is easy to assess if you know the student's history and they have an inhaler at school to use prn.

A seizure looks different than anaphylaxis, in my experience. Of course you could come upon a student in the midst of a seizure with no history of seizure and not breathing and they don't have an epipen and the school doesn't either.

So of course, assess. My issue is with the use of Benadryl instead of epi in the case of anaphylaxis. Benadryl is no longer part of the standard of care for an anaphylaxis episode. Because it doesn't work.

100kids, BSN, RN · Sep 22, 2016

Also, I kind of feel the student is old enough to carry her own epi on her person. Unless its just against NY policy for them to carry it with them. I feel she should keep it in her purse or back pack. I have several students on my campus who have epipens that they keep with them as well as those with inhalers. Naturally, we have a medication form on file with their doctor signature signing off on whether they've been educated on it. I follow up on it as well and once they show they can administer it correctly, they keep it with them. But 15....I think she should be allowed to start taking ownership of her allergy and carry her epi on her. But this is just my opinion.

NY law allows for students to self carry with physician and parental permission. The School Nurse also assesses whether the student is fully able to understand the When, Why and How of their medication before allowing them to self-carry. I have Elementary School kids who carry their own epi pens so now sure why this was not done with this student. Again we don't have the full story so we are all just guessing.

allnurses Guide · Sep 22, 2016

"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. "Instead of following Lia's Allergy and Anaphylaxis Plan on file in the health office, which clearly states, 'Give EpiPen First!' the nurse opted to have her call me to confirm before administering epinephrine, with my daughter's life held in the balance."

From the article ^^

There was an Action Plan that said give epi first. The nurse was wrong to wait.

People are afraid of epi - that's one of the reasons I use the video I posted earlier. The kids show how to give epi and then the data is backed up by a physician. Short and sweet.

mattfd37 · Sep 23, 2016

I actually called one of the allergy centers the other day who write orders for a lot of our students and I spoke with the head of the group and he said 'the biggest mistake nurses make in a school setting is delaying the use of the EpiPen. The Pen will slow down or cure the problem enough for EMS to reach them. Benadryl only delays the inevitable, You have to remember, these orders are also written for daycares where you have untrained personnel trying to decide whether to give it. You are not going to harm someone by giving them an EpiPen'. I agree with his statement and being in EMS for 20 years I'm glad people give it even if they are unsure.

allnurses Guide · Sep 23, 2016

I actually called one of the allergy centers the other day who write orders for a lot of our students and I spoke with the head of the group and he said 'the biggest mistake nurses make in a school setting is delaying the use of the EpiPen. The Pen will slow down or cure the problem enough for EMS to reach them. Benadryl only delays the inevitable, You have to remember, these orders are also written for daycares where you have untrained personnel trying to decide whether to give it. You are not going to harm someone by giving them an EpiPen'. I agree with his statement and being in EMS for 20 years I'm glad people give it even if they are unsure.

Thank you! Great advice.

JenTheSchoolRN, BSN, RN · Sep 23, 2016

I actually called one of the allergy centers the other day who write orders for a lot of our students and I spoke with the head of the group and he said 'the biggest mistake nurses make in a school setting is delaying the use of the EpiPen. The Pen will slow down or cure the problem enough for EMS to reach them. Benadryl only delays the inevitable, You have to remember, these orders are also written for daycares where you have untrained personnel trying to decide whether to give it. You are not going to harm someone by giving them an EpiPen'. I agree with his statement and being in EMS for 20 years I'm glad people give it even if they are unsure.

Yep, but I also wish they would change the orders. Anyone can give an Epi-pen. It is so easy to use.

I tell my teachers that they will never regret giving it; they may regret not giving it.

100kids, BSN, RN · Sep 23, 2016

Yep, but I also wish they would change the orders. Anyone gave give an Epi-pen. It is so easy to use.
I tell my teachers that they will never regret giving it; they may regret not giving it.

I tell my teachers if you have any concerns/doubts give the epi.

MrNurse(x2), ADN · Sep 23, 2016

I find it odd that the title reads the nurse when the cafeteria fed a peanut allergy kid something with peanuts in it. Individual blame versus corporate, very intentional choice.

OldDude · Sep 23, 2016

I find it odd that the title reads the nurse when the cafeteria fed a peanut allergy kid something with peanuts in it. Individual blame versus corporate, very intentional choice.

Ya think?

Speaking of epi-pens and action plans...I have 15 epi-pens in my clinic and 2 actual allergy action plans; otherwise I use the epi-pen RX label..."use as directed for anaphylaxis" being the usual instructions. I haven't run across instructions to administer epi in instances of suspected ingestion of an allergen without signs or symptoms...yet; sound like that may be the new norm though.

FloridaBeagle · Sep 25, 2016

I understand that, but a lot of the parents tell me to give it to them, but it's like, you didn't give it to me to administer . And I don't have children's, only adults, because I have a drawer full of medications for the staff, not the children.

Why are you taking care of staff? They are adults and can take care of themselves. Our district policy is clear that we are there to take care of students only. In an emergency situation involving an adult, they need to have their own Epi-Pen and fill out a consent form just like the parents do for the students. We wouldn't give benadryl in an emergency, so staff should be on their own for that one. Besides, with the side effect of sleepiness, do you want to be responsible if a staff member falls asleep and the class goes bananas?

You cannot go handing out meds to adults. You are asking for serious legal trouble. I would clear out that drawer and tell the staff they are responsible for themselves from now on, and if they want an epi-pen they need to fill out a consent that you put on file.