Seizure Management in Schools

Steps for schools

• Identify students with seizure disorders through a review of health history and/or medication forms, and collect additional needed information  
• Flag students with a seizure disorder within the health section of the school’s records or identify another method to easily track students (eg, spreadsheet, registry) 
• Notify teachers and other appropriate school personnel of students with a seizure disorder and provide training on how to recognize and respond to seizures (for resources, see education/training section) 
• Record and monitor key data for students with seizures, such as completion of needed forms, medication administration, and type and duration of seizures 
  • Seizure Information Forms, Epilepsy Foundation 
    Offers seizure observation form to use for documentation and tracking purposes 

• Assess students’ need for more intensive case management based on seizure frequency, attendance, hospitalizations/ED visits, etc. 
• When storing records and communicating regarding student health conditions, follow confidentiality guidelines 
  • HIPAA and FERPA, National Association of School Nurses  
    NASN resources on HIPAA and FERPA, including a webinar and 2 radio broadcasts
  • Data Privacy in School Nursing: Part 1 and Part 2, The Network for Public Health Law 
    Overview of HIPAA and FERPA with FAQs from school nurses 
  • Data Sharing Guidance for School Nurses, The Network for Public Health Law 
    Overview of laws with questions and examples for setting up data sharing agreements 
  • Joint Guidance on the Application of the Family Educational Rights and Privacy Act and the Health Insurance Portability and Accountability Act of 1996 to Student Health Records, US Department of Health and Human Services and US Department of Education 
    Guidance with FAQs to clarify implementation of HIPAA and FERPA in relation to school health services

How primary care providers can help

• Explain to families the importance of informing the school about the child’s seizure disorder, turning in all school health forms, and providing the school with medications 
• Maintain blank paper and electronic versions of school district health forms for families to complete 
• Assist families that may need help with completing health forms and fax them directly to the school nurse/school health office 
• Ask families to sign a consent form to allow communication with the school about the child’s seizures 
  
  • Sample HIPAA-Compliant Authorization for Exchange of Information, Connecticut State Department of Education 
    Consent form for schools and providers to share information 

• Notify the school of patients whose seizures are severe or require special monitoring
   

Steps for schools

• Ensure that students with seizure disorder have a current seizure plan on file 
  • Seizure Information Forms, Epilepsy Foundation 
    Multiple forms including seizure action plan for schools 

• As needed, develop an Individualized Healthcare Plan (IHP) for students with seizure disorders. The school may also need to develop a 504 plan or IEP to ensure equal educational access 
  • Seizure Information Forms, Epilepsy Foundation 
    Includes parent questionnaires for collecting more information about a student’s condition 

• When developing emergency plans, IHPs, and/or IEP/504 plans, consider school-sponsored activities, field trips, before- and after-school care, and times when a school nurse is not present 
  • Field Trips: Guidance for School Nurses, Connecticut State Department of Education 
    Information on considerations related to field trips for students with special health care needs 

• Periodically evaluate students’ plans to ensure they contain current information (eg, medications, contact information) and that their needs are being met 

How primary care providers can help

• Provide patients with seizure disorders with a seizure action plan for use at school. If possible, send the plan directly to the school nurse/school health office in addition to giving a copy to the family 
• Notify the school nurse/school health office about medication side effects, particularly those that should be reported back to you 
• Include your office contact information on the action plan 
• Respond promptly to questions from the school regarding the action plan and provide any information needed for the development of an IHP or other management plans 
• Keep in mind that not all schools have a school nurse present at all times. Ensure that the seizure action plan and any other orders are written in a way that can be understood by trained school staff 
  
  

Steps for schools

• Maintain written emergency protocols with clear communication procedures and responsibilities 
  • Seizure First Aid Resources, Epilepsy Foundation 
    Provides posters with instructions on seizure response 

• Train all staff on how to recognize and respond to seizures ​ (see educate/train staff)  

• Assure immediate access to emergency medications, including during field trips and school-sponsored activities (see manage medications) 

