School nurse taught epipen incorrectly!

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Hard to believe but it is true. Dd is in 4th grade. When she was due to start kindergarten, I picked three excellent public schools in our area, interviewed the nurses at all three (meaning a ten minute conversation on the phone to see what the nurse knew about food allergy and epipens), and picked the school with the best nurse. The nurse has always been great, but it turned out this year the district moved the nurses all around and we have a different nurse. The previous nurse was only there one day a week, but this one is there 1 1/2 days a week. Even though the previous nurse was only there one day a week, she trained every single school employee on the epi. There were never any battles about who needed to be trained. Dd has a 504, but I never asked to see it because everything was going great, so no need to.

School just started here 13 days ago and two days before school I went up and trained the teacher. There is a written plan that follows my daughter from year to year saying no peanuts in class room, no brownie meetings in class room, I go on field trips, etc. The old teacher had already given the new teacher everything. I didn`t feel any urgency to push for a 504 meeting, although I wanted the epi reviewed with the cafeteria. There are now 7 kids in the school with epis, including my daughter, so it is great that she is not the only one.

This year we also got a new principal. The old one was very vocal about the fact that she did not want any special needs kids in the school, but since the nurse was so pa aware it was really not a problem. As it turns out the new principal this year actually has an epi herself for bee stings and has used it on herself.

So on Monday I had planned to introduce myself to the new nurse---she is there on Mondays and every other Wednesday. As it turned out, late Friday I got a message from the office that there would be an allergy training meeting Monday at noon in my daughter`s room and I was invited. So Monday morning I poke my head in, introduce myself to the nurse, and asked who all would be at the meeting. She said just me, her (nurse) and the teacher (who I had already met with at length and trained). I said the cafeteria needs to be trained and the nurse said they can come if they want (the cafeteria is actually never freee at noon as they are serving lunch to the kids), but she is not "going to force" them to come. I said, if a child is going to have a reaction, the cafeteria is the most likely place for it to happen, they have to be trained, and the old nurse always trained them. Her answer was that the old nurse only had 4 schools, she has 5 (which is irrelevant because this nurse is actually at the school more than the old nurse was). Since when is having a high work load an acceptable reason not to train people that need to be trained? So we go around and around on this. She said she would call her district supervisor and see what the district supervisor says. I show up at noon for the meeting, and it turns out that the nurse during the four hours I was gone trained the whole cafeteria and the aides. We have our meeting which turned out to be all the teachers who have pa kids, me, the nurse, the vice principal, another parent of pa twins. The nurse shows the video, not the FAAN one, but one for the school district. It shows how to use the epi, but does not discuss what symptoms to watch for. Then the nurse demonstrates the epi incorrectly!!!! She must not have been watching the video herself when she showed it. I know it is rude to correct someone in front of a room full of people, but I thought I cannot sit her and let everyone learn it wrong. So I correct her, showed everyone, and basically for the rest of the meeting, all the teachers directed their questions to me instead of the nurse. In the middle of the meeting, it turned out that for the first time ever the cafeteria was passing out trail mix. They had never had trail mix before, only pb and j once a month. On the pb and j day, it is on the menu in advance, dd eats lunch in the classroom with a friend and does not go to after care because of the kids coming in from other classes who have not washed their hands. So the VP goes running out to make sure dd is alive and breathing because she has sat in the caf while 300 kids ate trail mix!!! That was Monday. I wondered if the nurse had shown the epi correctly or incorrectly when she trained the cafeteria staff, but yesterday and today both I was taken aside by school employees who had been at the training for the aides/cafeteria and wanted to know why the video showed it one way and the nurse demonstrated in a different way. Both of these people told me the nurse showed it the same way I had witnessed when I corrected her.

There are several issues here: 1. Most of the school has now been taught the epi wrong. 2. A 504 meeting is more than just showing the epi, someone has to talk about what should be done to avoid a reaction. 3. Cafeteria did not know that if they unexpectedly served peanuts, dd cannot eat in there. I know that the other 2 pa kids in her grade also do not eat in caf when peanuts are served. I was never notified about the trail mix, and would not have known if I had not been up at school for the meeting. Dd would have gone to after care and could have had a reaction. 4. Never was it discussed what symptoms to watch for. The old nurse was very good at going over how to know when to suspect a reaction.

