Medical Professional Publications

Managing Seizures in Schools Instead of the ED

Columbus, OH — January 2017

Most children who have a seizure at school do not need to be transported to an emergency department (ED), but many end up there anyway. How can providers help ensure that appropriate seizure management takes place in schools without a trip to the hospital?  

A recent study from clinicians and researchers at Nationwide Children’s Hospital identifies many of the barriers to that management, and suggests ways that the healthcare community (in collaboration with families and schools) can break them down.

“Hospital resource utilization is one issue, but we also want to figure out how to keep the disruption in a child’s life to a minimum,” says Debbie Terry, CNP, lead author of the study and a member of the nurse practitioner team in the Division of Neurology at Nationwide Children’s.

The research, published in the Journal of Child Neurology, surveyed 83 school nurses in Ohio about their knowledge of childhood epilepsy, their school’s staff members’ ability to identify and manage a seizure, their own availability to respond to a seizure at school and their school district’s policies on seizure management.

Among the most notable findings about barriers:

  • 38.5 percent of respondents said their school districts required transport to the ED after any convulsive seizure and/or a seizure during which rescue medication was given
  • Only 63.3 percent of respondents were confident they could correctly administer intranasal midazolam, at least partially because of the difficulty of drawing and giving the correct dose via syringe
  • 47.4 percent were confident they could swipe a vagus nerve stimulator with a magnet
  • 56.6 percent of respondents said they had enough information about a specific students’ seizures and their management
  • 85 percent of respondents were available to respond to seizures in rural schools, while only 32 were available in urban schools

Other findings were more promising. The large majority of nurses, for example, were confident they could recognize a seizure and give rectal diazepam. The Division of Neurology at Nationwide Children’s has used information from the study to modify some of its practices.

Providers at the hospital now make syringes prefilled with intranasal midazolam available to parents, who can supply them to schools. A seizure “action plan” has been developed as part of a child’s electronic health record, which can be given to school staff to help them respond to events.

Those are steps in the right direction, but they do not solve every problem, says Terry. District policies about ED transport, or how accepting a school might be of an action plan, or the number of nurses available in some areas, are all issues that can only be addressed through provider collaboration with education officials.

“As providers, we can make some changes and we can advocate for others,” Terry says. “We need to do a better job of communicating with schools to learn how we can best work with them. The barriers we identified were in Ohio, but there may be others elsewhere in the country. Other institutions should try to learn what those are and work to address them.”

Terry D, Patel AD, Cohen DM, Scherzer D, Kline J. Barriers to seizure management in schools: perceptions of school nurses. Journal of Child Neurology. 2016 Dec; 31(14):1602-1606. 

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