• Plan for access to medications during lockdowns, evacuations, and other disaster procedures 

How primary care providers can help

• Assist patients with obtaining medications to keep at school 
• Volunteer to review school emergency protocols 
• Assist schools in training staff on responding to seizures 
• Secure caregiver permission to communicate with the school to facilitate communication during urgent situations  
  
  • Sample HIPAA-Compliant Authorization for Exchange of Information, Connecticut State Department of Education 
    Consent form for schools and providers to share information  
    
    

Steps for schools

• Develop and maintain written policies and protocols for seizures within your district. Policies and protocols provide guidance for staff and communicate expectations for all stakeholders 
  • Nursing Procedures, Colorado Dept. of Education 
    Procedures for administering seizure medications and VNS magnet 

• Ensure that policies and protocols adhere to national and state laws and regulations, including state nurse practice acts 
• Policies and protocols should address:  
  • Routine and emergency management 
  • Medication administration and nursing delegation or administrative assignment 
  • Procedures for field trips, the bus, and before- and after-school activities 
  • Documentation 
  • Procedures for errors 
  • Use of written care plans 
  • Maintenance of a safe environment

How primary care providers can help

• Educate school leadership about the importance of written policies and protocols 
• Volunteer to help develop or review district policies and procedures to ensure that they are comprehensive, aligned with best practice, and practical given available staffing and resources  
  
  

Steps for schools 

• Work with families, providers, and insurers to obtain medication and supplies for school use 
• Ensure that medication is stored in secure yet easily accessible locations during the school day, during school-sponsored activities, and during field trips 
  • Guidelines for Provision of Health Services on Field Trips or Extracurricular Activities, Colorado Dept. of Education 
    Guidelines for health services during school-sponsored trips and activities 

• Maintain documentation of medications stored, medications administered, medication errors, and medication authorizations 
  • Sample Policies and Forms, Mass.gov 
    Sample medication orders, authorizations, logs, and policies 

How primary care providers can help

• When prescribing emergency medications, consider appropriateness for the school environment in terms of personnel available at the school and student privacy 
• Respond to questions from the school regarding medications 
• Assist families in securing medications to keep at school 
  
  

Steps for schools

Staff

• Define staff roles. At a minimum, all staff should receive basic information about seizures and how to identify and respond to emergencies 
• Identify training needs through knowledge and skills assessments 
• Provide regular training and assessment on relevant skills and information, keeping in mind the prior knowledge and health literacy level of the audience 
  • Nursing Procedures, Colorado Department of Education 
    Procedures for administering seizure medications and VNS magnet 
  • School Nursing Documents/Forms, Connecticut Department of Education 
    Includes medication administration training for unlicensed personnel 
  • Managing Students with Seizures: School Nurse Training Program, Epilepsy Foundation 
    Training program to enable nurses to better manage students with seizures 
  • Seizure Training for School Personnel, Epilepsy Foundation 
    Training program for other school staff to support students with seizures 
  • Chronic Health Conditions Toolkit for Non-Medical Staff in Schools, Tennessee Department of Education 
    Provides an overview of seizures and how to respond to emergencies for non-medical school staff 
  • Medication Training, Wisconsin Department of Public Instruction 
    Includes videos, procedures, tests, and skills sheets on seizure medications

Students

• Provide coaching and education when interacting with students in order to support increased independence in self-management  
• Consider offering self-management education 
  • Body and Mind, Centers for Disease Control and Prevention (CDC) 
    Educational website for youth about epilepsy

Families

• Provide educational resources for families 
  • Children with Epilepsy at School, American Academy of Pediatrics 
    Information for families on educating classmates about a child’s epilepsy 
  • How to Support a Child with Epilepsy, American Academy of Pediatrics 
    Information for families on caring for a child with epilepsy 
  • Living with Epilepsy, Epilepsy Foundation 
    Website with multiple resources for patients and families on managing epilepsy 