I really don`t know what to do. I could try to meet with the cafeteria staff and our class aide on my own, and show them everything correctly. Or I could talk to the principal who has an epi herself. The VP ia actually the one at the school who is supposed to oversee the 504s and IEPs.

Just don`t know what to do. It is a little awkward to go to the cafeteria on my own, and say, now I am going to retrain you because you were trained wrong. I think that could get a lot of people upset. But if dd has a reaction in the cafeteria, I don`t want her dying because epi was used incorrectly. Aside from that, there are 6 other kids now! Dd is actually old enough to do it herself as long as she is physically able, but what about the two pa first graders! What to do????

On Sep 22, 2004

Wow. First, how did she train them wrong (I'm wondering if I have been showing people incorrectly!) ? I think you can meet with the staff and keep it in the context of your child. Not "you were trained wrong", but "here's how you need to keep my child safe." Just an idea. paula

On Sep 22, 2004

I think you need to ask the vice principal about the best way to handle it- so that you are not going behind any backs.

I'm sure that the rest of the school personal would be happy to talk to you and would listen to you, but it would get back to the nurse- and unfortunetly you need her to be on your side.

I would also want something documented about the situation, and stating how you correcteted situation. By using the vice prinicipal you will be following the chain of command.

Also, the vp may need documtation about the nurse- this coud be just the first of many situations that the nurse is wrong- and whoever she reports to needs to be aware.

On Sep 22, 2004

Ugh! What a nightmare!!!

I think you have to go to the VP or the principal - whomever you think would be better - ASAP.

I would emphasize how happy you have always been at your dd's school and with the old nurse. (Let them know that you are not someone who easily finds fault, if you know what I mean.)

Find out what the VP or principal thinks should be done.

By all means write out your concerns and everything that went wrong, step by step. I am not sure who to turn that in to, at this point, but I definitely think there should be a record of this.

For goodness sakes: she was an idiot to tell you that she couldn't train the cafeteria because she has too many schools. [img]http://uumor.pair.com/nutalle2/peanutallergy/eek.gif[/img]

I, too, am curious how she explained using the epi. It seems that it must have been pretty bad if other people also noticed that it was different from the video. [img]http://uumor.pair.com/nutalle2/peanutallergy/eek.gif[/img]

Do you think there is any chance that the cafeteria could stop serving trail mix? It seems odd that they have added it this year when (it sounds like) there are more pa kids there than ever.

As for the 504 plan: are you happy with what is in it? It should be tailored specifically to your dd's needs. Everything should be spelled out: including who will be epi trained, who will train them. what procedures will take place if peanuts are served in the cafeteria, etc.

I'm so sorry you are dealing with this. [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img]

Good luck! Keep us posted!!!

Miriam

On Sep 22, 2004

Hi, I am at work and only came for a minute to read everyone`s responses, but people are asking how she did it wrong, so I`ll address that. I also called Dey pharmaceuticals this morning to confirm whether this other method is just a different method that works or whether it is unacceptable. I would much rather not make waves if it were not for the fact that I don`t want dd or another child dying if it is done wrong. Dey said (and I spoke with an actual pharmacist) that this method is incorrect and can cause the epipen to jam and malfunction. Here is what the nurse said: put the epi on the thigh, then leaving the epi on the thigh pull off the grey safety cap, then push until you hear the click, etc. The thing that was wrong is that you are supposed to pull of the grey safety cap before you put it on the thigh. And actually one of the people who came up to me at school who is an aide said that new nurse is just terrible, isn`t she? So I had already had the disagreement about whether to train the cafeteria, and I said I think so too, but I thought I was the only one who thought so, what makes you think she isn`t any good. So the aide said because she trained us on the epi different from the video. So it must have been really obvious. I definitely have to do something. About the trail mix, I don`t think they are going to serve it again. It was a mistake. The head of the caf ordered "fruit". Because it had raisins in it, whoever sends the lunches considered "trail mix" to be a type of fruit. I found this out from the VP. The problem is not having had a 504 meeting, the cafeteria knew not to serve it at the peanut free table, but they forgot that dd could not be in there. Not their fault that they forgot, the last 504 meeting was Sept. 2003. That is why there needs to be a meeting to discuss precautions, not just a meeting to train how to use epi.

