CHICAGO -- About a quarter of school nurses reported that U.S. students during the 2015-2016 school year had epinephrine administered and, in many cases, it was by unlicensed staff, a researchers reported here.
Around 16% of all reported doses of epinephrine were administered by unlicensed staff or students, according to Michael Pistiner, MD, of Massachusetts General Hospital in Boston, and colleagues.
Moreover, about a third of epinephrine doses were given to students who had no previous allergy known to the school, the authors stated in a at the annual meeting.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Pistiner's group argued that even though food allergy prevalence is under 10%, about 16% to 18% of kids have had an allergic reaction at school or daycare. Moreover, in the authors' home state of Massachusetts, 25% of epinephrine administration was to children whose allergy was unknown to the school, and added that new regulations addressing epinephrine in school are becoming widespread throughout the U.S.
The researchers conducted an anonymous electronic survey of school nurses around the country to attempt to get some answers to these questions. This survey was distributed to the email list serve of the National Association of State School Nurse Consultants.
Overall, 1,285 respondents completed all survey questions (86% of the 1,486 who started the survey), with the majority being from only nine states. A little over 40% of nurses responded that their schools had administered epinephrine during the 2015-2016 school year, for a total of 482 administrations of epinephrine in total. About 4% of participants who completed the entire survey said that epinephrine was administered by unlicensed staff. However, about a third of nurses who responded to the survey said they did staff more than one building.
While not involved with the research, Susanna McColley, MD, of Ann & Robert H. Lurie Children's Hospital in Chicago, told 51˶ that the results were not surprising as "nurses being spread between several schools is the norm in many communities," and that previously published studies indicate epinephrine has been administered by unlicensed staff.
"Pediatricians can advocate for training of non-nurse personnel in appropriate administration of epinephrine, similar to the way some school systems or even states have broadly taught CPR and use of AEDs," she said, adding that having more nurses in schools has broader policy or budget implications so "it's important to work with what's currently available."
Not only were a small portion of unlicensed staff administering epinephrine, but around 2% of participants completing the entire survey reported administering epinephrine to someone without a known prior allergy, and 8% of participants reported epinephrine was given to a child without a known prior allergy by a licensed school nurse.
McColley said that there is "minimal risk" of giving epinephrine to children, so training should emphasize "early recognition and administration" rather than avoiding unnecessary administration.
In addition, the survey found that around 10% of students had a severe allergic reaction that required more than one dose of epinephrine, and 3% of nurses who completed the survey said more than one dose of epinephrine was needed for a single event of anaphylaxis before emergency medical services arrived.
Primary Source
American Academy of Pediatrics
Pistiner M, et al "National school nurse survey of epinephrine use in schools" AAP 2017.