Staff Member with Pseudoseizures

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Specializes in School Nurse.

Hello! I have a coworker who has been diagnosed with psychogenic non-epileptic seizures (pseudo seizures). She has had several episodes on campus requiring EMS transport, she experiences violent convulsions lasting from seconds to 15 minutes, her post ictal phase seems to last hours to days. We have had to put the school on soft lockdown to keep students from witnessing the convulsions, 2 staff have been injured from her falling on them or while responding to her seizures and she has no idea when they are coming on.  She was cleared to be on campus by HR and I am feeling so unprepared to deal with the situation. 

We have no emergency response (other than general seizure first aid), she wants me to put a lorazepam pill in her mouth, WHILE SHE IS CONVULSING, to stop the seizure (which makes zero sense to me, from a pharmacological stand point, and I refuse to put anything in her mouth), and after the seizure is over, she wants to drive herself home. 

I am not sure how to proceed. Since she is a staff member, not a student, I don't technically have any access to medical information, nor am I permitted to be a part of the safety planning. But I am still expected to respond if she has any episodes. 

How would you approach this situation? My main concerns are: her physical safety, physical safety of the staff responding to her needs, student mental health after seeing/hearing the episodes, my liability for any injuries or for sending her home in her car. (I obviously refuse to be involved with allowing her to drive home, but I don't know how to prevent it.)

Thank you for any input ?

 

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Specializes in pediatrics, school nursing.

WOW. I wonder if this might be a better question for the Occupational Health sub-thread, as they likely are familiar with formulating plans for similar situations, but honestly, I think this is a question for your administration - like HR level stuff. If they worked anywhere else, they likely would not have access to a nurse, so why should you be expected to provide this level of specific care without orders and against your best judgement not to mention best practice?? I think I would refuse to comply with their demands and continue to call EMS unless a comprehensive plan of care was developed between the staff person, myself, their physician (neurologist? psychiatrist?) with oversight of HR/Superintendent, and the district lawyer. And make sure you have , STAT. I will never trust the school district to cover my butt.

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Specializes in kids.
k1p1ssk said:

WOW. I wonder if this might be a better question for the Occupational Health sub-thread, as they likely are familiar with formulating plans for similar situations, but honestly, I think this is a question for your administration - like HR level stuff. If they worked anywhere else, they likely would not have access to a nurse, so why should you be expected to provide this level of specific care without orders and against your best judgement not to mention best practice?? I think I would refuse to comply with their demands and continue to call EMS unless a comprehensive plan of care was developed between the staff person, myself, their physician (neurologist? psychiatrist?) with oversight of HR/Superintendent, and the district lawyer. And make sure you have malpractice insurance, STAT. I will never trust the school district to cover my butt.

Absolutely every ^^^^^ said!!

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Specializes in School Nurse. Having conversations with littles..

I absolutely agree with all the above.

By chance, can you visit with her about Nayzilam? Or, if you can't - whoever is in charge of these conversations?  In case one is not familiar with it-  It  is Ativan in a nasal spray. There is no way I would risk putting a pill in her mouth. The company will send a Nayzilam training kit- it is a wonderful improvement over the pill or rectal administration.

I can't imagine why she is still aloud by her Dr. to drive. I would venture to guess that the Dr. has not released her and even more certain that DMV doesn't know it. Which- if this is the case- the powers that be must not realize what a liability it is for the school if she causes injury while in her vehicle on school property.

 Is this a new diagnosis for her? Does she have a note from her Dr. that releases her to be at school? Can you give us an idea of the timeline- when these started and how many times this has happened at school? This is a great learning opportunity for us and can hopefully help you come up with more ideas to manage the situation as safely as possible.

My nurse brain is going crazy with you as you navigate trying to figure out  the safest possible way to handle this.

Hope you have a quiet day - Huggs

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Specializes in School Nurse.
Cattz said:

I can't imagine why she is still aloud by her Dr. to drive. I would venture to guess that the Dr. has not released her and even more certain that DMV doesn't know it. Which- if this is the case- the powers that be must not realize what a liability it is for the school if she causes injury while in her vehicle on school property.

 

 

I suspect that she is not being up front with her doctor about the frequency or severity of her episodes. She told me that since her license has not technically been pulled, she is going to continue to drive. The liability of the situation blows my mind. I'm not sure why the district is not more concerned. 

 

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Specializes in School Nurse. Having conversations with littles..

I'm sure you don't need anything else to take up your time. But, please document every conversation and attempt to come up with a safe plan- for all involved. 

Please update us. 

Huggs.

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Specializes in School Nurse. Having conversations with littles..

I have another thought. I'm not sure what State you are in. But, this type of hard situation is one that I would contact my State School Nurse Supervisor about for further guidance.

Sure hope you had a quiet day. ?

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Specializes in School Nursing.

Pseudo-seizures can be very frightening. I have had several students that had them. First of all, I can tell you from experience, that seizure medication does not stop or prevent these kinds of seizures. And yes, you are right, I still would NOT put anything in their mouths.  These people have completely normal EEG's. I had one student who would be having tonic clonic movements during her pseudo, and have a complete conversation with me about her weekends, her pets, school. When she was done she would walk with me to the clinic. Another student that I had, would just drop to the floor and have what looked like a grand mal seizure. He could seize for hours. The record was 8 hours. The ER MD was at a loss as to what to do to stop them, and so were the neurologists. They suggested therapy which was rejected by the family. There was no way to stop them, he had to seize until he was ready to stop. I would send him out almost weekly, sometimes twice. Our EMS first responders knew him by name. I've had a few others that were not as remarkable as these two. As far as driving, I never let my students drive home after one of these. But, with an adult staff member, I'm sot too sure. Can you write up a statement that basically states that the staff member has been advised not to drive, but is unwilling to follow said advice, and both you, the staff member and the Principal sign it?

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Specializes in kids.

Do you have an SRO? Mine always responds when there is an ambulance call. Would their observation lead to a recommendation to DMV re safety? Not sure if that can be done or not. Tough situation.

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Specializes in School Nursing.
NutmeggeRN said:

Do you have an SRO? Mine always responds when there is an ambulance call. Would their observation lead to a recommendation to DMV re safety? Not sure if that can be done or not. Tough situation.

We tried this with 2 students. The only thing that happened was that the MD signed off on the paperwork that they were OK to drive. Until MD's get some backbone, and say no to patients, and parents of patients, this will continue. Our SRO at the time had seen them, and was very upset that nothing happened.

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Specializes in kids.

There you go...I figured as much...

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Specializes in pediatrics, school nursing.

When I worked in Peds specialties, our Pedi Neuro said that there was a correlation between kids with pseudo-seizures and an "affinity for large stuffed animals and pillows". In other words, these kids' subconscious self knew enough that these episodes would be harmless if they carried around a large, padded surface to fall onto. They were also much less likely to occur when it would put them in a truly life-threatening situation - I.e. while driving - because their brains knew enough not to have one during that time. I'm not saying it's safe to let them drive, but it might be why some docs are OK with signing off on permission to drive. 

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