epipen administration

1. EpiPen Administration by Susan Reiss RN, NCSN

3. You may feel like this now� How on earth could I possibly know what to do? The whole thing terrifies me!How on earth could I possibly know what to do? The whole thing terrifies me!

4. But after this program, you�ll feel like this� You will be so excited because you will know how to save a life!You will be so excited because you will know how to save a life!

5. Your objectives are: Accurately recognize student-specific warning signs of allergic emergency Accurately identify student for whom epinephrine is prescribed Accurately read and interpret the student�s Emergency Care Plan (ECP) Correctly follow directions on the student�s ECP

6. Objectives continued� Accurately read the epinephrine (EpiPen) label and follow directions from the label Administer epinephrine by auto-injector Safely handle epinephrine in auto-injector Accurately describe the school�s plan for responding to life-threatening allergic emergencies Access resources appropriately, including emergency medical services, school nurse, physician, and parents

7. Epinephrine is the treatment of of choice for allergic reactions�

8. Epinephrine� It quickly constricts blood vessels, raising blood pressure It relaxes smooth muscles in the lungs to improve breathing

9. Epinephrine continued� It stimulates the heart beat It works to reverse the hives and swelling around the face and lips

10. How is epinephrine stored? Stable at room temperature until the marked expiration date Do not freeze, refrigerate, or expose to extreme heat or sunlight�it will cause it to oxidize and go bad..and turn brown. �The auto-injector is quite durable, but it may be damaged if mishandled.�The auto-injector is quite durable, but it may be damaged if mishandled.

11. How is epinephrine handled? Before using, make sure solution is clear and colorless Accidental injection into the hands or feet may result in loss of blood flow to the affected area and will require immediate treatment in the Emergency Department (ED) The loss of blood flow is a result of the blood vessel constriction action of the epinephrine, the same action which, in the large blood vessels of the body, will help keep someone from going into shock. In the emergency department the hands and feet are immediately injected with a medication to counteract the effects of the epinephrine.The loss of blood flow is a result of the blood vessel constriction action of the epinephrine, the same action which, in the large blood vessels of the body, will help keep someone from going into shock. In the emergency department the hands and feet are immediately injected with a medication to counteract the effects of the epinephrine.

12. How is epinephrine handled? After using epinephrine, the auto-injector should be placed in an impermeable container and given to EMS personnel to take to the ED. Be aware that after the injection there will be a needle extending from the end of the auto-injector.Be aware that after the injection there will be a needle extending from the end of the auto-injector.

13. The 5 �RIGHTS� of epinephrine administration� Right student Right medication Right dose Right route Right time

14. Identify the student with the known allergy. Use the photo on the ECP Introduce yourself personally to the student prior to allergen exposure Explain to the student that you will assist him/her with an EpiPen in the event of an allergen exposure. The student should be able to identify you as a resource in the event of allergen exposure. You should be able to easily identify the student within a group of students.You should be able to easily identify the student within a group of students.

15. Right medication� Epinephrine is available in an auto injector called an EpiPen

16. Right dose� An EpiPen comes in TWO different doses: EpiPen 0.3 mg (over approx.66 lbs.) EpiPen Jr. 0.15 mg (under approx 66 lbs.) Always make sure you have the right EpiPen dose for the student. The physician will have ordered the correct dose and auto-injector ahead of time. You simply have to make sure you have the EpiPen belonging to your student. It will be in the bag labeled with the student�s name along with the student�s emergency care plan. (Show an example of student-labeled bag with EpiPen and ECP). As you can see, the label for the adult EpiPen is different from the EpiPen Jr.Always make sure you have the right EpiPen dose for the student. The physician will have ordered the correct dose and auto-injector ahead of time. You simply have to make sure you have the EpiPen belonging to your student. It will be in the bag labeled with the student�s name along with the student�s emergency care plan. (Show an example of student-labeled bag with EpiPen and ECP). As you can see, the label for the adult EpiPen is different from the EpiPen Jr.

17. Right route� The EpiPen is administered into the large outer thigh muscles It can be administered into a bare thigh or through clothing. Here you see people practicing with an EpiPen trainer, hence the different color of the EpiPen.It can be administered into a bare thigh or through clothing. Here you see people practicing with an EpiPen trainer, hence the different color of the EpiPen.

18. Right time� Based on student�s symptoms and ECP e.g., hives spreading over the body, wheezing, difficulty swallowing or breathing, swelling in face or neck, tingling or swelling of tongue, vomiting, signs of shock, such as extreme paleness/gray color, clammy skin, loss of consciousness, or any other child-specific known symptom. Some students may need the EpiPen immediately upon exposure to the allergen before symptoms even start. Other students may require Benadryl or similar antihistamine medication immediately upon presumed exposure, with EpiPen administration at the first sign of a reaction to an allergen. The physician makes this determination in collaboration with the nurse and parents. The student�s ECP clearly outlines the steps to take in the event of allergen exposure. Any of the listed symptoms would require immediate EpiPen administration and 911 activation if exposure to an allergen has occurred, regardless of what�s written on an ECP.Some students may need the EpiPen immediately upon exposure to the allergen before symptoms even start. Other students may require Benadryl or similar antihistamine medication immediately upon presumed exposure, with EpiPen administration at the first sign of a reaction to an allergen. The physician makes this determination in collaboration with the nurse and parents. The student�s ECP clearly outlines the steps to take in the event of allergen exposure. Any of the listed symptoms would require immediate EpiPen administration and 911 activation if exposure to an allergen has occurred, regardless of what�s written on an ECP.