About the 504, I have actually never seen it. I knew in the past that every employee was trained, so I never had a need to see it. I think I need to get a copy of it. In the past, everything went as it should, peanuts only served once a month, dd eating in the class room on those days with a friend. It never crossed my mind that a nurse could train the epi incorrectly, especially when all she had to do was watch the video along with everyone else in order to see how to do it.

A friend of mine who has a child with seizures who has an IEP heard about this (her child is at a different school). She thinks I should write a letter to the VP, go in with the letter and give a little summary, that the epi was taught incorrectly, and that we need a meeting to review my daughter`s 504. I`m just not sure how to tactfully address that it was taught incorrectly.

[This message has been edited by Carefulmom (edited September 22, 2004).]

On Sep 22, 2004

Carefulmom, my advice is not to worry too much about being tactful about explaining your concerns re: the nurse demonstrating the epipen incorrectly.

You are absolutely correct that she is putting children in danger with her ignorance.

I agree that you need to have a copy of your dd's 504 plan. I have always had to review the 504 plan and sign it.

I know what you mean, though, since things have (fortunately) been going so well you haven't had any need to question how things have been being done.

I actually think this puts you in a very good position because you are a long time parent who has never made any "waves".

I'm glad to hear that the trail mix was a mistake. Hopefully they won't send it again.

Good luck and keep us posted,

Miriam

On Sep 22, 2004

Thanks California Mom and everyone else. I have written a letter to the VP who is the 504 cooridinator, and plan to cc the principal. I would really like people`s opinions before I hand it in. Most people on these boards are more tactful than I am. Here it is:

Dear Mr. _______,

Since you are the 504 coordinator at the school, I am writing to request a meeting to review my daughter`s 504. I am requesting that the cafeteria staff and lunchroom aides be present at the meeting as well as anyone else who wants to attend. My concerns are the following:

1. In the past I have always been present when the cafeteria staff and lunchroom aides were trained on the Epipen. I made a point of introducing myself to the school nurse last Monday morning and asked that the cafeteria staff be at the Epipen training meeting. The nurse told me that the cafeteria staff would not be trained. When I came at noon for the training with the teachers, I found out that the cafeteria had been trained earlier that morning. However, the school nurse trained them incorrectly in the use of the Epipen, and also trained the aides incorrectly. I know this because I have been stopped by several people who work at the school and know I am a parent of a food allergic child, who have asked me why the video showed the Epipen procedure one way and the school nurse demonstrated it another way. I know this is true, because as you probably remember, at the meeting with the teachers she also demonstrated it incorrectly until I corrected her. To be sure, I called Dey Pharmaceuticals, the manufacturer of the Epipen, and asked if there are two correct ways to do it, or is one way correct and the other way is incorrect. I was told by the pharmacist at Dey that they way the nurse demonstrated it was incorrect, can cause the auto-injector to jam, and malfunction. In that situation the child in anaphylaxis would not receive the medication. In addition, I have been told that at the meeting with the cafeteria staff and aides, no information was given as to how to even know if a child is having a reaction. In any case, usually at the meeting with the cafeteria staff, I am present and we discuss what steps need to be taken to avoid a reaction, such as if unexpected peanut products arrive which were not on the menu. This needs to be reviewed with the cafeteria staff. 2. For the first time in my daughter`s four years at the school, when she is in after-care and they are in the cafeteria, the cafeteria tables have crumbs. This has never been a problem during kindergarten, first grade, second grade, or third grade, but for some reason this year the tables are not clean either inside or outside the cafeteria. There is nowhere for my daughter to sit when her group at after-care is in

On Sep 22, 2004

Carefulmom, I think you worded it very well and were quite tactful.

I do think that you can request that the table situation gets taken care of ASAP. That should not have to wait for a 504 meeting.

Good luck, I like your letter.

