After reviewing the overhead content: Say, “It is most important to keep the child safe and respond in a calm and caring manner. This shows others that this is not an emergency.” Add: When timing the seizure, it helps to say the time out loud, it is easier to remember and if others are around, they will remember it too.
After reviewing the overhead content: Say, “ Absence seizures also involve a brief change in awareness, but no first aid is necessary. Teachers should, however, report seizure frequency for absence seizures. If absence seizures occur in clusters, this may lead to a brief period of disorientation.” Say, “Occasionally, a person having a complex partial seizure, if grabbed or restrained, may become combative. This is not a conscious act of aggression and should abate once the grabbing or restraining is stopped.”
After reviewing the overhead content: Say, “If a student has frequent seizures or seizure emergencies, recommendations on how best to respond to the emergencies should be discussed with the student’s parents and medical team and incorporated into the child’s Seizure Action Plan, IHP and IEP.”
After reviewing the overhead content: Say, “In some cases, it may be necessary to loosen or remove a seat belt strap that goes across the chest of a student in a wheelchair. These can sometimes restrict airflow and breathing. Lap belts and backpack style harnesses do not cause these same breathing restriction problems and may be left on during a seizure.”
After reviewing the overhead content: Say, “When a student has a seizure in water there is a high likelihood that he/she will have aspirated water and, as a safety precaution, it is important to have a medical evaluation.”
BEFORE viewing the next overhead: Say, “The school nurse is a critical member of both the education and healthcare support system for students with seizures. The school nurse is responsible for creating a Seizure Action Plan for each student to help organize, coordinate and communicate the needs of the student with seizures. This information can be easily incorporated into individual health plans, 504 plans and IEPs, and serve as a basis of training curricula for other school personnel.”
After reviewing the overhead content: Say, “Collaboration with the student, parents, school personnel and the student’s healthcare team is needed to set goals and formulate the Seizure Action Plan. This plan outlines what can be done outside the hospital setting to help a student during a seizure and, in some circumstances, to intervene to help prevent, stop or lessen some part or all of a seizure. It also helps reinforce steps that can be taken to reduce the social and educational impact.”
Additional content suggestion: Ideally the Parent Questionnaire should be completed prior to a student’s IEP meeting so this information can be easily integrated into the IEP. However, this may not always be possible. If necessary, the IEP meeting can be a good place to gather and clarify missing information from parents. Instructions: Ask participants to turn to the Parent Questionnaire in their packet. Review the overhead content. Briefly review the main sections of the Parent Questionnaire.
Instructions: Ask participants to turn to the Seizure Observation Record . Review overhead content. Briefly discuss different elements of the Seizure Observation Record.
Instructions: Ask participants to turn to the Seizure Action Plan . Review overhead content. Briefly discuss the different elements of the Seizure Action Plan.
BEFORE reviewing the overhead content: Ask, “ How do you currently communicate with parents and the student’s medical team?” Acknowledge the answers. Say, “Here are a few additional tips that may help you communicate more effectively.”
Notes to the presenter: Section 504 of the Rehabilitation Act and the ADA mandate the following: Accommodations and barriers must be removed so students with disabilities have access to publicly funded programs, including schools. Reasonable and individualized accommodations must be made in the schools. IDEA mandates the following: Students with disabilities must receive a free and appropriate education in the least restrictive environment based on the development of an IEP. These students must have educational opportunities equal to their non-disabled peers.
Instructions: Take 2 or 3 responses to the highlighted questions and allow for a brief group discussion. Keep discussion to 5 minutes or less. Let participants know up front that this will be a short discussion intended to bring issues to light but not to process all concerns. You will need to remain firm to your timetable and refer additional questions to the break, a specific question and answer period or the Issues Bin. Note to the Presenter: Some of these issues may have already been addressed during the previous discussion. In this case, restate what has been said and move on.
