Administration of Rectal Diastat®

<< NEUROLOGICAL

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 when a child is having a seizure, it can be a stressful situation, it is highly recommended that you familiarize yourself with the student’s seizure emergency 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, 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 Seizure Observation Recording Form with the seizure medication
  • Secured, but accessible storage of the medication should be considered in the student’s medication administration plan
  • The correct dose of rectal diazepam ordered by the health care provider should be locked into place on the device by the dispensing pharmacist
    • This is evident when the green READY is visible
    • Verify that the green READY band is present on the medication when the student first brings medication to school and prior to storing for future use
  • 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 student’s privacy and confidentiality when calling for assistance
    • Do not say the student’s name over the PA system or walkie-talkie
  • If possible, have someone assist with removing onlookers and other students to provide the student with privacy

Supplies:

  • Rectal diazepam medication kit (Diastat)®
  • Seizure Action Plan/healthcare provider’s order
  • Student’s Individualized Healthcare Plan (IHCP)
  • Parent/Guardian authorization form
  • Seizure Observation Recording form
  • Gloves
  • Lubricant
  • Blanket or pillowcase as barrier
Procedure Download
Skill Competency Download

First aid for a seizure:

  1. If someone is available, have them call for assistance
    • To assist with removing other students/staff from the classroom/area and to assist with obtaining the student’s emergency medicataion
  2. Ease the student onto a flat surface, such as the floor, being sure not to move the student any more than is necessary
  3. Turn the child onto his/her side to allow vomit/phlegm to be expelled rather than inhaled
  4. Place something soft under the child’s head to protect them from injury
  5. Ensure the child’s airway is not obstructed
  6. Loosen tight clothing around the child’s neck
  7. Do not restrict the child’s arms or legs
  8. Ensure there is no furniture or objects close to the child that could injure him/her
  9. Review the student’s Seizure Action Plan/healthcare provider’s order
  10. Gather the emergency medication and needed supplies in case seizure lasts longer than designated time frame

Procedure:                                             

  1. Identify that symptoms of a prolonged seizure are present and that based on the child’s Seizure Action Plan/healthcare provider’s order, medication needs to be given.
  2. 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 a seizure for more than 5 minutes, if student hasn’t responded to rescue medication, etc)
  3. Note the time of seizure onset on the Seizure Observation Recording form
  4. If student is not already in a side lying position, move them to a side lying position, if possible
  5. If possible, wash hands
  6. Assemble supplies and place on a clean surface.
  7. Review the six rights of medication administration to be sure it is:
    1. For the right student
    2. The right medication
    3. The right dose
    4. Being given at the right time
    5. Being given by the right route
    6. Being given for the right reason
  8. Check the medication expiration date
  9. Review the student’s allergy status
  10. Ensure proper documentation of parent/guardian authorization to administer medication
  11. Follow student’s Seizure Action Plan/healthcare provider’s order and ensure the appropriate amount of time has passed prior to administering the student’s seizure medication
  12. Put on gloves, if possible
  13. Review the six rights again to be sure it is:
    • For the right student
    • The right medication
    • The right dose
    • Being given by the right route
    • Being given for the right reason
  14. Make sure the delivery device is in the “Ready” mode
  15. While providing the student with as much privacy as possible, remove clothing from buttocks and drape the buttocks with a blanket, pillow case, or other barrier
  16. Push up on the cap with your thumb and pull to remove the cap from the syringe.
  17. Open the package of lubricant.
  18. Lubricate the tip by inserting it in the lubricating jelly.
  19. Move the student to a side-lying position with the upper leg forward so the rectum is exposed.
  20. Using non-dominant hand, separate the buttocks to expose the rectum.
  21. Using dominant hand, gently insert the syringe into the rectum until the rim is snug against the rectal opening.
  22. Push the plunger in slowly counting to three until the plunger stops.
  23. Hold the syringe in place after inserting the medication and count to three.
  24. Remove the syringe from rectum.
  25. Immediately hold the buttocks together and count to three again.
    • This helps keep the medication from leaking out.
  26. Keep the student on his or her side.
  27. Keep blanket, pillowcase, or other barrier in place to provide privacy for the student.
  28. Note time of medication administration.
  29. If alone and you have not already done so, call 911 or emergency medical services now.
  30. Monitor seizure activity, pulse and respirations.
  31. Keep student in side-lying position unless breathing and/or heartbeat stop.
  32. Instruct someone to bring an AED if available
  33. If breathing stops, begin rescue breaths.
  34. If breathing and heartbeat stop, begin CPR.
  35. Once rescue squad arrives, inform them of medication administered, including type of medication, dose and time.
  36. Remember to dispose of all used equipment and medicine safely out of the reach of children.
  37. Remove gloves and wash hands.
  38. Document the date, time and dose of medication given in addition to what was observed during the seizure.
  39. Follow up with the parent or guardian and healthcare provider, as needed.

References:

Bausch Health US, LLC. (2023). DIASTAT- diazepam gel. Retrieved June 9, 2023, from https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=88e0f275-dd7b-447d-b9d3-316a06da934f&type=display

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 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.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/e20153876

Hoerth, M. & Osborne Shafer, P. (2020, April 17). Rectal rescue medications. Retrieved June 9, 2023, from https://www.epilepsy.com/treatment/seizure-rescue-therapies/rectal-rescue-medicines

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  

Page last reviewed: February 21, 2025
Page last updated: February 21, 2025

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