There remains a paucity of data regarding use of student-specific and stock epinephrine in schools. There is significant potential for this information to influence policy regarding management of allergic reactions and to provide insight into risks to allergic children in the school environment.
In order to determine the nature and frequency of epinephrine use in schools, nursing records were reviewed from July 2008 through July 2013 for the New York City public school district, which serves approximately 1.2 million children in over 1,800 schools.
Within the New York City public school district, nursing records report 38 administrations of epinephrine in the school year starting in 2008, 35 in 2009, 65 in 2010, 86 in 2011, and 114 in 2012. Just 20.7% of epinephrine uses were for students with a medication administration form (MAF) for epinephrine on file. After the incident, 29.0% sought medical evaluation and subsequently provided a MAF to the school. However, 50.3% remained without a MAF for epinephrine.
In conclusion, epinephrine use in schools appears to be rising steadily, with a majority of uses in students without MAF for epinephrine. This rise may represent an increase in appropriate uses of this life saving medication for anaphylaxis, or a true rise in frequency of severe allergic reactions. Lack of MAF for a majority of epinephrine uses suggests a significant unmet need for allergy evaluation for at risk children and confirms the importance of stocking non-student specific epinephrine in schools.