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New Epinephrine Auto-Injector Rules

Posted on 12/09/2015 at 12:00 AM by MaryAnn Strawhacker

School Nurses:

While we wait for the Department of Education to interpret the new rules, below are the provisions of the law that will likely be of the most interest. I have placed my comments in italics and have cited the location of the passage in the attached Rules 2311C.pdf  for your reference.

  1. Schools may stock an epinephrine auto-injector. I added the emphasis on may because this means that districts have a choice as to whether or not they choose to participate.
  2. "This rule shall not be construed to require school districts or accredited nonpublic schools to maintain a stock of epinephrine auto-injectors. An election not to maintain such a stock shall not be considered to be negligence." Chapter 14.3(10) This part of the law is to support and hold blameless districts who choose not to participate.
  3. Districts must obtain a prescription for the auto injector from a licensed health care professional annually.  Chapter14.4 (3)
  4. The injector must be kept in a "secure , dark, temperature-controlled location (59-86 degrees) in each school building."  Chapter14.4 (3)
  5. If your district chooses to participate, you must stock a minimum of one pediatric and one adult dose for each building. Chapter14.4 (3) You may obtain a prescription for more that one dose and may supply other buildings.
  6. "A school nurse or personnel trained and authorized may provide or administer..." How will you train, supervise, supply, replace... your stock supply? These questions require a district level discussion, resulting in a policy to govern.
  7. Liability is waived "...provided they have acted reasonably and in good faith". Chapter 14.3(4)
  8. "...authorized personnel will submit a signed statement to the school nurse stating that the authorized personnel agree to perform the service of administering a stock epinephrine auto-injector to a student or individual who may be experiencing an anaphylactic reaction." It would appear that consent in writing must be obtained from the unlicensed staff member participating. This would also mean that they can refuse.
  9. The school must call 911 after the injector is administered. Chapter 14.3(4)
  10. Training for unlicensed staff is addressed in 14.3(5).
  11. Authorized school personnel OR the school nurse directly involved in a medication error or incident with stock epinephrine auto-injector shall be required to follow the incident protocol adopted by administration. Chapter 14.3(5) This implies that your district will write such a protocol, if one is not already in place.
  12. The school must "designate an employee to routinely check the auto-injectors throughout the school year and document in a log monthly throughout the calendar year for (1) The expiration date; (2) Any visualized particles; or (3)Color change." Chapter 14.3(6)
  13. The district must "develop a protocol to replace as soon as reasonably possible" and injector that is used or must be replaced. Chapter 14.3(6)
  14. Once a district uses a dose or commits an error with stock epinephrine, this must be reported to the Department of Education within 48 hours. Chapter 14.3(8). This means that the Department of Education needs to develop and approve a format.

As you can read, to be in compliance, a district must find a licensed health professional to write the prescription; fill the prescription; and, prior to any administration, write a policy to govern staff training (associated unlicensed personnel consent to administer and completion of authorization), med administration, storage, oversight of the med, errors associated with delivery, documentation when administered, parental notification, emergency protocol to address 911, disposal of outdated medication, and notification of the Department of Education (DE)… The DE must also create its own reporting format to cover errors and administration of epinephrine to a student. The whole process will take time.

Attached to this blog entry is the original set of rules and some sample policies I collected to get you started. Hope this is helpful to you and your district.
MaryAnn

PS  The website to obtain free Injectors is found at <www.EpiPen4Schools.com>

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