Asthma in School. Evilia Jankowski, MSA, BSN, RN MiSchoolNurse, Training and Leadership

Transcription

1 Asthma in School Evilia Jankowski, MSA, BSN, RN MiSchoolNurse, Training and Leadership

2 Managing Asthma in the School Setting: An Overview for School Staff

3 Medication Administration 3 Training for Designated School Personnel Photos/imagery here Copyright 1999 by MASN Revised 2019 Web site:

4 Asthma Affects 6.8 million children (9.3% overall). 36,000 children with asthma miss school each day. Asthma and School Children with asthma miss THREE times as much school as healthy children. Missed school absences = sustained cycle of reduced academic achievement. Akinbami L, The state of childhood asthma, United States, CDC Adv Data 2006:1-24 Hollenbach J and Cloutier M. JACI 2014 Cicutto et al JACI 2014 Kattan et al. JACI 2009 Basch CE, J School Health 2011

5 Barriers to academic success Lack of communication Families Clinicians Schools This results in: Students not having access to asthma medications, including rescue medications, in school Continued exposure to asthma triggers at school Hollenbach J and Cloutier M. JACI 2014 Cicutto et al JACI 2014

6 Asthma Federal Legislation 111th Congress ( ) bill to provide grants to schools for the development of asthma management plans and the purchase of asthma inhalers and spacers for emergency use, as necessary. Legislation Asthma State Legislation Stock Albuterol Colorado, Georgia, Missouri, Nebraska, New Hampshire New Jersey, New Mexico, New York, Ohio, West Virginia Asthma State Legislation Michigan PA 10 of 2000 Permits school children to carry inhalers and self-administer medication if they have asthma, providing written approval from a physician and parent is given to the school.

7 MDE

8 4 Components: School Asthma Management Program Sampro TM 1. Establishing a Circle of Support 2. Developing and sharing standardized Asthma Management Plans with schools 3. Developing comprehensive asthma education plans for patients and all school personnel 4. Empowering schools to employ environmental assessment strategies to reduce asthma triggers

9 Circle of Support Component 1:

10 Communication within the Circle of Support is crucial to ensure that the Asthma Action Plan is followed at home and at school.

11 Component 2: Developing and sharing Standardized Asthma Management Plans with schools

12 School Significance Patient Effect Asthma Action Plan: Essential Components A Asthma severity Recognize and provide direct patient care to patients with severe asthma. Monitor controller medication use. Student-centered care. Improves medication adherence. B Recurrent/severe exacerbations Recognize high risk students and step-up asthma care if needed. Provides symptom directed step-up care. Earlier transfer to higher level of care. C Prophylactic albuterol prior to exercise Recognize which students require scheduled albuterol prior to activity vs students who can selfcarry albuterol. Minimizes class absences for school nurse visits. D-F Stoplight zones Provide chronic, acute, and emergency treatment plan Allows for patientcentered treatment

13 Asthma Action Plan: Essential Components G Triggers School Significance Identify asthma triggers in the school. Educate patient about these triggers and avoidance. Patient Effect Decreases/avoids exposures to triggers. Improves asthma control. H Self-administer approval and nurse Designates children who can self-carry medications Allows early administration in acute need. agreement I Contact information Provides easily accessible and accurate provider contact information. Improves care coordination. J Parent release Authorizes providers and nurses to communicate in accordance with HIPPA and FERPA privacy laws. Ensures patient privacy and continued care coordination. K Nurse acknowledgement Acknowledges receipt and school agreement plan outlined in the AAP. Improves circle of communication between providers and school nurses.

14 GetAsthmaHelp.org

15 Component 3: Comprehensive Education Plan for Patients and Schools Links and resources for many national programs are available through the SAMPRO toolkit. Asthma education should be integrated amongst clinicians, schools and families address health literacy and multicultural beliefs

16 Asthma Basics American Lung Association

17 Open Airways For Schools Recognize the characteristics and potential causes of asthma Discuss the treatment and prevention of asthma symptoms in children Teach the Open Airways For Schools program directly to students with asthma Explain the objectives of the Open Airways For Schools program Describe the development and overall evaluation of the OAS curriculum

18 Asthma For School Personnel

19 Component 4: Assessment and remediation of environmental asthma triggers in schools Indoor air quality/ exposure to asthma triggers can greatly affect Children School staff Indoor Air Quality Management Programs (IAQ) Reduce asthma triggers Improve asthma quality through the use Interventions most successful when involve Janitors Bus drivers School administrators Teachers

20 Asthma in Michigan Schools

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22 Smoke Free Are the school buildings and grounds free of tobacco smoke at all times? Are all school buses, vans, and trucks free of tobacco smoke? Are all school events, like field trips and team games (both athome and away ), free from tobacco smoke?

23 Access to rescue inhalers Does your school have a policy or rule that allows students to carry and use their own asthma medicines? If some students do not carry their asthma medicines, do they have quick and easy access to their medicines?

24 Emergency Planning Does your school have a written emergency plan for teachers and staff to follow to take care of a student who has an asthma attack? In an emergency, such as a fire, weather, or lockdown, or if a student forgets his/her medicine, does your school have standing orders and quick-relief medicines for students to use?

25 Asthma Action Plan Do all students with asthma have updated asthma action plans on file at the school? An asthma action plan is a written plan from the student s doctor to help manage asthma and prevent asthma attacks.

26 School Nurse Is there a school nurse in your school building during all school hours? Does a nurse identify, assess and monitor students with asthma at your school? Does he/she help students with their medicines, and help them be active in physical education, sports, recess, and field trips? If a school nurse is not full-time in your school, is a nurse regularly available to write plans and give the school guidance on these issues?

