When to administer Epi-Pen?

[Frannie419]

I am new to school nursing, just started in August. The last nurse left everything in a mess and there was not even a list of students with medical alerts, I had to make one myself using whatever she had left.

I have had 2 instances where a child comes to me saying they think they are having an allergic reaction and what they are allergic to/when they ate it, but I have no documentation anywhere that they even have an allergy, let alone an EpiPen.

In one of those 2 cases, the student said her throat "felt funny" but no other symptoms, mom said she has a severe allergy but to not do anything since she only had a little bit, so that's what I did.

In the other case, the student ate candy that "may contain peanuts" and again, mom said not to call 911 as she was on her way to give him benadryl as his allergies were very mild and he was showing no alerting symptoms other than a headache.

So my questions are:

Can I still give Epi even if I don't have a confirmed diagnoses for the allergy?

Is it ever acceptable to question if a student is actually having a reaction? Or should I always just administer Epi when in doubt?

Do I always have to listen to the parents to not call 911 if I think I should?

[Cattz, ADN]

Dear Friend- School Nurses don't eat their young, so you have come to the right place for guidance.

Lots to unpack here. First thought- Does your school have a Health Enrollment Form? If not, that is something that I would send home today for every student. I don't know your enrollment, so this may be a daunting task. But, it is a place to start.  I will attach a copy of mine. Feel free to use it, change it to meet your needs, etc, or trash it if it doesn't work for you.  It is a document that I made up and has evolved over the years to meet my needs. This is where you will begin to gather that  health information to see what students have what diagnosis'.

What state are you in? And do you have a State School Nurse Consultant. Ours in Missouri is remarkable and a wealth of information and help. Does your state have guidelines for such needs? Here is the link to Missouri's- https://health.mo.gov/living/families/schoolhealth/pdf/sn-chat.pdf

There is a packet of forms in there for Allergies- the parent needs to get those completed/Dr. and parent signatures and return to you. This will provide you with kid specific instructions....from the Dr. So, you will know exactly what the Dr. wants done for each student.

Does your school stock Epi-Pens or have parents provided them?

Deep breaths. It's going to be OK. Until you get the completed forms back- Things I would think about- How long does it take EMS to get here? Use your nursing assessment and judgement. Call parents and document conversations. What parents say, don't always go along with what we would do in school. Something that I have had many times- is that parents handle things a lot differently because they live with it everyday. But, liability for the nurse and the school- many times, requires a different approach.

Good luck- We will help you figure this all out....and remember...the long Thanksgiving and Christmas Breaks are right around the corner. Biggggg huggggs to YOU!!

 

2023.24 NEWEST Health Enrollment Form.docx

[Frannie419]

Cattz said:

Dear Friend- School Nurses don't eat their young, so you have come to the right place for guidance.

Lots to unpack here. First thought- Does your school have a Health Enrollment Form? If not, that is something that I would send home today for every student. I don't know your enrollment, so this may be a daunting task. But, it is a place to start.  I will attach a copy of mine. Feel free to use it, change it to meet your needs, etc, or trash it if it doesn't work for you.  It is a document that I made up and has evolved over the years to meet my needs. This is where you will begin to gather that  health information to see what students have what diagnosis'.

What state are you in? And do you have a State School Nurse Consultant. Ours in Missouri is remarkable and a wealth of information and help. Does your state have guidelines for such needs? Here is the link to Missouri's- https://health.mo.gov/living/families/schoolhealth/pdf/sn-chat.pdf

There is a packet of forms in there for Allergies- the parent needs to get those completed/Dr. and parent signatures and return to you. This will provide you with kid specific instructions....from the Dr. So, you will know exactly what the Dr. wants done for each student.

Does your school stock Epi-Pens or have parents provided them?

Deep breaths. It's going to be OK. Until you get the completed forms back- Things I would think about- How long does it take EMS to get here? Use your nursing assessment and judgement. Call parents and document conversations. What parents say, don't always go along with what we would do in school. Something that I have had many times- is that parents handle things a lot differently because they live with it everyday. But, liability for the nurse and the school- many times, requires a different approach.

