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 before hand
- 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, student hasn’t responded to the rescue medication, etc.)
- Store the seizure emergency plan in a location that is easily accessible during a seizure
- Store 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
- 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
- The medication can be very irritating to the nasal membranes and create a burning sensation, additional adult assistance may be required to administer the medication
- Note: Nayzilam® is FDA approved for use in people with epilepsy who are 12 years of age and older
- Note: Valtoco® is FDA approved for use in children and adults with epilepsy who are 6 years of age and older
- Do not try to test or prime the nasal spray until before use. You will lose the dose
- Do not open the blister pack until ready to use
- Do not use if the nasal spray unit appears damaged
- Do not use past the expiration date printed on the blister pack
- Throw away (dispose of) the nasal spray unit after use
Supplies:
- Seizure Action Plan/Healthcare provider’s order
- Parent/Guardian authorization form
- Seizure Observation Recording Form
- Prescribed medication
- Gloves
- Bulb syringe
First aid for a seizure:
- If someone else is present, have them call for assistance
- To assist with removing other students/staff from the classroom/area and to assist in obtaining the student’s emergency medication
- Ease the student onto a flat surface such as the floor being sure to not move the student 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, emergency medication needs to be given
- Call for assistance, if you have not already done so
- Ask that another school staff person call 911 or emergency medical services 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 seizure for 5 minutes, student hasn’t responded to rescue medication, etc.).
- Note time of seizure onset on the Seizure Observation Recording form
- If the student is not already in a side lying position, move the student 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 and place on clean surface
- Review the six rights of medication administration to be sure it is:
- 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 the medication to ensure it has not expired
- Expiration date is located on blister packaging
- Review the student’s allergy status
- Ensure proper documentation of parent/guardian authorization to administer medication
- Follow the student’s Seizure Action Plan/healthcare provider’s order to ensure that the proper amount of time has passed prior to administering the student’s seizure medication
- Put on gloves, if available
- Review the six rights of medication administration 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
- Look into the student’s nostrils to determine if there is fluid or mucous in the nostrils
- If drainage or mucous is present, use a bulb syringe to remove it
- If a bulb syringe is not available, medication can still be administered if drainage or mucus is present
- When ready to use, open the blister packaging
- Review medication blister pack for specific directions on how to open
- Remove the nasal spray unit carefully
- Hold the nasal spray unit with your thumb on the bottom of the plunger and your middle and index fingers on each side of the nozzle
- Do not press the plunger yet
- If you press the plunger now, you will lose the dose
- Using your free hand to hold the crown of the head stable, place the tip of the nozzle into one nostril until your fingers, on either side of the nozzle, touches the bottom of the nose
- Press the plunger firmly to deliver the dose of the medication
- Make sure to firmly press the plunger using one motion
- The student does not need to breathe deeply when you give the medicine
- Remove the nozzle from the nostril after giving the dose
- The student may grimace or appear more restless momentarily after the medication is given
- 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 child, 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 administered, including type of medication, dose and time
- Remember to dispose of all used equipment and medicine safely out of the reach of children
- Remove gloves
- Wash hands
- Document the date, time and dose of medication given in addition to what was observed during the seizure on the documentation log
- 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
Dean, P., O’Hara, K., Brooks, L., Shinnar, R., Bougher, G., & Santilli, N. (2021). Managing acute seizures: New rescue delivery option and resources to assist school nurses. NASN school nurse (Print), 36(6), 346–354. https://doi.org/10.1177/1942602X211026333
Epilepsy Foundation. (2020, April 18). Nasal rescue medicines. Retrieved June 23, 2023, from https://www.epilepsy.com/treatment/seizure-rescue-therapies/nasal-rescue-medicines#How-is-it-given?
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
Epilepsy Foundation. (2023, February 22). Midazolam nasal. Retrieved June 23, 2023, from https://www.epilepsy.com/tools-resources/seizure-medication-list/midazolam-nasal
Hartman, A.L., Devore, C.D.L, American Academy of Pediatrics and the Section on Neurology, et al. (2016, January 1). Rescue medicine for epilepsy in education settings. Pediatrics, 137(1):e20153876. Retrieved April 8, 2020, from https://pediatrics.aappublications.org/content/137/1/e2015387
National Association of School Nurses. (2018). School nursing evidence-based clinical practice guideline: Students with seizures and epilepsy. Retrieved June 9, 2023, from https://www.pathlms.com/nasn/courses/8992
Neurelis. (2022). Instructions for use. For 5 mg and 10 mg doses. Retrieved June 9, 2023, from https://www.valtoco.com/sites/default/files/pdf/Instructions_For_Use.pdf
Neurelis. (2022, June 4). Confidence in the classroom. Retrieved June 23, 2023, from https://vimeo.com/723909451
Neurelis. (2023). VALTOCO is easy to administer. Retrieved June 9, 2023, from https://www.valtocohcp.com/dosing-and-usage
Prescriber’s Digital Reference (PDR). 2020. Lorazepam drug summary. Retrieved April 8, 2020, from https://www.pdr.net/drug-summary/Lorazepam-Intensol-Oral-Concentrate-lorazepam-2668.
UCB. (2023). How to use Nayzilam. Retrieved June 9, 2023, from https://www.nayzilam.com/how-to-use-nayzilam
UCB. (2023). Medication guide Nayzilam® (NAY-zil-am) (midazolam nasal spray, CIV. Retrieved June 9, 2023, from https://www.ucb-usa.com/nayzilam-med-guide.pdf
Procedure last reviewed: February 24, 2025
Procedure last updated: February 24, 2025
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