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Naloxone Administration in School Settings Toolkit
Developing a School Emergency Response Procedure
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A procedure is a sequence of steps that should be followed to implement policies. This procedure may vary slightly by site even within a school district pending the environment and resources.
Schools are encouraged to consider the following questions for the development of the school’s procedure.
- Who is the population of students, staff, and visitors to be served?
- Where will the emergency response be delivered and where the naloxone will be secure, accessible, and stored per manufactures directions in those locations?
- Which school staff, at the designated location, will be trained to respond and to administer the medication when an emergency response is needed? Who else should be a part of the emergency response team, besides the person trained to the given the medication?
- Consider when the trained staff will be available to provide this emergency response. During the school day only? During other after school hour events?
- How staff will be initially trained and remain competent in the knowledge to identify a possible opioid overdose, know, and administer the medication appropriately, initiate 911, and provide rescue breathing as needed?
- What type of communication, notification, and documentation will need to be completed as part of the emergency response and medication administration?
This Naloxone Emergency Response Procedure template is an example that schools can use to help develop a procedure specific to their situation. It is not complete and will need additional information before it can be used by a school. It is not meant to replace existing procedure templates in use by the school.
Documentation is the process of communicating in written form about essential facts. Documentation is necessary because it provides a record of what happened. It provides information about the characteristics and care given to the person, including the outcomes of the care given.
It is recommended to record the encounter in the student’s school health record and/or on an incident report for student, employee, or visitor as applicable. Nurses must document per the School Nursing Scope and Standards of Practice.
Documentation should include:
- Description of the person’s symptoms
- The route (intranasal or intramuscular) that naloxone was administered
- The dose (amount of medication) of naloxone that was administered and that “used” medication / device was sent with EMS responders.
- The person’s response to naloxone
- If rescue breathing and/or CPR were initiated and the length of time
- The time Emergency Medical Services (EMS) was notified, arrived, and transported the person for further medical care.
Documentation of the event and response can be used as a tool to help evaluate the emergency response procedures, determine what adaptations might be necessary for the future, help to inform ongoing and future training and may be required by the school’s risk management team.
Documentation of medication administration is further covered in the Minnesota Medication Administration Guide.
Communication is necessary to notify the appropriate school staff and family in the event of a suspected overdose, emergency response, and medication administration. The school should consider who must be notified, what information must be shared, and when the communication needs to occur.
Personnel to consider notifying, as appropriate, include:
- Student Support Administrator
- Health and Safety Administrator
- Health Services Administrator or Lead Licensed School Nurse
- Building Principal (if not already involved)
- Licensed School Nurse or other Health Services staff in the building (if not part of the initial emergency response)
- School Counselor or School Social Worker
- School Resource Officer
- Naloxone Coordinator
- Medical Director/Healthcare Provider for naloxone condition specific protocol standing orders)
Staff communication regarding a drug-related incident may be necessary when there is a need to coordinate staff support and implement student support planning. A briefing might include advice to staff about the basic facts of the incident and advice about appropriate responses staff might give to questions that they may be asked. This will help to avoid exacerbating the situation or spreading rumors. The nature of the briefing for staff will vary considerably depending on the nature of the incident.
It may be that in responding to a person experiencing an opioid overdose, school staff may also come across illicit drugs or drug paraphernalia. Schools may want to consider creating a procedure for the response to this situation.
If any drugs or drug paraphernalia poses a safety risk to others on or around the scene or arriving to the scene, here are some considerations:
- Universal precautions (wearing gloves) and safe handling of sharps should be taken when handling any substances and/or objects to prevent exposure to infectious disease
- Move objects so that risk for harm or injury is lowered
- If substances or drug paraphernalia are handled document and note
- Who handled the substance or related items
- Who was present
After an opioid overdose event, schools may want to consider how they can support those who responded, witnessed, or may have been impacted by the event. Determine what communication might be necessary for staff, students, and families, including directing them to relevant community resources as needed.
Additionally, taking time to complete an after-incident review allows individuals to discuss both individual and team-level performance, review the process, what went well, identify errors if made, determine if there is a need for additional training, and develop a plan to improve future responses. This review should occur within 24 to 72 hours following the incident. Schools are encouraged to incorporate an after-incident review within their procedures.
A Guide for Conducting an After-Incident Review is available for to further help schools with this process.