A new AAP clinical report highlights issues to consider when prescribing seizure medications for students with epilepsy and creating school medical orders or action plans.
The clinical report Rescue Medicine for Epilepsy in Education Settings is available at www.pediatrics.org/cgi/doi/10.1542/peds.2015-3876 and is published in the January issue of Pediatrics.
Epilepsy is one of the most common neurologic diagnoses, affecting nearly 1% of U.S. children over their lifetime. Because many do not have complete control over their seizures, school staff should know what to do if a child has a seizure, according to the report from the AAP Section on Neurology and Council on School Health. Advanced planning for students with epilepsy should be completed by a team representing the medical home, school and family before school begins.
Ideally, school nurses write action plans for students with epilepsy based on medical orders from health care professionals. If there is no school nurse, schools may ask prescribing professionals to provide an action plan instead of technical medical orders, or even to train other school staff.
One option is to modify a generic action plan. (See resources.) The action plan should account for:
- least restrictive and most appropriate rescue medication option;
- how to manage potential adverse side effects;
- when the rescue medication should be administered to avoid status epilepticus;
- when it is safe for a child to remain in school following a seizure;
- when to activate emergency medical services; and
- details of communicating with the family and/or physician about the frequency of reporting seizure rescue medication use.
Pediatricians and other prescribing professionals should familiarize themselves with local and state regulations regarding administration of seizure rescue medications by school personnel. In situations of potential liability, an action plan containing instructions on seizure management for unlicensed assistive personnel can ease concerns and help to ensure appropriate care.
Details of the individual action plan and transportation to and from school can be included in an individualized education program or 504 accommodation.