19. Steps in EpiPen administration�Breathe� Have student lie down Look at the directions on the EpiPen It states: Form fist around autoinjector (black tip down) With your other hand, pull off gray cap. Hold black tip near outer thigh Swing and jab firmly into outer thigh so auto-injector is perpendicular (at 90 degree angle) to thigh. 5. Hold firmly in thigh for several seconds. You�ve done the 5 �rights� and now it�s time to actually administer the medication. Review slide. All you have to do is follow the directions.You�ve done the 5 �rights� and now it�s time to actually administer the medication. Review slide. All you have to do is follow the directions.

20. A quick review� Case study You are the teacher in charge of a class you have just taken outside for a math problem. It�s spring and the flowers are blooming and the bees, unbeknownst to you, are buzzing. You have a child with a known bee allergy requiring immediate EpiPen administration if stung. You�ve made it a point, because you are an astute teacher, to see the nurse to review your student�s ECP and secure his EpiPen before going outside. The unthinkable happens� You, the teacher, have been trained by your wonderful nurse in management of life-threatening allergies in schools and in EpiPen administration.You, the teacher, have been trained by your wonderful nurse in management of life-threatening allergies in schools and in EpiPen administration.

21. What are the steps you would take? Have student lie down and administer the EpiPen immediately Dispatch 2 students to the front office with the name of the student and code word �allergy� Keep student warm, reassured, and away from allergen Once the students go to the front office with the word �allergy� and the student�s name, we know you have administered an EpiPen and there is a life-threatening situation. The front office staff will immediately call 911 requesting paramedic backup and dispatch the nurse to your location.Once the students go to the front office with the word �allergy� and the student�s name, we know you have administered an EpiPen and there is a life-threatening situation. The front office staff will immediately call 911 requesting paramedic backup and dispatch the nurse to your location.

22. The EpiPen buys you 15 minutes of time� Activating emergency services via 911 immediately is critical Know who the CPR trained staff are in your building so that persons trained in life support can be dispatched to your location

23. After EpiPen administration you must remember to� Document the time of administration. Have someone notify the student�s doctor (on emergency card) regarding incident and where student is being transported. Notify parent/guardian regarding incident, student�s condition, and hospital destination. The time of administration is important so that the EMS personnel will know how soon they can administer additional epinephrine, usually 15-20 minutes after the first dose if student still has symptoms.The time of administration is important so that the EMS personnel will know how soon they can administer additional epinephrine, usually 15-20 minutes after the first dose if student still has symptoms.

24. What about field trips? Being the the ever-prepared teacher you are, you will see the nurse at least 2 days prior to leaving to review the student�s ECP and answer any questions you may have. You will meet with the allergic student, explaining that you will have his/her EpiPen and you will be readily available to the student throughout the trip. This includes on student�s bus and at lunchtime. Student �buddy� Explain to the student the need for a buddy that can run to get you in the event of an allergen exposure.Explain to the student the need for a buddy that can run to get you in the event of an allergen exposure.

25. Field trips cont. You must have telephone access to call 911 at all times while off school property with students

26. Can I be sued if I make a mistake? If you volunteer to do this for a student, you will have been delegated by the parent/guardian in writing to administer this medication in the event of an emergency. In addition, you will have been trained by the parent/guardian(or the school nurse) about the student�s specific ECP. The paperwork has been reviewed by our district attorney. PS : If you administer a dose of epinephrine to an allergic child and the child did not need it, you will not hurt the child. The risk of not using the EpiPen when you suspect an allergic reaction, may be death-producing for the child. Remember, the effects of the EpiPen wear off in 15 minutes. It is far better to err on the side of caution.PS : If you administer a dose of epinephrine to an allergic child and the child did not need it, you will not hurt the child. The risk of not using the EpiPen when you suspect an allergic reaction, may be death-producing for the child. Remember, the effects of the EpiPen wear off in 15 minutes. It is far better to err on the side of caution.

27. You are now prepared to administer an EpiPen in a life-threatening allergic emergency! Congratulations! Now all allergic children will have a safer environment at school and on field trips because you will know what to do.Congratulations! Now all allergic children will have a safer environment at school and on field trips because you will know what to do.

28. One more thing: You must pass the EpiPen post test and demonstrate competency by being evaluated on the EpiPen trainer by your school nurse. This training is good for one year only and must be repeated annually in order to remain current.