Diastat Training Module Natomas Unified School District

Objectives Upon completion of the Seizure/Diastat training you will demonstrate and/or verbalize: Recognition and treatment of different types of seizures Administration of an emergency anti-seizure medication Management of seizures in the school setting based upon the physician’s orders and seizure medication authorization Have staff watch the Seizure Training Module first.

Objectives Continued Safe and correct management of pupil requiring Diastat during a seizure. Basic emergency follow-up procedures Techniques and procedures to ensure pupil privacy Record keeping requirements

Pre-Test Take Pre-test Answers will be reviewed at the end of the presentation.

Procedure for Diastat at School Parent request/consent for Emergency Anti- seizure medication. Physician authorization for Emergency Anti- seizure medication. Seizure Emergency Action Plan completed by doctor. Electronic request for volunteers is sent out. Volunteer must have current CPR. Agreement to administer Diastat is voluntary.

Continued Volunteer must complete training before giving medication. Documentation of completed training must be retained in volunteer’s personnel file. Volunteer may rescind offer to administer Diastat up to three days after training. After that time, volunteer may rescind offer to administer with a two week notice. Volunteering to administer Diastat is student specific.

Continued Volunteer must report every administration of Diastat to the School Administrator and the District Nurse. Retraining is required every yearly. Periodic review with volunteer can be done by the district nurse throughout the school year.

What is Diastat? Diastat is a gel form of Diazepam Used for emergency seizure situations Anti-seizure medication

Mechanism of Diastat Action Diazepam belongs to a class of medications called benzodiazepines which produce a calming effect on the brain and nerves (central nervous system). It is thought to work by increasing the effect of a certain natural chemical (GABA) in the brain.

Types of Seizures requiring Diastat There are two types of seizure emergencies: Status Epilepticus – a prolonged clonic-tonic seizure lasting for an extended period of time. This period of time is determined by the student’s physician. For some it is 5 minutes for others it is less and some more. Acute Repetitive Seizure – a series of seizures or cluster seizures, each lasting a short period of time. In between seizures, the student regains consciousness.

Indicators for Diastat administration This medication is used to treat episodes of increased seizures (e.g., acute repetitive seizures, breakthrough seizures) in people who are already taking medications to control their seizures. This product is only recommended for short-term treatment of seizure attacks. It is not for ongoing daily use to prevent seizures. Uncontrolled seizures can turn into serious (possibly fatal) seizures that do not stop (status epilepticus).

Side Effects of Diastat Mild side effects might be: Drowsiness/sleepiness Dizziness Diarrhea Unsteadiness

Side Effects of Diastat More severe side effects might be: Slow/shallow/difficult breathing Mental/mood changes (e.g., anxiety, restlessness, hallucinations, sleep problems) Slurred speech Trouble walking.

Allergic Reaction to Diastat Symptoms include: Rash itching/swelling (especially of the face tongue/throat) dizziness trouble breathing

Contraindications Diazepam is contraindicated in patients with a known: Known hypersensitivity to this drug. If Diastat has been given within 4 hours prior at home. Because of lack of sufficient clinical experience, in children under 2 years of age. Contraindicated in acute narrow angle glaucoma.

Standard Procedure for Administering Diastat Time the seizure and get ready to administer the Diastat. If orders state that Diastat is to be given immediately proceed to the following steps below. Have someone call 9-1-1 Place the student on their side, where they cannot fall. Get the medication or have someone get it from the locked area and bag with blanket..etc. Pass out Child Administration Instructions with this slide.

Standard Procedure for Administering Diastat Get the syringe out Push up with your thumb and pull to remove the cap fromthe syringe (Be sure seal pin is removed with the cap) Lubricate rectal tip with lubricating jelly. Turn student on the side facing you. Bend their upper leg forward to expose rectum. Separate buttocks to expose rectum.

Standard Procedure for Administering Diastat Gently insert syringe tip into rectum. (Rim of syringe should be snug against rectal opening) SLOWLY count to 3 while gently pushing plunger in until it stops. SLOWLY count to 3 before removing syringe from rectum. SLOWLY count to 3 while holding buttocks together to prevent leakage. Keep student on the side facing you, note time given and continue to observe.

Follow-up and Observations After Administering Diastat Watch breathing pattern of student Begin CPR if student stops breathing or as needed. Continue to observe Remain with the student. Never leave a student having a seizure unattended. Continue to time the seizure until it has stopped Never put anything in the mouth of someone having a seizure.

Pupil Privacy Request another staff member move other pupils away from area. Have someone get the emergency treatment packet for the student (which should be kept in a private place for confidentiality). Have a bag which contains a blanket or other appropriate article to be used to cover pupil and avoid exposure and a small item like a jacket to place under the head (provided by parent).

Documentation and Records Complete Seizure Log and Seizure Incident Report. This documentation includes: Pupil name Name of medication Dose Date Time given Length of seizure Observation Status of pupil Action taken after seizure Provide copy to school nurse.

Emergency Care Plans Chain of responsibility regarding Diastat administration in the school setting, i.e., Physician (Doctor’s orders) Parent (request for unlicensed personnel to administer Diastat) Administration (sending out email to request volunteers) Trainer of volunteer (District Nurse) Volunteer (Teacher, secretary, aide, principal) EMS/911. Review the pupil’s Seizure Emergency Action Plan (this is only for the personnel directly responsible for delivering the emergency care).

Video DO NOT DISPOSE OF REMAINING MEDICATION IN THE SINK. Place syringe in the shapes container in the health office.

Review Questions Review: Practice scenarios on Nickie ® Training Doll Seizure log Facts for school personnel Seizure Emergency Action Plan Physician’s Authorization Practice scenarios on Nickie ® Training Doll Take Post-test Go through checklist

References https://healthy.kaiserpermanente.org/health/care/consume r/health-wellness/drugs-and-natural-medicines https://www.epilepsy.com http://www.druginformation.com/RxDrugs/D/Diazepam %20Rectal%20Gel.html California School Nurses Organization. (2012). http://www.csno.org/diastat-issues/

Resources Epilepsy Foundation Northern California 155 Montgomery Street Suite 309, San Francisco, California 94104-4108. Phone: (415) 677-4011Toll Free: (800) 632-3532. http://www.epilepsy.com Diastat AcuDial Epilepsy & Seizure Resource Center. Back To School. http://www.diastat.com/resource- center#school WebMD http://www.webmd.com/drugs/drug-94251- Diastat+AcuDial+Rect.aspx?drugid=94251&drugname =Diastat+AcuDial+Rect