“Saving Lives of Students and Staff: The New West Virginia Epinephrine Law/Rule Rebecca King MSN, MEd, RN, NCSN School Nurse Liaison/504 Coordinator WVDE-Office of Special Programs

Congratulations to WV School Nurses

West Virginia Status and Stats

Top 5 Medical Diagnoses/Procedures 2010/11 School Nurse Needs Assessment Medical Diagnoses In-School Specialized Health Care Procedures Asthma Inhalers for Asthma Behavioral Disorders Emergency Medications Anaphylactic Reaction Long-Term Medications Obesity Special Diets per Federal Form Mental Disorders (Depression, Bipolar, Schizophrenic, Suicidal) Seizure Management Close 5th places….. Ear, Nose and Throat/ Migraine or Severe Headache/Seizures

WHY are increases in Allergies occurring in WV? Students Environment (art material, etc.) School programs Etc.

System Response to Severe Allergy Allergen MADGE Immunoglobin E Hypotension Bradycardia Vasoconstriction of Respiratory System Epinephrine (adrenaline) to the RESCUE

Epinephrine/Adrenaline

Harm vs. Help Temporary relief due to short half-life of 2-3 minutes for epinephrine. Hence a rebound effect and need to call 9-1-1 or possibly administer another dose. Restore blood pressure, heart rate and respiratory status

States with Laws allowing Stock Epinephrine in Schools

Objective #1: Participants will learn about the new W.Va. law and WV State Board of Education Rule on the county option of stock epinephrine for undiagnosed students and staff.

Passage of Epinephrine Law or W.Va. §18-5-22c Signed by Governor with effective date of July 8, 2013

Status of State Board Medication Administration Policy Incorporated into WV State Board of Education Rules by the WV Council of School Nurses through WVBE Policy 2422.8-Medication Administration Public comment period ended on November 12, 2013 Request for approval will be at the December 11-12, 2013 State Board meeting

What does this mean to me?

County Boards have the OPTION of Stock Epinephrine Policy County Boards of Education will have OPTION to develop medication policies allowing stock epinephrine. Administered under the prescription and standing orders of a MD or DO to students and school personnel who are experiencing signs and symptoms of severe allergic reactions/anaphylactic shock without prior diagnoses.

County Boards have the OPTION of Stock Epinephrine Policy The training and delegation of administering epinephrine will be done by SCHOOL NURSES with delegation and assignment to other nurses (registered nurses and licensed practical nurses) and designated qualified personnel (teachers at will, aides and secretaries) working in the school system.

Education and Training in Anaphylaxis and Epinephrine by the School Nurse(s)

Doses and Half Life Doses: Epinephrine 0.15 mg for weight of 33 pounds to 66 pounds Epinephrine 0.3 mg for weight of 66 pounds or greater Half Life: The plasma half-life is about 2-3 minutes.

Concerns of Harm? Benefits definitely outweigh any minimal risk factors. Temporary relief due to short half-life of 2-3 minutes for epinephrine. Hence a rebound effect and need to call 9-1-1 or possibly administer another dose. Restore blood pressure, heart rate and respiratory status

Objective #2: Participants will learn about the storage and reporting of epinephrine use in schools.

Storage Schools shall maintain epinephrine auto-injectors in a SECURE, unlocked, location, which is only accessible to school nurses, health care providers and authorized nonmedical personnel and not by students.

Reporting West Virginia Poison Center at http://www.wvpoisoncenter.org/Default.aspx.

West Virginia Poison Center Report each reaction resulting in the administration of epinephrine injections to the West Virginia Poison Center by calling 1-800-222-1222 after emergency medical services have transported the student or staff member to acute care.

Poison Center Reporting Information The notification should include the name of the student, the student’s age and gender, date and the approximate time the incident occurred, symptoms observed, who administered the injection, the name of the school the student attends,…

Continued… a contact telephone number, the rational for administering the injection, the response to the epinephrine administration, the dose of epinephrine administered and any other necessary elements to provide a complete report for the individual situation (templates will be provided to schools).

Objective #3: Participants will be familiar with EpiPen4Schools Program offered through Mylan Pharmaceutical.

Cost to Schools

EpiPen4Schools Program Go to http://www.epipen4schools.com/ and follow the directions. Download order application form for FREE EpiPens You will need a prescription from a MD or DO (your designated medical consultant)

No more than two 2-Pak Units per school

Next steps… After you have completed the steps above, BioRidge Pharma will find a pharmacy near your school that is able to fill the prescription and forward a copy of your valid prescription to the pharmacy. All orders will be shipped directly to your school.

NEW Auvi-Q School Discount Program How? Email: auvi-q.sd@andanet.com OR Call: (855) 722-8847 for an application

QUESTIONS?

TOGETHER we can save lives!

Rebecca King WVDE-Coordinator School Health, Section 504 and Coordinated School-Public Health rjking@access.k12.wv.us 304.558.8830