Asthma Management Recommendations For Child Care Centers

Transcription

1 City and County of San Francisco Edwin M. Lee, Mayor Asthma Management Recommendations For Child Care Centers These recommendations are intended to help provide a safe child care environment for children with asthma. Management of worsening asthma or an asthma emergency should be in accordance with each child s specific Asthma Emergency Care Plan. Each child with asthma should have an ASTHMA INFORMATION PACKET, which contains the following: 1) ASTHMA EMERGENCY CARE PLAN and MEDICATION FORM These forms contains information about the child s asthma, triggers, symptoms, asthma medications, and emergency contact numbers. The child s healthcare provider should sign these forms. There should be 2 copies at the child care center: one copy should be stored in the child s medical file and the other copy should be stored with the child s medications so that it can be easily referenced during an exacerbation. These should be updated as needed but no less than annually. 2) NEBULIZER CONSENT FORMS (LIC 9166) This form should be provided to the parents by the child care center after the parent has demonstrated how to administer medication to his/her child to all staff members who may be responsible for administering medication to the child. The parent should sign 1 copy of this form for every staff member who has received instruction. This form should be stored at the center in the child s medical file. You can obtain the ASTHMA INFORMATION PACKET from your child care health consultant. Section A Responsibilities of PARENTS/GUARDIANS of each child with asthma: o Return the ASTHMA INFORMATION PACKET to the child care center manager at the beginning of the year. o Ensure that all information in the child s medical file is kept up-to-date. o Communicate regularly with childcare providers about the child s asthma (e.g.. quickrelief medication usage, symptoms, and current coughs, colds or other illnesses). o Ensure that asthma medication is: Always available. A healthcare provider can Clearly labeled with the name of the medication, name of prescribe an the child, dosage, and special instructions. extra set of Removed promptly and replaced when expired. medications, Administered with a spacer and mask stored at the center. spacer and mask to be stored at Section B Responsibilities of CHILD CARE PERSONNEL: the center. o Provide the ASTHMA INFORMATION PACKET to parents/guardians of children with asthma at the beginning of the year. o Understand: o Which children at the center have asthma. o How to recognize and respond to worsening asthma and asthma emergencies.

2 o How to administer quick-relief asthma medications. o Meet with the child s parents/guardians upon enrollment to discuss the child s particular asthma triggers and tips for administering asthma medications. o Ensure that quick-relief (albuterol) medication: Is available in the classroom or with the provider if the child is outside of classroom. Use is recorded in the Medication Administration Log. Is disposed of appropriately when expired or when the child is no longer present. o Communicate with their supervisors and parents/guardians about observed asthma symptoms and administered medications. o Undergo annual asthma training in-person or online. o Allow children with asthma to participate in physical activities unless medically contraindicated. Section C Additional considerations o CLEANING THE INHALER: Inhalers should be cleaned at least once a week, depending on frequency of use. Talk to the child's parent/guardian about cleaning. o ENROLLMENT: A child with a known diagnosis of asthma should not be present at a child care center without the appropriate forms, medications, and equipment. A new enrollee s start date may be delayed until the requested information is made available to the child care center manager, at the manager s discretion. o ENVIRONMENTAL TRIGGERS: Steps should be taken to minimize asthma triggers at the center. Child care personnel should be aware of the asthma triggers for children with asthma and take special steps to minimize exposure for these children. Please see the attached checklist for information about common asthma triggers in child care settings. Your child care health consultant can help connect you with an environmental health expert at the San Francisco Department of Public Health if you have specific concerns. o EXERCISE: Some children with asthma need asthma medication prior to physical activity. This information should be provided by the child s healthcare provider on the Asthma Emergency Care Plan and discussed with the parent/guardian. Alternate or indoor activities should be made available to children with asthma, if necessary. o FIELD TRIPS: Children with asthma should be able to participate in field trips as long as asthma triggers are anticipated and minimized and medications are available. o FLU SHOTS: Annual flu shots are recommended for children who are 6 months and older because viral infections are the primary cause of flare-ups in young children. o SMOKE: The center should be smoke-free at all times. Smoking is prohibited within 20 feet of a child care center entrance, exit or operable window. Centers experiencing repeated incidents of smoke should post No Smoking signs outside the center. If the incidents continue, notify your child care health consultant. o QUESTIONS: Please talk to your child care health consultant if you have any questions or concerns about general asthma management or care for specific children. Asthma cannot be cured, but it can be controlled! The San Francisco Department of Public Health can provide annual in-person trainings. For online training, we recommend the California Department of Public Health (California Breathing) child care training video: esources/childcare-trainingvideo