Allow 5-10 minutes for this exercise. MODIFICATION #1: Large group exercise Have participants locate the completed Parent Questionnaire and Case Study. Go through the Seizure Action Plan asking participants to volunteer answers for the sections listed on the overhead. Facilitate a brief discussion around any dissenting opinions. MODIFICATION #2: Nurses write in answers on the Seizure Action Plan Have participants locate the completed Parent Questionnaire and Case Study. Ask participants to take five minutes to complete the four sections of the Seizure Action Plan. Choose two volunteers to share their answers. Facilitate a short discussion around any dissenting opinions.
School nurse-presentation revised version 2013 webinar only
Dennis Dlugos, MD, MSCE Dennis Dlugos, MD is an AssociateProfessor, Neurology & Pediatrics andDirector of the Pediatric Regional EpilepsyProgram at the Children’s Hospital ofPhiladelphia.1
Seizure First Aid,Action Plans, andDelegation IssuesModule II
3Learning Objectives: Module II Provide appropriate first aid for a student duringand after a seizure Identify when a seizure is an emergency andknow the appropriate response
Learning Objectives: Module II Describe the steps in the seizure actionplanning process Identify the essential components of aSeizure Action Plan Know key issues related to the delegation ofmedication administration4
5Routine First Aid: Care and Comfort Most seizures are not medical emergencies Basic first aid may vary depending onwhether there is:– No change in awareness or consciousness– Altered awareness– Loss of consciousness Don’t give anything by mouth until thestudent is back to normal state and able toswallow normally
Interventions for Seizure First Aid May be used at any time during a seizure(VNS magnet) May be prescribed after a specific number ofseizures, length of seizure, or change inpattern (Rescue med)6
7No change in Consciousness(Simple Partial Seizure) Stay calm Time seizure Reassure student that he or she is safe Explain to others if necessary Protect student’s privacy
8Altered Awareness(Complex Partial Seizure) Speak softly and calmly Guide away from potentially harmful objects such astables, chairs and doors Allow for wandering in a contained area If lasts 5 minutes beyond what is routine for that student oranother seizure begins before full awareness is regained,follow emergency protocol DO NOT restrain or grab (may result in combativeness) DO NOT shout or expect verbal instructions to be obeyed
9Loss of Consciousness(Generalized Tonic-Clonic Seizure) Protect from potentially harmfulobjects Observe and time events Ensure airway is unobstructed Cushion and protect head Turn student on one side Remain with student until fullyconscious Follow the student’s SeizureAction Plan DO NOT put anythingin mouth DO NOT restrain
10When is a Seizure an Emergency? First time seizure Convulsive seizure lasting more than 5 minutes Repeated seizures without regaining consciousness More seizures than usual or change in type Student has diabetes or is pregnant Seizure occurs in water Student is injured Parents request emergency evaluationFollow the seizure emergency definition and protocol as defined byhealthcare provider and included in the Seizure Action Plan
11Use of PRN Rescue Medications Prescribed for seizure clusters andprolonged seizures Emergency protocol should include: Medication name How and when it should be given Specific administration instructions What to do following administration Monitor responses and side effects Follow Seizure Action Plan emergencyresponse protocol
12Tonic-Clonic Seizure in a Wheelchair Do not remove from wheelchair unless necessary Secure wheelchair to prevent movement Fasten seatbelt (loosely) to prevent student fromfalling but remove harness belt to prevent choking Protect and support head Ensure breathing is unobstructed and allowsecretions to flow from mouth Pad wheelchair to prevent injuries to limbs Follow relevant seizure first aid protocol
13Tonic-Clonic Seizure on a School Bus Safely pull over and stop bus Place the student on one side across seatfacing away from the seat back (or in theaisle if necessary) Follow standard seizure first aid protocoluntil the seizure abates and child regainsconsciousness Continue to the destination or follow schoolpolicy
14Tonic-Clonic Seizure in Water Place the student on their back and supporthead so that their head, mouth and nose arealways above the water Remove the student from the water as soonas it can be done safely If the student is not breathing, begin rescuebreathing Always transport the child to the emergencyroom even if he/she appears fully recovered
