Identifying Barriers to Implementation of Stock Epinephrine Bills: The Texas Experience

Abstract

Life-threatening anaphylaxis is a risk for approximately 160,000 Texas children. About twenty-five percent of first anaphylactic reactions happen at school. Stock epinephrine allows injectable epinephrine to be stored and readily available for any school personnel when needed. In 2015, Senate Bill 66 (SB66) authorized Texas public and charter schools to stock epinephrine within each school district and at off-campus school sanctioned events. However, potential challenges to implementation SB66 may exist. To identify the barriers of implementation of SB66, the Texas Stock Epinephrine Committee designed a survey, disseminated by the Texas Department of State Health Services (DSHS) School Health Program to all Texas school districts. The survey included dichotomous questions to identify existing stock epinephrine policies, and four questions to identify barriers to implementation, if no policy existed. One-tailed z-test for proportions was used for analysis. The survey was distributed to 1266 school districts, with 43 responders (3.3%). Seventy-five percent (32/43) replied there was no existing stock epinephrine policy. There was no difference between rural versus urban districts (p=0.0747). Identified barriers included 1) perceived injector cost (32%), 2) absence of clear policy guidelines (24%), 3) absence of registered nurse/personnel to give the medication (24%), and 4) no identified ordering physician (16%). In districts without stock epinephrine, 64% reported anaphylaxis had occurred on a campus in the past. Stock epinephrine is needed to ensure child school safety. Several perceived and real barriers to implementation of SB66 exist, highlighting the need for development of potential solutions to eradicate these obstacles.