Bette Carr, MSN, RN, NCSNSchool Nursing and Health Services

Wisconsin Department of Public Instruction

The speaker has no disclosures or conflicts of interest.

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?

ADA

IDEA

Section 504

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

2006 Healthy Learner Model: Special School District #1, Minneapolis Public Schools Related Services

MaryMarc

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