18Questions for Parents of a Studentwith Seizures Encourage parent(s) to complete action planand may take persistence May be helpful to interview the parent(s) toobtain and clarify information Update annually and when any changesoccur
19Seizure Observation Record To be completed by school personnel whenreporting a seizure(s) Helps to identify seizure types, duration,triggers, and patterns Helpful to use for planning appropriateseizure plans, safety precautions, and needfor accommodations or changes
ExampleCopies of the SeizureObservation Record andSeizure Action Plan areavailable on the EFEPAwebsite:http://www.efepa.org/programs-and-resources/school-information/
Seizure Action Planning Process Should generally be signed and approved bythe treating health care provider, parent, andschool nurse Distribute to relevant school personnel withparent(s) permission at the beginning of aschool year, upon diagnosis or when achange in health status occurs22
23Assessment & Information Gathering Gather seizure history and treatment information Speak with the student’s medical team to clarifytreatment and emergency response protocol Observe and document any in-school seizures Speak with teachers and other school personnelabout:– Possible seizure precipitants (triggers)– Observed or perceived impact on learning and behavior
25Communication Tips Set up a method for communicating withparents/guardians on a daily or weekly basis Be a liaison for parents and teachers regardingany status changes Have teachers regularly note physical, emotionalor cognitive changes Create a “substitute teacher” folder with theSeizure Action Plan and other relevant informationand keep this folder in a secure location
26Delegation Issues:Laws and Mandates Applicable Federal laws or mandates that mayimpact delegation include:– Section 504 of the Rehabilitation Act of 1973– Americans with Disabilities Act (ADA)– Individuals with Disabilities in Education Act(IDEA) Local and state laws, such as nurse practice actsand school district policies, generally govern theadministration of medications in schools What are the state or school regulations in your areafor delegation of medication administration?
27Tips for Effectively ManagingDelegation Know state nurse practice act, school district policies,and applicable state and federal mandates and laws Recognize that identifying when a change in behavioror seizure occurs does not require a skilled nursingassessment and is part of basic seizure first aid Bring parents and school personnel together to attemptto find a workable solution Explain to all parties that you are obligated to put thehealth, safety and welfare of the student first
28More Tips for Effectively ManagingDelegationWhen a school nurse delegates a task underhis/her nursing license the nurse is responsible forthe following: Ensuring that the delegate is appropriate Providing training and ongoing assessment anddocumentation of the competence of a delegate Ongoing assessment of the students healthoutcome
29The Challenge of DelegationUsing Diazepam rectal gel and other seizurerescue treatments may be handled in differentways depending on school district policy,school policy and parent preference. How is it handled in your school? What challenges have you come across? How have you dealt with these andsimilar issues in your school?
30Exercise:Review a “Seizure Action Plan” Review and discuss how you might complete anduse the following sections of the Seizure Action Plan:– Seizure Information– Basic First Aid– Emergency Response– Special Considerations and Precautions Use case study for discussion and practice
Pennsylvania Epilepsy AffiliatesContact us for more information regarding the information in thisprogram and access to seizure action plan & observation forms.31Sue LivingstonEducation CoordinatorEpilepsy Foundation Eastern PA919 Walnut Street, Suite 700Philadelphia PA 19107www.efepa.org 215-629-5003Andrea ZonneveldCommunity Educator & Events CoordinatorEpilepsy Foundation Western/Central PA1501 Reedsdale Street, Suite 3002Pittsburgh, PA 15233www.efwp.org 412-322-5880
Other AvailableSchool ProgramsThe EFEPA and EFWCP offer additional on-sitetraining programs for School Personnel andStudents on First Aid & Seizure Recognition. Wealso offer assistance in IEP/504 Planning. Checkout our website or contact us to set up yourschool’s next session today!•Eastern PA:http://www.efepa.org/programs-and-resources/school- information/•Western/Central PA: http://efwp.org/programs/ProgramsPSA.xml32
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