Bette Carr, MSN, RN, NCSN School Nursing and Health Services Wisconsin Department of Public...
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Transcript of Bette Carr, MSN, RN, NCSN School Nursing and Health Services Wisconsin Department of Public...
Bette Carr, MSN, RN, NCSNSchool Nursing and Health Services
Wisconsin Department of Public Instruction
Participants will be able to identify potential barriers, as well as resources, for implementation of seizure procedures.
What do you feel was the biggest barrier this past year in providing appropriate health
services to students with seizures or epilepsy?
Lack of certainty on:◦ What seizures look like for this child
◦ Medications, doses, routes, and side effects
◦ Timeliness of EMS services
◦ Whether I have the knowledge to train others
◦ Delegating seizure monitoring and medication administration to others
Professional development that includes research-based information
Network with other school nurses Refresh your assessment skills Spend time with the student and family Preparation of seizure curriculum for others Preparation of individualized health care
plans for students
Communicate with the health care provider (HCP) any concerns that you might have regarding the student or plans
Use resources that you have available to you:
◦ Medical advisor◦ Webcast training◦ Other districts or nurses in your area◦ Epilepsy Foundation◦ WASN/NASN
Health care provider requests: ◦ Orders that are outside your comfort zone◦ Non-FDA-approved medication routes
Parents request:◦ That 911 not be called◦ That the child remain in school after emergency
medication has been given ◦ That they will not sign a release of information
Plan ahead!oRequest a meeting and develop a care plan
oEncourage the health care provider to be part of the planning
o Involve your medical advisor if needed
oEncourage the family to sign a release and explain that the release can be very specific to the seizure disorder care
Plan ahead!o Let the family and health care provider know
that the school wants to be prepared to provide the safest care possible for their child
o Is a 504 Plan needed?
o Involve your supervisor or director if needed
Leadership skills Preparation of a curriculum and protocol Preparing an individualized care plan Deciding who to train-developing a team of
responders Obtaining time to train Documenting those who have been trained Periodically reviewing the plan
Curriculum:◦ Recognize when urgent care is needed◦ How to access that care◦ How to handle an emergency◦ Know how to respond to the child◦ CPR, seizure recognition
NASN program Epilepsy Foundation information
Protocols from other districts Protocols from health care providers Discussing specific situations with your
medical advisor WI Department of Public Instruction website WISHeS website
Protection of the student’s privacy Health information sharing Classroom or school setting event management Prevention of bullying
Be prepared and share a plan with the teachers on how to provide for a student’s privacy during a seizure:
If allowed by the family, discuss the child’s condition with the class ahead of time and let the students know what is expected of them
Remove the other students from the area
If giving rectal medications have a packet made up with a sheet or other physical barrier for privacy
Use other adults as a barrier if needed
Concern for child’s safety Fear of doing something wrong Recognizing postictal somnolence vs.
medication sedation Sufficiently trained staff EMS services readily available
Planning and reviewing Practice plan Check with local health care provider for
changes in care plan Have parents video record what the
child’s postictal and post-medication behavior looks like
Student: Wyatt, 13-year-old Health condition: epilepsy, tonic-clonic seizures Treatment: taking Valproic Acid 15ml b.i.d. Emergency medication: Diazepam 10 mg rectal
gel Order states:
◦ Administer Diazepam 10mg rectally for seizures lasting greater than 2 minutes, call parent, and stay with student until the parent arrives to pick up the child.
Questions:◦ What do Wyatt’s seizures look like?◦ Has Wyatt ever received emergency medication?
What was his reaction to the medication? Is he fearful of getting it at school in front of his peers?
◦ Is the nurse in the building and available to assess?◦ Is the Unlicensed Assistive Personnel (UAP) capable
of monitoring the student?◦ How long will it take for the parent to arrive?◦ How long will it take for EMS services to arrive if
there are problems?
Resolution:◦ Draft a care plan that takes into account the
answers to the questions◦ Have parent sign release and communicate with
the HCP◦ Train the staff that work with the student◦ Prepare an emergency kit that includes all
necessary items and a barrier◦ Make decisions on whether care can safely be
given without EMS services being called
Student: Anna, 5-year-old Health condition: autism, complex-partial
seizures Med at school: taking Carbamazepine 100mg
2 chewable tablets at noon Emergency medication: Midazolam 1ml
intranasal MAD (mucosal atomization device) Order states:
◦ Administer Midazolam 0.5ml in each nostril for seizures greater than 5 minutes or for 3 or more seizures in 24 hrs lasting less than 5 minutes. Call 911after use.
Questions:◦ What do Anna’s seizures look like?
◦ Has Anna ever received emergency medication? What was her reaction to the medication?
◦ Is the nurse in the building and available to assess the seizures?
◦ Is the Unlicensed Assistive Personnel (UAP) capable of monitoring the student’s repeated seizures?
◦ How long will it take for EMS services to arrive once called?
Resolution◦ Draft a care plan that takes into account the
answers to the questions◦ Have parent sign a release and communicate with
the HCP◦ Train the staff that work with the student in
recognizing seizures and in timing of the seizures
Perceived barriers:◦ School nurse knowledge and confidence◦ Difficult requests◦ Training of others◦ Privacy◦ Safety
Overcoming these barriers:◦ Increase knowledge and skills which increases
confidence◦ Improve communication between student-family-
health care provider-school nurse-staff