School nurse delays giving epi pen

[kidzcare]

"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?

[FloridaBeagle]

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.

I have. In addition, several MD offices tell me NOT to give benadryl period. Epi or nothing seems to be the majority of orders I get.

[kidzcare]

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.

I have a drawer of meds too. Mostly ibuprofen for headaches. BUT- I don't hand it out as "the nurse" I house it in my office and they take it just as they would a medication that they carries in their work bag or purse. I tell all staff that I cannot give them medical advice and when they ask for meds, I direct them to the meds and they get them themselves

[JenTheSchoolRN, BSN, RN]

I have a drawer of meds too. Mostly ibuprofen for headaches. BUT- I don't hand it out as "the nurse" I house it in my office and they take it just as they would a medication that they carries in their work bag or purse. I tell all staff that I cannot give them medical advice and when they ask for meds, I direct them to the meds and they get them themselves

I do the same thing.

[bathrobemom, LPN]

The nurse should've stuck to the medication orders. There's a reason why they were written that way. If there was a question, she should've asked when she received the orders, not during a reaction.

I disagree with several comments that I've read. What I learned in nursing school and through personal experience is that you use Epi first. I don't even need Benadryl anymore. I used to take Benadryl for allergic reactions caused by a food allergy, I was too scared to use my Epi pen and didn't realize how dangerous it was to not use it.

Then my allergies got worse; I became allergic to more foods and my reactions became more severe. I joined an online group that is really geared more towards moms that have kids with food allergies, but they let me join and I learned a lot-it's really helped me.

There's this idea out there that Benadryl "masks" symptoms of anaphylaxis. I don't know if that's true. All I knew was it costs $2 for a generic bottle of Benadryl and $80 or more for 2 Epis. I was skeptical at first, but I had a very severe reaction that scared the heck out of me. My beloved Benadryl didn't work fast enough and two Epi pens barely helped. I never wanted to go through that again, so I started listening to the "Epi first" crowd.

I thought "Epi with known ingestion" was stupid, it's a waste of an expensive medication when I didn't know if I was going to have a reaction. Well, you can either use an Epi and totally avoid a reaction or you can sit around wondering if you're going to end up in the ER later, struggling for your life. You could be that person that waits too long to use an Epi and dies.

Then it happened, I ate some cookies I'd never eaten before, thought I'd checked them over. Double checked. Well, I'm sitting there at the table looking at the ingredient list (again) and it states that there's freakin' hazelnuts in the cookies! Oops. I had an Epi that was about to expire so I used it. No reaction, nothing. Sure beats getting comatose from Benadryl and wondering if and when I'll react later.

Another thing I've noticed about using an Epi pen is that I won't react a second time if I use my Epi pen asap. In the old days when I used Benadryl I used to have biphasic reactions (a second reaction). Not only does this cause a lot of anxiety, but it interferes with my life. Anaphylaxis doesn't care if you're awake or not, what time it is. Hard to go to work when you're wondering if you're going to have an anaphylactic reaction because you almost always have biphasic reactions.

If a child (or adult) asks for an Epi pen, you should give it. You don't know what's going on inside someone that is having a reaction. Many kids with food allergies have been taught from a very early age that they need to use an Epi pen when they are having a reaction. They know it will hurt, so for a kid to request an Epi pen says a lot, kids are usually scared of injections. You can't go by how people look or act. I have multiple food allergies, I'm allergic to cats, dust, mold, leaves, grass, flowers, weeds, and latex, yet I've never had hives in my life. One of my first symptoms is severe anxiety, you can't see that.

All I have to share is the tiny bit of knowledge from nursing school, personal experience, information that I've learned from others dealing with allergies, and information from news stories. If that's not enough to change someone's mind, I hope it's enough to get people thinking and doing their own investigations.

[lvnforschool]

After reading this article I immediately looked over my Epi-pen emergency plans. We have boxes for the doctor to check if to give Epi-pen or Benadryl. I will say for the ingestion of food allergy it says EPI-pen on those. Now for Bee sting it mostly says to give Benadryl first then Epi-pen. I am now worried about the order being called into question if I was to give straight Epi-pen. Of course if I felt they were in any kind or duress Epi-pen 1st but will I be in trouble for NOT following the dr order of Benadryl first? You just never know who will balk at something you did (right VS wrong).

[rbytsdy]

Is anyone on the NASN listserv? Apparently this nurse is not being written up or disciplined because she followed the orders correctly. The student came in complaining of a scratchy throat. I sincerely doubt she had reason to suspect exposure to peanuts considering the student ate cafeteria food. Our cafeteria food is supposed to be peanut free. According to a poster on the listserv, the ER physician also personally sent an email supporting her. Don't forget - the media angles the story they want.

[MrNurse(x2), ADN]

Seems the school district needs to update its policy.

John Hersey High School Nurse Properly Dealt With Student's Peanut Allergy: District 214 - Arlington Heights, IL Patch

[coughdrop.2.go, BSN, RN]

This goes back to the conversation about changes in prophylaxis protocol. Although there was uncertainty about the student ingesting the substance, the student did and that warranted Epi-pen use. There should be no waiting until the student has respiratory symptoms. That's too late in my book. Protocol needs to be updated and health professions need to be educated.