Given that when a child is having a seizure, it can be a stressful situation, it is highly recommended that you familiarize yourself with that child’s seizure emergency care plan before hand
Considerations:
- Given that the medication can be dispensed in different formats and dosages, the school nurse should always review the medication and order upon receiving it at the school
- Given that when a child is having a seizure, it can be a stressful situation, it is highly recommended that you familiarize yourself with that child’s seizure emergency care plan beforehand
- NOTE: The student’s Seizure Action Plan should indicate when 911 should be called (i.e. on immediate onset of a seizure, after the student has been having a seizure for 5 minutes, or if the student hasn’t responded to the rescue medication, etc.)
- Store the Seizure Action Plan in a location that is easily accessible during a seizure
- Store the Seizure Observation Recording Form with the seizure medication
- Secured, but accessible storage of the medication should be considered in your medication administration plan
- The school nurse should develop a plan to systematically check the expiration date on the medication to ensure the medication has not expired
- Lorazepam expires 90 days after it has been opened and requires refrigeration
- Midazolam can be stored at room temperature and there is no specific expiration date once the medication has been opened (other than the actual expiration date printed on medication)
- Be sure to ensure the child’s privacy and confidentiality when calling for assistance.
- Do not say the child’s name over the PA system or walkie-talkie
- If possible, have someone assist with removing onlookers and other students to provide the child with privacy
- NOTE: The Food and Drug Administration (FDA) has not approved lorazepam or midazolam for administration via this medication route. Since healthcare providers are currently prescribing the medications via this route, if you have questions or concerns, discuss this with the prescribing healthcare provider or the pharmacist
Supplies:
- Seizure Action Plan/Healthcare provider’s order
- Student’s Individualized Healthcare Plan
- Seizure Observation Recording Form
- Medication
- Syringe or dropper
- Gloves
- Gauze or paper towel
First aid for a seizure:
- If someone is present, have them call for assistance
- East the student onto a flat surface such as the floor being sure not to move the child any more than is necessary
- Turn the child onto his/her side to allow vomit/phlegm to be expelled rather than inhaled
- Place something soft under the child’s head to protect them from injury
- Ensure the child’s airway is not obstructed
- Loosen tight clothing around the child’s neck
- Do not restrict the child’s arms or legs
- Ensure there is no furniture or objects close to the child that could injure him/her
- Review the child’s emergency care plan
- Gather the emergency medication and needed supplies in case seizure lasts longer than designated time frame
Procedure:
- Identify that symptoms of a prolonged seizure are present and that based on the student’s Seizure Action Plan/healthcare provider’s order, that medication needs to be given
- Call for assistance, if you have not already done so
- As that another school staff person call 911 or emergency medical servics, if indicated on the student’s Seizure Action Plan
- NOTE: The student’s Seizure Action Plan should indicate when 911 should be called (i.e. on immediate onset of seizure after the student has been having a seizure for 5 minutes, or if the student has not responded to rescue medication
- Note time of seizure onset on Seizure Observation Recording Form
- If student is not already in a side lying position, move them to a side lying position, if possible
- Explain the procedure to the student at their level of understanding
- If possible, wash your hands
- Assemble the needed supplies
- Review the six rights of medication administration to ensure that it is:
- For the right student
- The right medication
- The right dose
- Being given at the right time
- Being given by the right route
- Being given for the right reason
- Be sure to check medication to ensure that it has not expired
- Review student’s allergy status
- Ensure proper documentation of parent/guardian authorization to administer medication
- Follow Student’s Action Plan to ensure the appropriate amount of time has passed prior to administering the student’s seizure medication
- Put on gloves
- Review the six rights again to be sure that it is:
- For the right student
- The right medication
- The right dose
- Being given at the right time
- Being given by the right route
- Being given for the right reason
- Open the bottle of medication
- Place the syringe or dropper into the bottle of medication until the end of the syringe/dropper is in the fluid
- Draw up the correct dose of medication, ensuring that the dose is correct once the syringe or dropper is removed
