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Epinephrine commonly administered by unlicensed school staff
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CHICAGO — As many as one in five anaphylactic events among children without known allergies are treated with epinephrine administered by an unlicensed school nurse or staff member, according to a recent presentation at the AAP 2017 National Conference & Exhibition.
“School nurses can’t be everywhere all the time,” Michael Pistiner, MD MMSc, FAAP, director of food allergy advocacy, education and prevention at MassGeneral Hospital for Children, said in an interview with Infectious Diseases in Children. “Having a full-time nurse in the school would be ideal, but in some cases, that is not a possibility. It is important that epinephrine is available because we know that first-time allergic reactions do occur in schools. Having epinephrine available to treat anyone who experiences anaphylaxis is very important.”
To understand current school policies regarding anaphylaxis management and the use of epinephrine, the researchers conducted a national, anonymous. electronic survey that included school nurses practicing within the United States.
Of the 1,486 school nurses who responded to the survey, 86% answered all questions. A significant amount of school nurses had administered epinephrine in their schools (41%). In the 2014-2015 school year, 24% of nurses reported any use of epinephrine. This number dropped to 15% in the 2015-2016 school year.
Unlicensed staff administered epinephrine more frequently in the 2014-2015 school year than in the 2015-2016 school year (4.3% vs. 2.7%). In many cases, epinephrine was administered to a child without known allergies (8% in 2014-2015; 4.8% in 2015-2016). Two doses of epinephrine were needed in 2.9% of anaphylactic events in 2014-2015 and 1.7% of anaphylactic events in 2015-2016.
“Training is key. If a school nurse has staff who are well-trained and know their role in the school’s emergency protocol, then it extends their reach significantly,” Pistiner told Infectious Diseases in Children. “If there are staff members who can recognize an allergic reaction, then they can quickly involve all the people in the school who will need to be involved when a child or staff member experiences an allergic reaction.” – by Katherine Bortz
Reference:
Pistiner M, et al. National school nurse survey of epinephrine use in schools. Presented at: The 2017 AAP National Conference & Exhibition; Sept. 16-19; Chicago.
Disclosure: Pistiner is a member of advisory board panels for DBV Technologies and Kaleo Pharmaceuticals.
Perspective
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Nina Fekaris, MS, BSN, RN, NCSN
I am not surprised by the findings that found that the majority of people administering epinephrine might not be licensed school nurses, but rather school staff that have been trained and certified. In fact, many states have enacted their own laws to address exactly this issue. For example, in Oregon, we are required to train school staff to be able to administer epinephrine and train them to recognize undiagnosed signs and symptoms of anaphylaxis.
State-mandated training allows for consistency throughout the state so that every child, no matter what school they are attending in the state of Oregon, has the same protection as far as emergency epinephrine use is concerned. I believe every state needs to have some type of legislation that helps guide this practice and supports the licensed school nurse and, in doing so, ensuring the protection of children.
I was surprised, however, by the percentage of people who were administered epinephrine at school and then required a second dose before 911 got there. I understand that in many of our more rural areas that might be the case, but I think that speaks to the need to have affordable, life-saving, medical care available to our students. Two doses of auto-injectable epinephrine is pretty expensive and for many of our families that is a significant financial burden, however if you are in an area where 911 response is delayed or might take a while, then it is absolutely vital for those children. Part of our advocacy is that families be able to afford it.
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