EpiPen Administration

<< RESPIRATORY

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:

  • EpiPen®
  • Gloves
  • Approved Sharps Container
  • Alcohol Pad (if possible)
  • Band-Aid (if possible)

 procedure download skill competency

This video was developed in partnership with the Wisconsin Department of Public Instruction
  1. 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.
  2. 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.
  3. Gather needed supplies and place on a clean surface near the student.
  4. Quickly talk to the student and evaluate the situation. Prepare the student.
  5. Position student, providing as much privacy as possible. The injector can be given through clothing in most circumstances.
  6. 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.   
  7. Check the epinephrine autoinjector and order to be sure it is:
    1. For the right child
    2. The right medication
    3. The right dose, an approximation of the child’s weight may be needed, if using a stock epinephrine auto-injector
    4. Being given at the right time and
    5. Being given by the right route.
  8. Be sure to check the medication to ensure that it is not expired
  9. Wash your hands, if possible. In a true emergency situation, there may not be time to do this step.
  10. Put on gloves.
  11. Quickly review the Five Rights once again while checking the epinephrine auto-injector to be sure that it is:
    1. For the right child
    2. The right medication
    3. The right dose (an approximation of the child’s weight may be needed)
    4. Being given at the right time and
    5. Being given by the right route.
  12. Remove the EpiPen® auto-injector from the container.
  13. Remove the blue safety guard from the pen.
  14. Firmly press the orange tip against the student’s mid-outer thigh until click is felt, and then hold for 3 (three) seconds.
    • The pen can be given through clothing in most circumstances.
  15. Remove and massage the area for 10 seconds.
  16. Replace the pen back into its container and place it into an appropriate sharps container or hand to emergency medical responders.
  17. If alone with the student and you have not already called 911 or emergency medical services and notified parents, do so now.
  18. Monitor student’s pulse and respirations.
  19. Once the emergency medical responders arrive, inform them of the medication administered, including the type of medication, dose, and the time given.
  20. If not done already, dispose of the injector in an approved sharps disposal container or give to the emergency medical responders.
  21. Remove gloves and wash hands.
  22. Document medication administration in student’s medication administration log.
  23. 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.

EpiPen® EpiPen Jr® (2016). How to Use Your EpiPen® (epinephrine injection) Auto Injector. Retrieved April 22, 2020, fromhttps://www.epipen.com/about-epipen/how-to-use-epipen

Food Allergy Research & Education (2015). Food allergy & anaphylaxis emergency care plan. Retrieved April 22, 2020, from http://www.foodallergy.org/file/emergency-care-plan.pdf

Food Allergy Research & Education (2015). Symptoms. Retrieved April 22, 2020, from http://www.foodallergy.org/symptoms

National Association of School Nurses (2015). Get Trained: Training Tools. Retrieved May 1, 2020, from https://www.nasn.org/ToolsResources/FoodAllergyandAnaphylaxis/GetTrained/TrainingTools

Page last updated on: March 15, 2021