[img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img] Miriam

On Sep 22, 2004

Thanks, California Mom. That is really helpful. It is hard to know just how direct to be, but it should help that the principal has an epi. I`m sure she must already know how serious anaphylaxis is, even if the VP doesn`t.

On Sep 23, 2004

Good letter. I can't believe the epi-pen instructions from the nurse. I'm not sure even how she could get it that wrong! Crazy!

On Sep 23, 2004

Wonder if the original policy (if one was used) came from sources who were [i]qualified[/i] to develop them? If so, what sources did they reference. You know, that "Chain of Command" type of thing.

That whole, What would another similiarly trained, experienced, prepared, and licensed individual have done?

Cooks and Dinner, so to speak.

General Disclaimer: I am not offering advice in any manner or form.

On Sep 23, 2004

I just want to tell you that there might be a good reason that the school nurse trained everyone to administer the Epipen in the way she did -- it is the method now currently recommended by my allergist's office (the more senior of the allergists is always ranked in the to 10 allergists nationally). It is also the method our school nurse uses and teaches.

The reason for this is that too many times people have gone to administer the Epipen and held it in the wrong direction, injecting the epinephrine into their hand instead of into the patient. There have been deaths as a result of this. (Because a second epipen wasn't immediately available).

Think about it. Let's assume you're *not* a medical professional or terribly familiar with how Epipens work. Wouldn't you naturally assume that the grey cap actually protects the needle part of the epipen, so once you remove the grey cap, that's the part that should be held against the patient's thigh?

By holding the Epipen against the leg, then removing the grey cap, you guarantee that the correct end is against the patient's leg.

This doesn't negate the fact that the Dey representative says that the Epipen could jam. But I just want to say that the school nurse referred to in the original post may not be quite as stupid in this regard as everyone seems to be implying.

--Debbie

On Sep 23, 2004

Quote:

Originally posted by DRobbins: [b]I just want to tell you that there might be a good reason that the school nurse trained everyone to administer the Epipen in the way she did -- it is the method now currently recommended by my allergist's office (the more senior of the allergists is always ranked in the to 10 allergists nationally). It is also the method our school nurse uses and teaches.

The reason for this is that too many times people have gone to administer the Epipen and held it in the wrong direction, injecting the epinephrine into their hand instead of into the patient. There have been deaths as a result of this. (Because a second epipen wasn't immediately available).

Think about it. Let's assume you're *not* a medical professional or terribly familiar with how Epipens work. Wouldn't you naturally assume that the grey cap actually protects the needle part of the epipen, so once you remove the grey cap, that's the part that should be held against the patient's thigh?

By holding the Epipen against the leg, then removing the grey cap, you guarantee that the correct end is against the patient's leg.

This doesn't negate the fact that the Dey representative says that the Epipen could jam. But I just want to say that the school nurse referred to in the original post may not be quite as stupid in this regard as everyone seems to be implying.

--Debbie[/b]

Whoooooooooooooooooa. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

[This message has been edited by MommaBear (edited September 23, 2004).]

On Sep 23, 2004

Debbie,

do you think there might be an indication for a redesign in Dey products? Don't know myself.

On Sep 23, 2004

Well, that is an interesting point. I never really thought about that. I do have to say, though, that I have used the epi, and the instructions are right on it! If someone bothers to read it, they would see that the end that is going to have a needle come out is the end with the black tip. Momma Bear, I have watched the old nurse train people and she never trained it this way. And the video showing it the other way (pull of gray safety cap, then put it on the thigh) was put out by the school district. I do think that is a good point that maybe the nurse had a reason to teach it that way. But the fact that someone may not take ten seconds to read the instructions on it in the moment doesn`t seem to justify having them do it in a way that may cause it to jam and malfunction. Plus when I corrected her in the meeting, she did not say "oh, we are doing it a new way because of staff not knowing which end had the needle". And at the beginning she actually told people to inject it below the knee, but she immediately corrected herself. So that also makes me think she truly does not know how to do it.

