KEARNY BOARD OF EDUCATION          File Code:      5141.22          

Kearny , New Jersey    07032

Policy  

       EMERGENCY ADMINISTRATION OF EPINEPHRINE VIA EPI-PEN TO PUPIL  

1.  The Kearny Board of Education shall develop a policy for the emergency administration of epinephrine via epi-pen to a pupil for anaphylaxis provided that:

a.   The parents or guardians of the pupil provide the Board of Education or chief

school administrator written authorization for the administration of the epi-pen;

b.   The parents or guardians of the pupil provide the Board of Education or chief

school administrator written orders from the physician or advanced practice nurse that the pupil requires the administration of epinephrine for anaphylaxis and does not have the capability for self-administration of the medication;

c.   The Board or chief school administrator informs the parents or guardians of the

pupil in writing that if the procedures specified in this section are followed, the district and its employees or agents shall have no liability as a result of any injury arising from the administration of or failure to administer the epi-pen to the pupil;

d.   The parents or guardians of the pupil sign a statement acknowledging their

understanding that if the procedures specified in this section are followed, the district shall have no liability as a result of any injury arising from the administration of or failure to administer the epi-pen to the pupil and that the parents or guardians shall indemnify and hold harmless the district and its employees or agents against any claims arising out of the administration of or failure to administer the epi-pen to the pupil; and

e.   The permission is effective for the school year for which it is granted and is

renewed for each subsequent school year upon fulfillment of the requirements in subsections a. through d. of this section.

f.    In addition to following the procedures set forth herein, the nurse or designee

shall call 911 and arrange for any child receiving the epi-pen to be transported to the nearest hospital facility.  

2.   The policy for the administration of medication to a pupil shall provide that the school

nurse shall have the primary responsibility for the administration of or failure to administer of the epi-pen.  The school nurse may designate, in consultation with the Kearny Board of Education or chief school administrator, another employee of the school district to administer epinephrine via epi-pen to a pupil for anaphylaxis when the nurse is not physically present at the scene provided that:  

a.   The designated person has been properly trained in the administration of the epi-pen by the school nurse using standardized training protocols established by the Department of Education in consultation with the Department of Health and Senior Services;

Emergency Administration of Epinephrine Via Epi-Pen to Pupil   File Code:  5141.22  Page 2  

b.   The parents or guardians of the pupil consent in writing to the administration of the epi-pen by the designated individual;

c.   The Kearny Board of Education informs the parents or guardians of the pupil in

writing that if the procedures specified in this section are followed, the district and its employees or agents shall have no liability as a result of any injury arising from the administration or failure to administer the epi-pen to the pupil;

d.   The parents or guardians of the pupil sign a statement acknowledging their

understanding that if the procedures specified in this section are followed, the district shall have no liability as a result of any injury arising from the administration or failure to administer the epi-pen to the pupil and that the parents or guardians shall indemnify and hold harmless the district and its employees against any claims arising out of the administration or failure to administer the epi-pen to the pupil; and

e.   The permission is effective for the school year for which it is granted and is renewed for each subsequent school year upon fulfillment of the requirements in subsections a. through d. of this section.  

Procedure for Epi-Pen Administration  

1.   The School Nurse will assemble packet of information pertaining to Epi-Pen Administration.  The information contained therein shall be followed.

2.   The School Nurse will verify the student’s doctor’s order requiring Epi-Pen usage for the student.

3.   In “consultation with the Kearny Board of Education,” designee(s) will be assigned by the School Nurse to administer the Epi-Pen in the event the School Nurse is unavailable to do so.

4.   The School Nurse will train the designee(s) in Epi-Pen Administration using standardized training protocols established by the Department of Education in consultation with the Department of Health and Senior Services and arrange for training in Anaphylactic Shock and CPR Certification.

5.   The School Nurse will ensure that the designee knows where the student’s Epi-Pen is stored and memorialize this information in writing.  The School Nurse will have designee sign a form indicating his or her knowledge of where the Epi-Pen is stored. 

A copy of this form will be maintained in the student’s file.

6.   The School Nurse will prepare an individualized Health Care Plan and an individualized Emergency Care Plan.  The School Nurse will receive input from the parents and designee when preparing these documents.  The School Nurse will ensure that the designee understands how to follow the plan in these documents by reviewing the procedure with him or her at least every school year.

7.   The School Nurse will have the parent/guardian sign the Parent Release and Indemnification in the presence of a notary.