Good luck- We will help you figure this all out....and remember...the long Thanksgiving and Christmas Breaks are right around the corner. Biggggg huggggs to YOU!!

 

2023.24 NEWEST Health Enrollment Form.docx

Wow! You are amazing!! Thank you so so much! I'm in Illinois, my school does have extra EpiPens for use and every year we do send out what's called Student Medical Information forms. The problem is, not every one turns it in or includes things I should know ?. I also sent out a mass email at the beginning of the year to please bring anything your child may need for their health (epipens, inhalers, meds, etc). For those 2 kids, all I have is word of mouth from parents, but I'm not sure if that's enough info to administer epinephrine 

[Cattz, ADN]

Dear Friend- School Nurses don't eat their young, so you have come to the right place for guidance.

Lots to unpack here. First thought- Does your school have a Health Enrollment Form? If not, that is something that I would send home today for every student. I don't know your enrollment, so this may be a daunting task. But, it is a place to start.  I will attach a copy of mine. Feel free to use it, change it to meet your needs, etc, or trash it if it doesn't work for you.  It is a document that I made up and has evolved over the years to meet my needs. This is where you will begin to gather that  health information to see what students have what diagnosis'.

What state are you in? And do you have a State School Nurse Consultant. Ours in Missouri is remarkable and a wealth of information and help. Does your state have guidelines for such needs? Here is the link to Missouri's- https://health.mo.gov/living/families/schoolhealth/pdf/sn-chat.pdf

There is a packet of forms in there for Allergies- the parent needs to get those completed/Dr. and parent signatures and return to you. This will provide you with kid specific instructions....from the Dr. So, you will know exactly what the Dr. wants done for each student.

Does your school stock Epi-Pens or have parents provided them?

Deep breaths. It's going to be OK. Until you get the completed forms back- Things I would think about- How long does it take EMS to get here? Use your nursing assessment and judgement. Call parents and document conversations. What parents say, don't always go along with what we would do in school. Something that I have had many times- is that parents handle things a lot differently because they live with it everyday. But, liability for the nurse and the school- many times, requires a different approach.

Good luck- We will help you figure this all out....and remember...the long Thanksgiving and Christmas Breaks are right around the corner. Biggggg huggggs to YOU!!

 

[Cattz, ADN]

Sorry- IDK how I posted my message 2 times. But, I have more thoughts for you.

[Cattz, ADN]

I would document every conversation and every time you call a parent. You may have to call and remind them to get the Health information form back to you. Even send home another copy in the grade cards. It may take awhile to get your office and how you do your school nurse practice. But, it will be worth it.

I have a cover sheet when I send home the special health care paperwork.  I keep a copy of the cover sheet, This is my documentation of when I sent it and exactly what forms were in the packet        For instance-

This is some of the wording on the cover sheet of the Food Allergy Paperwork.

"Instructions for Completing Food Allergy Paperwork"

Child's name:______________________________ Date:________________

Dear Parent: Attached you will find very important paperwork for your child.

We are not familiar with your child's health care need like you, the parent. Therefore, we need your help to keep your child safe while at school. To accomplish this, it is critical that this completed paperwork be returned to school before your child attends. Failure to do so- will not allow us to make the safest plan possible.

It is the parents' responsibility to provide the information and is to be updated BEFORE each new school year. Please do so according to the instructions below:

Here is where I put the title of each page and explain if it is to be completed and or signed by parent and or Dr.

IF CHIDL IS SUPPOSED TO HAVE ANY MEDICATION(S) - PRESCRIPTION AND/OR OVER THE COUNTER: PLEASE MAKE SURE THAT YOU PROVIDE TO SCHOOL. THIS PAPERWORK IS LITTLE HELP WITHOUT ANY NEEDED MEDICATIONS.

______________________________________

More general information to help you if needed. Here is the link to a wealth of manuals and guidelines. https://health.mo.gov/living/families/schoolhealth/office-management.php

Under Guidelines and Manuals- One that I use the most is Prevention and Control of Communicable Diseases. It is my only source that I or my schools use to determine if a child can be in school, exclusion, general information about the specific illness, etc. The Manual for School Health Programs may also have some really good information for you.