On Sep 23, 2004

Quote:

Originally posted by MommaBear: [b]Debbie,

do you think there might be an indication for a redesign in Dey products? Don't know myself.[/b]

If we were talking about a brand new product that was being evaluated for user-friendliness, then I'd say "yes". But since Epipens have been out there and so many people expect the grey arming cap to be on the opposite side from the needle, I'd have to say no, there shouldn't be a redesign that changes the way the Epipen is used. A redisign to prevent jamming if the pen is used the way that nurse was training people might be useful, though.

--Debbie

On Sep 23, 2004

Quote:

Originally posted by Carefulmom: [b]Well, that is an interesting point. I never really thought about that. I do have to say, though, that I have used the epi, and the instructions are right on it! If someone bothers to read it, they would see that the end that is going to have a needle come out is the end with the black tip.[/b]

Absolutely. But in an emergency, people without a lot of training can make mistakes even with the written instructions right in front of them. (Don't get me wrong -- I agree with you that the school nurse in question sounds like an idiot for more than one reason [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img] )

In the case that my allergist told me about, it was a married couple involved. The husband was allergic to nuts, and had an anaphylactic reaction. The wife got the epipen, pulled off the cap, turned the epipen around thinking that she was placing the needle toward her husband's thigh, and pressed. Since she had the epipen backward, the epinephrine was injected into her hand. They didn't have another epipen available, and her husband didn't make it. [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img]

I think this was a case of someone being well trained enough to recognize the situation and know that she needed to use the Epipen, but she wasn't familiar enough with it to do it correctly in an emergency situation. She did so much correctly -- she recognized anaphylaxis, got the Epipen, removed the Epipen from its container, removed the grey arming cap, applied it to her husband's thigh... She just had the Epipen rotated 180 degrees.

So, so sad.

--Debbie

On Sep 23, 2004

Well I agree that is a very sad story, but what it really drives home is that a person should have more than one epi. Dd has four at school, although it is a big school and very spread out. All four are in different places. By the way, do most people have the epi in school locked up or not? Maybe I`ll start a thread on that.

On Sep 23, 2004

Quote:

Originally posted by DRobbins: [b] If we were talking about a brand new product that was being evaluated for user-friendliness, then I'd say "yes". But since Epipens have been out there and so many people expect the grey arming cap to be on the opposite side from the needle, I'd have to say no, there shouldn't be a redesign that changes the way the Epipen is used. A redisign to prevent jamming if the pen is used the way that nurse was training people might be useful, though.

--Debbie[/b]

Hmmmmmmmmmmmmm. Don't know if I agree with that. There are many reasons items are redesigned (could you elaborate on the "userfriendliness"), but healthcare products are rapidly, if not periodically undergo [i]quality improvement[/i] and considering the new number of people diagnoses with conditions on a daily basis, I don't see the efficacy in halting [i]quality improvement[/i] for the reasons you describe, [i]if a better product[/i] were possible.

I mean, I am constantly exposed to product/equipment/procedural [i]quality improvement[/i] and adapt. I have to, for the benefit of those a product is intended for.

The epi-pen can be a lifesaving tool, but *personally*? I'm not ready to say it is beyond improving upon. I mean, in light of some of the advances in healthcare I have personally seen.

Has which end is the "business" end has been an issue in the past, and has it possibly cost someone their life? Would this indicates a need for improvement or at least a careful re-evaluation?

[b]I mean, *should there be any doubt* which end is the "business" end?[/b] Should there be a need to place an inordinate amount of attention in training on this issue? Or should the product be more *obvious* in this regard? Among other concerns persons have voiced?

General Disclaimer: I am not offering advice in any manner or form. Just asking questions and relaying my own personal highly individual and unique situation.

On Sep 23, 2004

How many people have "Ana-Kits"?