Emergency Administration of Epinephrine Via Epi-Pen to Pupil File Code: 5141.22   Page 3  

School Nurse Responsibilities  

1.   Assemble information pertaining to Epi-Pen Administration and keep up-to-date and ready for parent/guardian.

2.   Verify parent’s/guardian’s submission of order from doctor or advanced practice

nurse, which states that the student does not have the capability to self-administer the medication and Epi-Pen usage for student is required.  Maintain original of doctor’s order in student’s file.

3.   After receiving written authorization and orders from the doctor or advanced practice nurse that the student requires epinephrine, coordinate a meeting with school administrators, the parent/guardian and the student (if appropriate).

4.   Act as liaison among family, the health provider and educators to assure that the health care needs of the student are addressed while attending school.

5.   Determine and be accountable for the appropriateness of delegated nursing tasks.  Abide by the New Jersey State Board of Nursing regulations in reference to the delegation of nursing duties.  (N.J.A.C. 13:37-6.2).     

6.   In consultation with the Kearny Board of Education and principal, establish criteria for choosing an appropriate designee.  After receiving principal’s input, choose proposed designee(s).  Submit list of proposed designee(s) to superintendent for transmittal to the Board of Education.

7.   Educate the school staff about anaphylaxis, its causes, signs, symptoms and treatment.

8.   Train designee(s) in Epi-Pen Administration and arrange for Anaphylactic Shock training, and CPR certification for designee(s).  The designee(s) must secure a CPR Providers course completion card issued by a training center for the American Heart Association or a course completion card for adult, infant and child CPR issued by the American Red Cross.  Ensure that designee knows where Epi-Pen is stored.  Memorialize this information in writing, have designee sign and acknowledge receipt of a copy of same.  Maintain original in student’s file.

9.   Train designee(s) in the “one-client-one-task” principle, i.e., the task is not transferable to any other person.  The designee(s) shall be trained to:

n   Assess the scene for safety;

n   Maintain universal blood and body fluid precautions;

n   Maintain an open airway and assist ventilations as needed;

n   Assess level of consciousness, check for airway, breathing and circulation and vital signs if possible;

n   Obtain appropriate history relative to the allergic event; and

n   Determine if patient is in mild or severe distress;

a) Mild Distress: itching, isolated hives, nausea, no respiratory distress;

b) Severe Distress: stridor (a harsh, high-pitched sound in inhalation or

exhalation), bronchospasm, severe abdominal pain, respiratory distress, tachycardia, shock, edema of lips, tongue or face or generalized hives.

Emergency Administration of Epinephrine Via Epi-Pen to Pupil File Code: 5141.22   Page 4  

10. Prepare an individualized Health Care Plan for the student in collaboration with the family, student and physician, taking into consideration the regulations covered in section 504 of the Rehabilitation Act.  Prepare an individualized Emergency Care Plan with input from parent/guardian, including designee and plan of action when Epi-Pen is needed.  Ensure that designee entirely understands how to follow the Emergency Care Plan by reviewing the procedure with designee at least every school year.

11. Have parent/guardian sign Parent Release and Indemnification in the presence of a notary.  Provide parent/guardian with a copy of Parent Release and Indemnification and copies of N.J.S.A. 18A:40-12.5 and 18A:40-12.6.

12. Submit final list of designee(s) to superintendent at time of implementation of program.  Furnish updates to superintendent when there are any changes in designee(s).

13. Follow this procedure every school year.  

Parent/Guardian Responsibilities  

1.   Obtain order from doctor or advanced practice nurse stating that the student requires the administration of epinephrine for anaphylaxis and does not have the capability for self-administration, therefore, requiring Epi-Pen administration in school.  Provide school with a new doctor’s or advanced practice nurses’s order every school year.

2.   Provide Epi-Pen to school and ensure that it has not expired.

3.   In the presence of a notary, sign Parent Release and Indemnification as specified in N.J.S.A. 18A:40-12.5 and 18A:40-12.6.  Retain copy of Parent Release and Indemnification for records.

4.   Sign form approving designee(s) to administer Epi-Pen in the event school nurse is

unavailable.

5.   Receive information from school regarding training programs for designee(s).  Provide input for Health Care Plan and Emergency Care Plan.  Sign and receive a copy of Emergency Care Plan.

6.   Follow the above procedure every school year.  

Amended:    February 20, 2001