School nurse taught epipen incorrectly!

Posted on: Wed, 09/22/2004 - 3:31am
Carefulmom's picture
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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????

Posted on: Wed, 09/22/2004 - 4:38am
pgrubbs's picture
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Joined: 10/27/2003 - 09:00

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

Posted on: Wed, 09/22/2004 - 5:19am
jami's picture
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Joined: 09/02/2004 - 09:00

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.

Posted on: Wed, 09/22/2004 - 7:06am
California Mom's picture
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Joined: 07/14/2000 - 09:00

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

Posted on: Wed, 09/22/2004 - 8:41am
Carefulmom's picture
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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).]

Posted on: Wed, 09/22/2004 - 8:55am
California Mom's picture
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Joined: 07/14/2000 - 09:00

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

Posted on: Wed, 09/22/2004 - 11:14am
Carefulmom's picture
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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

Posted on: Wed, 09/22/2004 - 1:15pm
California Mom's picture
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Joined: 07/14/2000 - 09:00

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

Posted on: Wed, 09/22/2004 - 2:11pm
Carefulmom's picture
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Joined: 01/03/2002 - 09:00

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.

Posted on: Thu, 09/23/2004 - 12:06am
pgrubbs's picture
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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!

Posted on: Thu, 09/23/2004 - 12:16am
MommaBear's picture
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Joined: 09/23/2002 - 09:00

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.

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