On Sep 25, 2004

Just wanted to update everyone on what happened with the letter. I went in yesterday with the letter that I posted here a few days ago. I wrote it to the VP since he is the 504 coordinator, and cc-ed the principal. Well when I went into the office, the principal walked in while I was standing there. I asked if she had a minute. She said she had literally a minute; she had somewhere to be. So I said I had written the VP a letter and made a copy and I figured she would want to know about this. She seemed pretty receptive, and then said she knew that I had said that the way the nurse trained everyone was incorrect, but that she was trained the same way the nurse showed it, and she had used it on herself and it worked. So I said that I had called Dey, the maker of Epipen, and they said that way is incorrect and that it can malfunction. She said she would look into it----that she knows how serious a situation it is, and then she said "I know what it`s like to be choking and gasping for breath and it isn`t fun". So even though she sort of defended the way the nurse did it, she did seem very concerned. I really think that someone who has experienced anaphylaxis is going to do whatever is necessary to keep her 7 students with epipens from having to go through that. I definitely think she gets it. Then I went to the VP and gave him the letter. He was very friendly but said that the cafeteria knows what to do if peanuts showed up unexpectedly, and said there are no crumbs in the cafeteria, that the table is cleaned every day. I said that I was surprised to hear that the tables are cleaned every day after lunch because when I get there at 3:00 I have seen the crumbs. So we went over to the caf (this was at 8:00 right after breakfast) and they were cleaning the tables. That did not really prove anything, since dd says the tables are clean during the school day, it is after the school day when she is in after care that they are dirty (as soon as she gets to after care, so it is not like the kids in after care have gotten them dirty). He said dd should speak up and ask that the tables be cleaned. That made no sense, because the after care rents the cafeteria space from the school, it is not the after care`s job to clean up the mess that is there when they arrive at the cafeteria when school gets out. Besides, by this point, the cleaning supplies are in the part of the caf that is locked up, so the person at after care would have to leave all the kids unattended in the caf, and walk across the entire school to get cleaning supplies at the other end.

Well, anyhow, I figure with the principal having an epi herself, hopefully this will somehow all get taken care of. I don`t think she is going to stand for crumbs on the tables when dd and other food allergic kids are in the caf after school. As far as the technique on the epi, I still think since Dey said don`t do it that way, I don`t want them learning it that way for my child. I have no say on how they do it if one of the other 6 kids has a reaction, but I don`t want them doing it that way on mine. I think I`ll wait about a week, and if I don`t hear anything, I`ll have to go back and talk to the VP and schedule a meeting for me to re-train everyone.

Just wondering if everyone thinks this is a good solution, or does anyone have any other suggestions?

On Sep 25, 2004

Oh boy; I'm sorry to hear that things haven't exactly turned out the way you had hoped they would, so far.

I totally agree with you: if Dey says the way the nurse did it was wrong then it shouldn't be taught that way to school personnel. Plain and simple, period. IMHO.

It sounds like the VP doesn't want to admit that the tables are dirty. It's too bad, because that is such an easy thing to fix.

I resent the idea that he thinks your dd should "speak up" when the table is dirty. This should not be her responsibility. An adult in charge should be taking care of that. That is part of your daughter being able to safely attend school.

Did they say anything about getting you a copy of the 504 plan?

I think you are correct to re-visit the epi-pen training issue if you don't hear back within the week.

Good luck!

hugs}}} Miriam

On Sep 25, 2004

Quote:

Originally posted by MommaBear: [b]How many people have "Ana-Kits"?[/b]

MB, I thought I read somewhere a while back that these kits were being phased out. I could be wrong though.

On Sep 25, 2004

I just read today that ANA kits have been discontinued. California Mom, I just figure that I am going to ask for a 504 meeting with the cafeteria staff and lunchroom aides. They had better say yes. I think they have to, right? I am going to retrain them. Since my method is the same as the method in the video, I don`t see how they can object. It is not like I am going to teach some method that no one has ever seen. About getting a copy of the 504, after we got into the whole thing about the tables and my dd should be "empowered" to ask the after care people to clean the tables (which is not going to happen because the after care person would have to leave 20 kids unattended in the caf and walk across the entire school to get cleaning supplies because the part of the caf that has cleaning supplies is locked up after school), anyhow I did not ask for a copy of the 504, but it is in the letter. Since my letter said I would like to aim to have a meeting within 2 or 3 weeks, I guess I`ll wait 2 weeks and then ask the VP. If he says no, I am going to call the old nurse (I have her home phone and see what she thinks I should do). I am just hoping that when the principal "looks into it" that she will decide to go ahead with a meeting with me retraining everyone, or the nurse retraining everyone with me present. I hope they don`t go ahead and do it and tell me after the fact. If so, I guess I`ll have to ask for a third meeting, because I cannot trust that the nurse trains correctly unless I see it for myself.

