Epi-Pens

[shellfrmmo, ASN, BSN, LPN, LVN, RN]

I am wondering what your protocol is for Epi-Pens?

We have a lot of students with food allergies. We do not have an epi-pen on hand for general use- this is in our policy. We only have 2 that are RX to specific students. the epi-pens for those students are in a locked cabinet in the locked health office.

Issue #1 :

The school serves breakfast starting at 7. The nurses do not arrive until 7:30. Meaning there is no access to the epi-pens. I will say our school is very deligent about students with allergies. BUT... it still bothers me greatly that we have the potential for a major medical disaster on our hands. All of our kitchen staff is trained to use an epi-pen.

Which also leads to the fact that our nurses office not that close to the cafeteria.

1. Is there an epi-pen for general use in your kitchen area?

2. Our your students with food allergies epi-pen in the kitchen area?

Myself and the head of the kitchen are trying to work out an Action Plan on what to do in an emergency situation. Any input is very helpful!!!!!!

Issue #2:

Would you use another student's RX epi-pen for an anaphylactic reaction? (I mean we are deciding the fate of a child's life here!!!)

Thanks!!!!

[Flare, ASN, BSN]

We actually have standing orders in my district for Epipen and benadryl from our school MD, so we do have epipens on hand and so forth, so I wouldn't have to make that kind of call. I think without the standing order, though it would be walking a legal tightrope to use an epipen rx'd for another student on someone without a doctor's order. On the other hand, we're talking about a matter of life and death that can be swiftly attended to. i'd have a hard time just standing there protecting the airway. I think if it were me, i'd push for a standing order.

There are cabinets and holders you can get to mount epipens in a place such as a cafeteria. They are usually tamper proof, but able to be opened in case of emergency

[Jolie, BSN]

I am fortunate not to have to answer question #2, since Nebraska has a state law mandating the establishment of standing orders for treatment of presumed severe asthma and/or anaphylaxis, and also that each school stock an emergency box with adult and pediatric Epi-pens as well as nebulizer solution and machine. This protocol applies to students, staff and visitors to school buildings during the regular school day. It is considered a model for similar protocols nationwide. If anyone is interested, please read:

http://onwebmanager.net/asthma/view/view.php?read_id=103

http://www.education.ne.gov/legal/webrulespdf/RULE592006.pdf

As for your other questions, I believe the issue has less to do with the location of Epi-pens or other emergency supplies than with the availability of staff trained to recognize an airway emergency and respond appropriately. Unless your buildings are huge, obtaining an Epi-pen from the office or nurse's room is probably not the limiting factor. Trained responders are, and they must be present in the building when students are there, especially during meal services.

I don't know the regulations in your area, and I really don't want to start a debate about nursing care versus trained assistants. I just don't have the energy for that. But here in NE, where we are guided by state protocol, trained non-health care responders are a vital component in the protocol. I would estimate that approximately 10-20% of all staff members have completed the training process, which takes about 3 weeks. Re-training is every 2 years.

Our emergency kit is located in the nurse's office of the building, as are individual students' Epi-pens and other meds if they have personal orders for them. With only one exception (a student with a rare medical condition which made him allergic to virtually all foods) meds are kept in the office. Some older students have orders allowing them to self carry inhalers. We allow self-carrying of Epi pens as well, with parent and physician OK, but most parents and doctors do not want this, fearing that their student may not recognize and self treat promptly enough. The one exceptional student I mentioned carried his meds on his person in a fanny pack because it was truly dangerous for him not to have immediate access to them. But since he was too young to self administer, all of his teachers were trained responders. His class never had a sub. If his teacher was absent, another med- trained teacher from the grade level took over that class and the sub covered the other teacher's class instead.

The availablility of numerous trained responders makes this protocol work well for us. None of our buildings have 100% nursing coverage, although a nurse is always available by phone. Our building principals and assistant principals are trained responders. None of the buildings opens in the morning without a designated administrator, so there is always a trained responder in the building when students are present. If I were you, this would be the focus of my concern, not so much where the meds are located.

Good luck!