Considerations:
- Identify symptoms of a severe allergic reaction as indicated on Emergency Action Plan, if possible. These may include:
-
- obstructive swelling of the lips,
- tongue, and/or throat;
- trouble swallowing;
- shortness of breath or wheezing;
- turning blue; drop in blood pressure,
- feeling faint, confused, weak,
- passing out; loss of consciousness;
- chest pain;
- a weak pulse; and/or
- a sense of “impending doom”.
- Given that when a child is having a severe allergic reaction, it can be a stressful situation, it is highly recommended that you familiarize yourself with the student’s severe allergic reaction emergency plan beforehand.
- If your school participates in a stock epinephrine program, be sure to:
- Know your school’s plan and protocol regarding stock epinephrine administration
- Know the storage locations of the stock epinephrine, and
- Have proper training to administer the stock epinephrine
- Your school nurse or other licensed health care professional must review the epinephrine administration procedure with you to ensure that you have the skills to perform this emergency medication administration.
- Store the severe allergic reaction emergency plan and epinephrine auto-injector in a location that is easily accessible during a severe allergic reaction.
- Be sure to check the expiration date on the medication package to ensure that the medication is not expired.
- Also, make sure that the medication is clear and replace the medication if it is discolored.
- As this is an emergency situation, it is important to act quickly while ensuring everyone’s safety.
Supplies:
- AUVI-Q®
- Gloves
- Approved Sharps Container
- Alcohol Pad (if possible)
- Band-Aid (if possible)
- Identify that symptoms of a severe allergic reaction are present and that based on the child’s severe allergic reaction emergency plan, medication needs to be given.
- Call for assistance. Ask that another school staff personnel call 911 or emergency medical services and notify parent. Remove other students from the area, as necessary.
- Gather needed supplies and place on a clean surface near the student.
- Quickly talk to the student and evaluate the situation. Prepare the student.
- Position student, providing as much privacy as possible. The injector can be given through clothing in most circumstances.
- Quickly review the medication administration form, the medical provider or district protocol/plan form, and the parent/guardian consent form, if available, as you review the “5 Rights” of medication administration.
- Check the epinephrine autoinjector and order to be sure it is:
- For the right child
- The right medication
- The right dose, an approximation of the child’s weight may be needed, if using a stock epinephrine auto-injector
- Being given at the right time and
- Being given by the right route.
- Be sure to check the medication to ensure that it is not expired
- Wash your hands, if possible. In a true emergency situation, there may not be time to do this step.
- Put on gloves.
- Quickly review the Five Rights once again while checking the epinephrine auto-injector to be sure that it is:
- For the right child
- The right medication
- The right dose (an approximation of the child’s weight may be needed)
- Being given at the right time and
- Being given by the right route.
- Pull AUVI-Q® up from the outer case.
- Pull red safety guard down and off of AUVI-Q®.
- The red safety guard is made to fit tightly. Pull firmly to remove.
- To reduce the chance of an accidental injection, do not touch the black base of the auto-injector, which is where the needle comes out.
- If an accidental injection happens, get medical help right away.
- Place black end of AUVI-Q® against the middle of the outer thigh, then push firmly until you hear a click and hiss sound, and hold in place for 2 (two) seconds.
- Place the used AUVI-Q® into an appropriate sharps container or hand to emergency medical responders.
- If alone with the student and you have not already called 911 or emergency medical services and notified parents, do so now.
- Monitor student’s pulse and respirations.
- Once the emergency medical responders arrive, inform them of the medication administered, including the type of medication, dose, and the time given.
- If not done already, dispose of the injector in an approved sharps disposal container or give to the emergency medical responders.
- Remove gloves and wash hands.
- Document medication administration in student’s medication administration 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
Campbell, R.L., & Kelso, J.M. (2020). Anaphylaxis: Emergency treatment in a R.M. Walls and A.G. Randolph (Eds.) UpToDate. Retrieved: April 22, 2020.
Campbell, R.L., & Kelso, J.M. (2020). Prescribing epinephrine for anaphylaxis self-treatment In a A.M. Feldweg (Ed.) UpToDate. Retrieved: April 22, 2020.
Food Allergy Research & Education (2015). Food allergy & anaphylaxis emergency care plan. Retrieved May 1, 2020, from http://www.foodallergy.org/file/emergency-care-plan.pdf
Food Allergy Research & Education (2015). Symptoms. Retrieved May 1, 2020, from http://www.foodallergy.org/symptoms
kaleo, Inc. (2020). AUVI-Q® (epinephrine injection, USP) administers epinephrine in 3 steps. Retrieved on April 22, 2020, from https://www.auvi-q.com/hcp/about-auvi-q#administration.
National Association of School Nurses (2015). Get trained: Training tools. Retrieved on May 1, 2020, from https://www.nasn.org/ToolsResources/FoodAllergyandAnaphylaxis/GetTrained/TrainingTools.
Page last updated on: March 15, 2021