On Sep 25, 2004

Quote:

Originally posted by e-mom: [b] MB, I thought I read somewhere a while back that these kits were being phased out. I could be wrong though. [/b]

say it isn't so. [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img]

On Sep 26, 2004

Dd had a friend sleep over last night. It turns out that the mom when she came to pick up her daughter today is now working at the school as a paid aide. She was at the epipen meeting with the nurse, the aides, and the cafeteria staff. This mom has had dd spend the night several times, and is great with the epi, so I know I can really believe what she says. Turns out at this meeting when the principal asked where the epis were, the nurse said in the office, and the principal said where in the office (which is great that she really wanted the exact location), and the nurse said where the epis are, but no one said that the epis are locked!! I know they are locked, and I said to this mom, did the nurse tell everyone where the keys are, and the mom said the nurse never even said they are locked----I just about fell over. In addition, the nurse said none of the kids have an epi in the caf. I think mine is the only one with an epi in the caf, but the nurse said none of them do! So what good is it to have an epi in the caf, if dd has a reaction in the caf no one knows it`s there and someone will waste precious time going to the office to get her epi. This is absolutely infuriating---had I been at this meeting, I could have cleared all this up.

On Sep 27, 2004

Just got a call from the school nurse. They are retraining the cafeteria staff on Wednesday, and I am invited. So I guess the letter must have done some good! I`ll bet the prinipal said to retrain, thank goodness! Hopefully the aides will be there then to retrain also.

On Sep 29, 2004

Just wanted to let everyone know that they retrained the cafeteria staff and lunchroom aides today in my presence, and the meeting went really well!! I could not believe that it was the same nurse, because she was so well prepared. She brought two handouts, one on the symptoms of anaphylaxis, and one with diagrams on how to use the epi (correctly). People had lots of questions related to my daughter which the nurse could not have known the answer to, so hopefully she got the fact that I should have been there the first time. The crumbs in the cafeteria were addressed, and I think it is going to get taken care of. They asked me to bring wipes, and when dd comes to the caf for aftercare, they are going to wipe down one table and bench for her and a friend. At least she will have somewhere to sit. They are still trying to figure out why the tables all have crumbs. So I thought the letter really helped. It sure pays to put everything in writing. I did not yet get a copy of the 504; if I don`t have it by next week, I`ll ask again.

On Sep 30, 2004

Carefulmom,

Great job handling this! It shows how even when things are going seemingly fine, that we need to check up to make sure everyone is on the same page.

Prevention of a reaction and speedy treatment if a reaction does occur will keep our kids safe. And, our confidence in our children's safety when out of our care, will help both us and them to grow.

You should be proud of your accomplishments [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img] , Naturemom

On Sep 30, 2004

Question for DRobbins...or anyone else in Massachusetts...my son's IHP says the school nurse is to train everyone to use EpiPens according to the Department of Public Health Regulations. Do you know if the new method is the method that the DPH uses? I was advised by a 504 expert that that is the wording I should use. I never thought to check out what exactly the regulations are. Does anyone know?

I checked out the AnaKit a while ago. You have to precisely measure a dose according to the child's weight. I thought that was more complicated than an EpiPen because kids are always growing. I didn't like the AnaKit.

Does anyone remember when we were coming up with songs and rhymes to help people remember how to administer an EpiPen? I'll have to do some searching for that thread. I think it would be helpful.

Also, I think it is just as important to recognize the symptoms of anaphylaxis as it is to know how to use an EpiPen. Remember when Nathan had his reaction, the teachers and chaparones thought he was having an asthma attack and only gave him an inhaler. My school nurse requires the Emergency Health Care Plan that is put out by FAAN becuase it lists the symptoms on it. Maybe you should look into that.

On Sep 30, 2004

My posts are acting really funny.

[This message has been edited by Heather2 (edited September 30, 2004).]

