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:

  • Sometimes children with seizure disorders can have prolonged seizures. Longer seizures may contribute to complications.  Depending on the student’s seizure emergency plan, medication for prolonged seizures may be needed
  • 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
  • Store the seizure emergency plan in a location that is easily accessible during a seizure
  • 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
  • Be sure to check expiration date on the medication package
  • Remember to keep health care information confidential

Supplies:

  • Rectal diazepam medication kit (Diastat)®
  • Gloves
  • Lubricant
  • Blanket or pillowcase as barrier
This video was developed in partnership with the Wisconsin Department of Public Instruction
Procedure Download
Skills Competency Download

First aid for a seizure:

  1. Call for assistance if someone else is present
  2. Place the child on a flat surface such as the floor being sure not to move the child 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 child’s emergency care plan
  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 emergency plan, medication needs to be given.
  2. Note time of seizure onset.
  3. Call for assistance, if you have not already done so.
  4. Assemble supplies and place on a clean surface.
  5. Check the medication kit and the medical order to be sure it is
    1. For the right child
    2. The right medication
    3. The right dose
    4. Being given at the right time and
    5. Being given by the right route.
    6. Also check to ensure the medication has not expired.
  6. Follow the student’s health care plan and ensure the appropriate amount of time has passed prior to administering the student’s seizure medication.
  7. Ask that another school staff person call 911 or emergency medical services, and notify parent.
  8. Wash your hands if possible.
  9. Put on gloves.
  10. Recheck the medication kit and medical order to be sure it is
    1. For the right child
    2. The right medication
    3. The right dose
    4. Being given at the right time and
    5. Being given by the right route.
  11. Make sure the delivery device is in the “Ready” mode.
  12. While providing the student with as much privacy as possible, remove clothing from buttocks and drape the buttocks with a blanket, pillowcase or other barrier.
  13. Push up on the cap with your thumb and pull to remove the cap from the syringe.
  14. Open the package of lubricant.
  15. Lubricate the tip by inserting it in the lubricating jelly.
  16. Move the student to a side-lying position with the upper leg forward so the rectum is exposed.
  17. Using non-dominant hand, separate the buttocks to expose the rectum.
  18. Using dominant hand, gently insert the syringe into the rectum until the rim is snug against the rectal opening.
  19. Push the plunger in slowly counting to three until the plunger stops.
  20. Hold the syringe in place after inserting the medication and count to three.
  21. Remove the syringe from rectum.
  22. Immediately hold the buttocks together and count to three again.
    • This helps keep the medication from leaking out.
  23. Keep the student on his or her side.
  24. Keep blanket, pillowcase, or other barrier in place to provide privacy for the student.
  25. Note time of medication administration.
  26. If alone and you have not already done so, call 911 or emergency medical services now.
  27. Monitor seizure activity, pulse and respirations.
  28. Keep student in side-lying position unless breathing and/or heartbeat stop.
  29. If breathing stops, begin rescue breaths.
  30. If breathing and heartbeat stop, begin CPR.
  31. Once rescue squad arrives, inform them of medication administered, including type of medication, dose and time.
  32. Remember to dispose of all used equipment and medicine safely out of the reach of children.
  33. Remove gloves and wash hands.
  34. Document the date, time and dose of medication given in addition to what was observed during the seizure.
  35. Follow up with the parent or guardian and healthcare provider, as needed.

References:

Bausch Health Companies Inc. (2020). Administration and disposal instructions. Retrieved May 1, 2020, from http://www.diastat.com/Portals/_default/Skins/diastat/pdfs/Diastat%20Administration%20Instructions%202020.pdf.

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

Hartman, A.L., Devore, C.D.L, American Academy of Pediatrics and the Section on Neurology, et al. (2016). Rescue medicine for epilepsy in education settings. Pediatrics, 137(1):e20153876. Retrieved April 8, 2020, from https://pediatrics.aappublications.org/content/137/1/e20153876.

Lagae, L. (2011). Clinical practice: The treatment of acute convulsive seizures in children. Eur J Pediatr, Apr;170(4):413-8. doi: 10.1007/s00431-011-1403-z. Epub 2011 Feb 8.

National Association of School Nurses. (2018). School nursing evidence-based clinical practice guideline: Students with seizures and epilepsy. Retrieved April 8, 2020, from https://www.pathlms.com/nasn/courses/8992

Wilfong, A. (2020). Seizures and epilepsy in children: Refractory seizures and prognosis. In a D.R. Nordli, Jr. (Ed.), UpToDate. Retrieved April 8, 2020.

Wilfong, A. (2020). Management of convulsive status epilepticus in children. In a D.R. Nordli, Jr. (Ed.), UpToDate. Retrieved April 8, 2020.

Acknowledgment of Initial Reviewers:

The procedure list and video for this procedure were developed in collaboration with the Wisconsin Department of Public Instruction.

Freddi Adelson, MS, RN
School Nurse Consultant
Wisconsin Department of Public Instruction

Bette Carr, MSN, RN, NCSN
School Health Associates
Co-Owner/Consultant

Page last reviewed: October 5, 2021
Page last updated: October 5, 2021

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