27 Asthma Education Does the school nurse or other asthma education expert teach school staff about asthma, asthma action plans, and asthma medicines? Does someone teach all students about asthma and how to help a classmate who has asthma?

28 Physical Activity Can students with asthma fully and safely join in physical education, sports, recess, and field trips? Are students medicines nearby, before and after they exercise? Can students with asthma choose a physical activity that is different from others in the class when it is medically necessary? Can they choose another activity without fear of being ridiculed or receiving reduced grades?

29 Indoor Air Quality Does the school have good indoor air quality? Does the school help to reduce or prevent students contact with allergens or irritants, indoors and outdoors, that can make their asthma worse? (Including mold, dust mites, cockroaches, and strong odors or fumes from things like bug spray, paint, perfumes, and cleaners.) Does the school exclude animals with fur or feathers?

30 Tragic School Death

31 Medical Emergency Response Team MERT

32 Medical Emergency Response Plan Outlines staff actions during Minor medical emergencies Major medical emergencies Not first aid or CPR steps or sequences MERT members CPR and First Aid Certified Designated by Administrator

33 Members of M.E.R.T Team Medical Emergency Response Team Members Principal Secretary Paraprofessional Teachers Teachers with students with special needs School Nurse P.E. Teacher Other

34 What does a medical emergency look like? Bleeding Shortness of breath Unconscious Group assembled Screaming for Help

35 Many actions occurring simultaneously 1. Recognize emergency 2. Check to make sure the scene is safe. 3. Call 911 from? 4. Assemble MERT Announce Secure Mode 5. Buddy Classrooms utilized 6. Take First Aid, AED, EPI, ECP to scene 7. Provide care to patient 8. Call parents 9. Meet EMS and show them to patient 10. Meet parents in parking lot 11. Inform Central Administration 12. Scene control 13. Communication Plan / Rumor Control 14. Documentation of event 15. Debrief Lessons learned/ QI

36 Communication Plan Communication Mode Phones Call Button Walkies/Radio Runners Protocol Cell Phone Classroom Phone Office Phone Walkie/Radios Procedure Radio Check-in Base Daily Check in Track down

37 Medical Emergency Response Anaphylaxis Asthma Cardiac Seizures Diabetes Opioid Overdose Other Injuries including Shock and Blood Loss

38 Asthma

39 What is Asthma? 1. Tightened muscles constrict airway 2. Airway wall inflamed/thickened 3. Mucus is produced

40 Early Warning Signs Physical and emotional changes Happen before the child begins to experience breathing difficulties. Not the same for everyone Could be signs of other illnesses

41 Early Warning Signs Physical Early Warning Signs Shortness of breath Tightness in chest Pain in chest Less able to exercise Tired Itchy throat Watery eyes Fever Dry mouth Clammy skin Pale Fast Heartbeat Sneezing Congestion Dark circles around eyes Emotional Early Warning Signs Gets upset easily Feels sad Wants to be alone Feels nervous Gets excited easily Feels restless

42 Allergens including house dust mites, animal dander, molds, pollen and cockroach droppings Tobacco smoke Asthma Triggers Air pollution, strong odors or fumes Many patients with asthma develop asthma symptoms when exercising. This is called exercise-induced bronchoconstriction (EIB) Medications including aspirin or ibuprofen, and beta-blockers Emotional anxiety and stress Viral and bacterial infections such as the common cold and sinusitis. Exposure to cold, dry air or weather changes. Acid reflux, with or without heartburn.

43 Asthma Symptoms Shortness of breath Chest tightness or pain (a young child may say that his chest hurts or feels funny ) Chronic coughing Trouble sleeping due to coughing/wheezing Coughing that is: constant made worse by viral infections happens while your child is asleep triggered by exercise and cold air Wheezing or whistling sound when your child exhales Shortness of breath or rapid breathing, which may be associated with exercise Fatigue (your child may slow down or stop playing) Problems feeding or grunting during feeding (infants) Avoiding sports or social activities

44 Quick Relievers (Rescue Meds) Relax the muscles of the airway Generally work within 5 minutes ARE USED TO TREAT AN ASTHMA ATTACK OR SYMPTOMS OF AN ASTHMA ATTACK

45 What is a Spacer? Spacer or Valved Holding Chamber Holds the medicine KEEPS MUCH OF THE MEDICATION IN THE AIRWAYS INSTEAD OF ON THE TONGUE, THE BACK OF THE THROAT OR IN THE AIR

46 Benefits of using a Spacer Getasthmahelp.org

47 1. Take off the cap and shake canister; attach to spacer 2. Breath out all the way 3. Hold the inhaler/spacer as instructed by the doctor MDI Metered Dose Inhaler 4. Press down on the inhaler one time, then breath in slowly for 5 seconds 5. Keep breathing in slowly as deeply as possible 6. Hold breath and count to ten slowly 7. Let breath out slowly for 5 seconds 8. Wait 1 minute between each puff 9. If no improvement after 10 minutes, call doctor immediately

48 If you have asthma, your asthma may be poorly controlled if you... Asthma Rules of 2 Take a quick relief (rescue) inhaler (like albuterol) for problems more than 2 times a week Awaken at night with asthma problems more than 2 times a month Refill a quick relief inhaler more than 2 times a year If you have asthma and it is poorly controlled, call your health care provider!

49 Asthma Action Plan

50 Asthma Emergency Treatment Plan

51 Medical Emergency Response

52 What questions do you have?

53 Thank You! Evilia Jankowski MSA, BSN, RN