On Sep 30, 2004

I think my username blew up again. I'm trying Heather3 now.

I went on the Massachusetts Department of Public Health website and read the regulations. There isn't anything specific about "proper use of an auto injector" so I may have to investigate further. However, I thought I would post the link in case you feel like reading the document. Perhaps your Department of Public Health has similar regulations that you can call upon with your school. Good luck.

[url="http://www.mass.gov/dph/regs/reg105cmr210.doc"]http://www.mass.gov/dph/regs/reg105cmr210.doc[/url]

On Sep 30, 2004

Heather 2, go to [url="http://www.epipen.com."]www.epipen.com.[/url] I think there is something on there about how to use.

On Sep 14, 2006

I know this is an old thread but I have a question.

At the allergist's office yesterday I spoke w/the nurse about EpiPen training for the school. I told her I was curious in how the school staff was trained to use the Epi since I read this thread a few days ago. Anyway I asked her to show me how they teach people to use the epi and she showed me to do it the way the school nurse in this thread taught people! Put it on the thigh, remove the grey cap and push. I told her what I learned in this thread and she said their DEY rep tells them both ways are correct and they're actually leaning towards recommending to everyone to do it this way (as posted above).

So, what is right??

On Sep 15, 2006

[url="http://www.epipen.com/howtouse_low.aspx"]http://www.epipen.com/howtouse_low.aspx[/url]

The website says to remove grey cap, swing and jab into the thigh, listen for clicking hold 10 seconds.

This is how I would administer and this is how my doctor and school nurse have gone about it.

On Sep 15, 2006

I read somewhere (probably on this message board) that one of the most common errors in administering the epipen is thinking that the needle is under the grey cap. People end up sticking themselves.

Putting the black tip against the leg before taking off the grey cap eliminates this error.

On Sep 15, 2006

The instructions are right on the pen clearly saying to take off the gray cap first. I always emphasize to the teachers that if they panic in the moment, they can just look at the pen and the instructions are right on there. It is pretty clear on the pen. I vote for doing it the way the pen says to do it.

On Sep 15, 2006

California DOE also instructs to pll grey cap first: [url="http://www.cde.ca.gov/ls/he/hn/epiadmin.asp"]http://www.cde.ca.gov/ls/he/hn/epiadmin.asp[/url]

On Sep 15, 2006

I called DEY this morning to ask them about this. Here is what they said:

Placing the epipen against the thigh and then removing the cap and pressing down is the OLD way of administering epipen. It is ok to do it this way, and should not cause the epipen to jam or malfunction. Some nurses may prefer this method when administering epipen to a squirmy child.

The reason they changed to the current, recommended method (remove grey cap, swing and jab epipen into thigh) is because some people were not pressing the epipen hard enough against the thigh to activate it. Swinging the epipen into the thigh ensures that there will be enough force to activate the spring mechanism.

I highly recommend using expired epis on an orange to get a feel for how hard you need to press. To me it feels like you have to press the trainer much harder than the real thing.

Cathy

------------------ Mom to 7 yr old PA/TNA daughter and 3 1/2 yr old son who is allergic to eggs.

On Sep 15, 2006

Quote:

Originally posted by Momcat: [b]I highly recommend using expired epis on an orange to get a feel for how hard you need to press. To me it feels like you have to press the trainer much harder than the real thing. [/b]

That's been my observation, too.

--Debbie

On Sep 15, 2006

I'm going to ask the school nurse which method she taught and then go from there. I've saved that link, thank you!

------------------ Tracy

On Sep 19, 2006

Our school follows the Faan Food Allergy Action Plans. I just went there looking for the link and I see that they have updated it and it gives choices for the doctor to check EPI or Antihistimine depending on the symptom. The second page is directions for using Epi pen as well as Twinject. They say pull off gray cap, hold black tip near outer thigh, swing and jabuntil auto injector mechanism functions. hold in place and count to 10. remove the epi pen unit and massage in injection area for 10 seconds. [url="http://www.foodallergy.org/school.html"]http://www.foodallergy.org/school.html[/url] click on Food Allergy Action Plan and the sample plan will be there. it is PDF 2 pages.

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