- If the dose is incorrect the fluid can be squirted back into the bottle and withdrawn again
- Retract the student’s lower lip
- Place the syringe between the lower gum and the cheek on one side of the mouth
- Slowly give half the amount of medication into the mouth
- Close the lips together and rub on cheek on the outside
- Repeat this on the other side of the moth to give the rest of the medication
- Administer the medication slowly, taking care not to spill the drug outside of the oral cavity
- Take care not to squirt the medication onto the tongue or into the open throat of the student
- Do not place the syringe or dropper between their teeth as they may bite it
- There is no need to open the student’s jaw as the medicine dose does not neen to be swallowed
- After squirting the medication into the gum remove the syringe/dropper but keep the lip retracted for a few seconds
- Use gauze swabs to wipe their mouth after
- If the student is not already lying on their side, place the student on their side
- Note the time of the and slowly squirt the drug into the mouth between the lip and gum
- Squirt half of the medication into one side of their mouth and the remaining medication into the other side of the mouth
- Administer the medication slowly, taking care not to spill the drug outside the oral cavity
- Take care not to squirt the medication onto the tongue or into the open throat of the child
- Do not place the syringe or dropper between their teeth as they may bite it
- There is no need to open the child’s jaw as the medicine does not need to be swallowed
- After squirting the medication into the gum remove the syringe/dropper but keep the lip retracted for a few seconds
- Use gauze swabs to wipe their mouth after
- If the student is not already lying on their side, place the student on their side
- Note time of medication administration and document on Seizure Observation Recording Form
- If EMS/911 has not been called yet, call 911 or EMS services if indicated on student’s Seizure Action Plan
- Stay with the student, monitoring breathing
- If breathing stops, begin rescue breaths
- Instruct someone to bring an AED, if available
- If breathing and heartbeat stop, begin CPR
- Once rescue squad arrives, inform them of medication administration, including type of medication, dose, and time
- Remember to dispose of all used equipment and bottles of medicine safely out of the reach of students
- Remove gloves
- Wash hands
- Document the date, time and dose of medication given in addition to what was observed during the seizure and recorded on Seizure Observation Recording Form
- Follow up with parent/guardian and healthcare provider, as needed
- Follow up with the parent or guardian and healthcare provider, as needed.
References:
Butler, S.M., Boucher, E.A., Tobison, J., & Phan, H. (2020). Medication use in schools: Current trends, challenges, and best practices. J Pediatr Pharmacol Ther., 25(1), 7–24. doi: 10.5863/1551-6776-25.1.7
Centers for Disease Control and Prevention. (2022, January 2). Seizure first aid. Retrieved June 6, 2023, from https://www.cdc.gov/epilepsy/about/first-aid.htm
Epilepsy Foundation of America. (2020). Oral rescue medicines. Retrieved June 23, 2023, from https://www.epilepsy.com/treatment/seizure-rescue-therapies/oral-rescue-medicines
Epilepsy Foundation of America. (2020). Seizure training for school nurses: Caring for students. [On-demand course]. Retrieved June 23, 2023, from https://learn.epilepsy.com/courses/take/school-nurse-OD-v2a/lessons/45652454-course-introduction
Hartman, A. L., Devore, C. D., Section on Neurology, American Academy of Pediatrics, Council on School Health, American Academy of Pediatrics, & Doerrer, S. C. (2016). Rescue medicine for epilepsy in education settings. Pediatrics, 137(1), 10.1542/peds.2015-3876. https://doi.org/10.1542/peds.2015-3876
Hoerth, M. & Osborne Shafer, P. (2020, April 16). Oral rescue medications. Retrieved June 9, 2023, from https://www.epilepsy.com/treatment/seizure-rescue-therapies/oral-rescue-medicines
University of Wisconsin Hospitals and Clinics Authority. (2019). Treatment of prolonged seizures with buccal lorazepam or midazolam. Retrieved June 9, 2023, from https://assets.ctfassets.net/4yx69hifndy8/7212.pdf/356405feb2fc7291285c7c7a6bf1d8d2/7212.pdf
Wilfong, A. (2022, September 20). Seizures and epilepsy in children: Refractory seizures. In a D. R. Nordli (Ed.). UpToDate. Retrieved June 9, 2023, from https://www.uptodate.com/contents/seizures-and-epilepsy-in-children-refractory-seizures?search=buccal%20midazolam&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#
Page last reviewed: February 20, 2025
Page last updated: February 20, 2025
The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same. The information is not intended to substitute for, supplement or replace clinical judgment. If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider. The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.