I'll help you with anything I can. It is hard to start fresh, especially when you may have different practice standards than the school and parents have been used to. If you remain consistent and don't waver from what your expectations are- you will eventually get most on board with how you do things. IDK if you were familiar with the school climate and education in general. But, it is a whole new world and I am pretty sure our "Nurse Brains" do not work like the non-medical people in the school. 

Hang in there, you will make a difference.

a.

[Cattz, ADN]

One more really important document for Food Allergies. This is the Federal Food Program form that is required to be returned before any food substitutions can be made by any school that participates in the Federal School Food Program. You may already know about it, but just in case. Here is the link https://dese.mo.gov/media/pdf/medical-statement-student-requiring-meal-modification   

I have been told by my Food Service peeps that if we don't have this form and make substitutions without it...the school can be in big trouble. 

On a practical note, it absolutely saves the school from having to cater to requests to not serve this or that to a student that just doesn't like a certain food. So, it is actually very helpful. It is also helpful sometimes when the parent realizes that the school will not make substitutions without it. If they don't hurry to the Dr. to get it done, that is on them.

Good luck!

[k1p1ssk, BSN, RN]

Adding on to the above, wonderfully stated comment, if you have stock epi (which it sounds like you do), you should have standing orders that guide how you use it - this would come from your district/school physician. Try and locate these orders and if you don't have them, create some. They need to be renewed yearly. I believe the epipens4schools website has a sample one you can use! Without the standing orders or student-specific orders, administering the epi would most likely be outside of your scope of practice and could potentially be considered illegal (unless your state BON allows for emergency medication to be administered by a nurse without orders, but I doubt they do). 

Are there other nurses in your district/city you can connect with to help you find these things and help you with what is done to make sure you have everything you need?

[raebabelvn, LVN]

All great information provided!

So for severe allergies... I follow the general plan laid out by FARE. I have attached it as well. This is generally for food allergies, BUT I follow the guidelines for insect bites/stings as well. One or more severe symptoms, or two or more mild symptoms involving two systems.

We have stock epi here, and I've used it a lot. Do not be afraid to epi, its so much better to be safe than sorry. I've called parents before of students who were having a reaction and they've said the same (don't call 911, benadryl first, wait for me, etc). Just remember, you are the licensed health care professional, you are seeing what's happening first hand, if you think you need to epi, then do not hesitate. And document, document, document.

FARE_FAAECP-2023-for download_fillable.pdf

[NutmeggeRN, BSN]

Cattz said:

Dear Friend- School Nurses don't eat their young, so you have come to the right place for guidance.

? This right here!

There is a wealth of info here in this thread. I would also strongly encourage you to join both your state association and NASN (if they are not unified). There are thousands of school nurses across the country ready to support you!

And  we send out that health form every single year in Sept. As you grow into your role, you will find what works best for you.

I am in HS and I cull the file of extra copies of info and unnecessary papers. It cleans things up and it gives me a chance to do a quick review. I print a roster with columns of  conditions..asthma, allergies, conditions etc so I have a quick running reference until I know what I am dealing with. Also work with whoever is sending kids to your school (if that happens) to get an annual list to start working from. 

Good Luck!!

[Jane Rodrigues]

I had a student no none allergies to bee stings and he came in watery eyes skin started to have hives and called mom and she said she was allergic and that was her one kid. Administered Epi Pen and he said thank you EMS arrived and gave him a steroid shot and went to the ER. Yep. I'm no longer a school nurse but my 6 years experience, you need to make your own lists and update every year. Also I had a waiver letter I would make all parents sign regardless if they agreed to have emergency medicine for their child or not. I work middle school and high school and elementary school.  Good luck. It's a great job. I'm furthering my education so I went back to bedside. 
Jane R. LVN to BSN student (2025)

[Cattz, ADN]

Frannie- Checking in to see how you are doing with this?