How primary care providers can help

• Volunteer to assist with developing, reviewing, or delivering trainings (see resources above) 
• Recommend or provide patient education materials 
• Communicate with school nurses about children and families that may need additional education, such as newly diagnosed patients 
• Advocate for adequate numbers of licensed school nurses in schools 
  
  

Steps for schools

• Assist families without a primary care provider and/or insurance with accessing health care 
  • Does Your Child Have Health Insurance? AASA 
    Toolkit to assist schools in identifying uninsured children and connecting them to coverage 
  • Health Insurance for Children: How Schools Can Help, CDC 
    Guidance for schools on connecting students with health insurance 

• Obtain consent from caregivers to communicate with students’ primary care providers (consider including in annual consent form) 
  
  • Sample HIPAA-Compliant Authorization for Exchange of Information, Connecticut State Department of Education 
    Consent form for schools and providers to share information 

• Notify caregivers (and primary care provider, if appropriate) of seizures that occur at school  
• Communicate with students’ providers and caregivers regarding any concerns 
• Identify local resources that can support students with seizure disorders 
  • Parents for Healthy Schools, CDC 
    Collection of resources, including guidebook, presentation, e-learning module, and idea sheets for engaging parents in school health, including chronic condition management 
  • Partner Build Grow, The Center for Health and Health Care in Schools 
    Action Guide for sustaining school-based approaches to support cognitive, social, emotional, and physical health 
  • Nine Elements of Effective School-Community Partnerships to Address Student Mental Health, Physical Health, and Overall Wellness, Coalition for Community Schools 
    White paper on ways school-community partnerships can create positive health and academic outcomes 
  • Partnership Building to Support Students Managing Chronic Health Conditions, National Association of School Nurses 
    Webinar on how to create, strengthen, and sustain partnerships to support students with chronic health conditions to be safe, healthy, and ready to learn 

• Consider partnering with a local hospital, public health department, nursing school, your local Epilepsy Foundation chapter, or community provider to provide education to staff, families, and/or students 

How primary care providers can help

• Obtain consent from caregivers to communicate with the school 
  
  • Sample HIPAA-Compliant Authorization for Exchange of Information, Connecticut State Department of Education 
    Consent form for schools and providers to share information 

• Recommend community resources and partners that can support students with seizure disorders 
• Consider serving as a consultant to the school district or participating on a school health or wellness committee 
  
  

Steps for schools

• Ensure adequate school nurse staffing 
  • Role of the School Nurse in Providing School Health Services, American Academy of Pediatrics  
    Policy statement outlining the importance of a school nurse in every school 
  • School Nurse Workload: Staffing for Safe Care, National Association of School Nurses
    Position statement on appropriate schoool nurse staffing

• Assure quick access to emergency medications​ (see manage medications and plan for emergencies) 
• Implement needed accommodations​ as outlined in IEP and/or 504 plans 
• Manage potential triggers in the school environment​ 
• Create a positive social climate that fosters acceptance, inclusion, and full participation for all students 
  • Take Charge: Classroom Epilepsy Education Programs, Epilepsy Foundation  
    Student education programs to help students understand and support classmates with epilepsy 

How primary care providers can help

• Work with families and schools to support full participation by students with seizure disorders 
• Advocate for adequate school nurse staffing 
  
  

Steps for schools

• For students with frequent seizures, consider having school nurses provide case management or additional services such as conducting home visits, assisting with making appointments, connecting families with transportation assistance, etc. 
  • Translating Strategies into Actions to Improve Care Coordination for Students with Chronic Health Conditions, National Association of School Nurses 
    White paper that proposes a common definition of care coordination and identifies actions for implementing effective chronic condition management in schools 

• Provide additional support and training opportunities to equip school nurses to identify issues relating to uncontrolled seizures and develop solutions 

How primary care providers can help

• In districts with adequate health services staffing, partner with school nurses, counselors, social workers, and school-based health centers to support case management and care coordination through the school and suggest services and supports that would be helpful to the student and family