3 City and County of San Francisco Edwin M. Lee, Mayor Dear Parent/Guardian, It has come to our attention that your child has a diagnosis of asthma or uses asthma medications, but certain important items are missing or expired. Please provide the following to the child care center as soon as possible so that we can be sure your child is receiving the best possible care: Current Physical Exam Asthma Emergency Care Plan and Medication Form Nebulizer Consent Form (LIC-9166) Quick-Relief or Rescue (Albuterol) Medication Spacer Mask Other: You can expect the child care center to do the following to help your child: o Minimize exposures to asthma triggers at the center o Keep a log of asthma medications administered at the center o Communicate with you about asthma symptoms observed at the center o Undergo regular training to be prepared to prevent and manage asthma flare-ups o Talk to me a certified nurse if there are any questions or concerns Let s work together to make sure your child can thrive! Sincerely, Your Child Care Health Consultant

4 Medication Log Child Name: Date Time Medication Dose/Amount Reason Given Staff Initials

5 How to Use an Inhaler with Spacer and Mask PRIMING A METERED DOSE INHALER Priming a metered dose inhaler is important before using it for the first time to be sure it provides the right amount of medicine. It may need to be primed again if it has not been used in a while. To prime most inhalers, take the cap off the mouthpiece, shake the inhaler well and spray it into the air. Check the instructions to see how many times you need to spray the inhaler to prime it, and when you need to prime it again. The inhaler is now ready to use. USING A SPACER WITH A MASK If your health care provider has prescribed a holding chamber with a mask for your child, follow these steps: 1. Insert the mouthpiece of the plastic holder into the holding chamber. 2. Shake the inhaler well. Keep the inhaler upright. 3. Place the mask on the child s face covering both the nose and mouth firmly. 4. Press the canister only once. 5. Have the child breathe in and out slowly for at least five breaths. Then remove the mask from the face. If your health care provider has prescribed more than one spray, wait at least one minute and repeat these steps again. This is general information. Read the instructions that come with the inhaler prescribed by your health care provider and follow them carefully. Also ask your health care provider to show you how to use the inhaler and to watch you use it. This handout was adapted and modified from the original developed by the Pediatric Asthma Coalition of New Jersey. Information in this handout is not intended to diagnose health problems or take the place of medical advice. For asthma or any medical condition, seek medical advice from your child s or your health care professional. Updated 12/3/2013

6 Quick Relief Medication Medicamentos de Efecto Inmediato Should always be available at child care center Siempre tenga disponible en la guardería Controller Medication Medicamentos de Efecto Prolongado For use by the family each day at home Para uso de la familia todos los días en casa ProAIR HFA Advair HFA Proven.l HFA Flovent HFA Ventolin HFA Pulmicort Flexhaler Updated 1/21/2014 Xopenex HFA QVAR

7 ASTHMA FRIENDLY CHILD CARE A Checklist for Parents and Providers Asthma is the most common chronic childhood disease. Children with asthma have sensitive airways. They are bothered by many things that start (or trigger ) their symptoms and make their asthma worse. The most common asthma triggers are allergies to dust mites, cockroaches, animal dander, mold, and pollens, and exposure to irritating smoke, smells, or very cold air. Children's asthma can also be triggered by excessive exercise or an upper respiratory infection. The airways of people who have asthma are chronically" (almost always) inflamed or irritated, especially if they are exposed to their triggers every day. This makes it hard for them to breathe. Asthma can be controlled by being aware of its warning signs and symptoms, using medicines properly to treat and prevent asthma episodes, and avoiding the things that trigger asthma problems. Each child's asthma is different, so it is important to know the asthma triggers and treatment plan of each individual. Use this checklist to learn how to make your child care setting a safe and healthy environment for children with asthma and allergies, or to help you choose a health child care placement for your child. Avoiding or Controlling Allergens Dust mites Surfaces are wiped with a damp cloth daily. (No aerosol "dusting" sprays are used.) Floors are cleaned with a damp mop daily. Small area rugs are used, rather than wall-to-wall carpeting. Woven rugs that can be washed in hot water are best. (Water temperature of at least 130. F/54. C kills dust mites.) If wall-to-wall carpeting can't be avoided, children are prevented from putting their faces, nap mats, blankets or fabric toys directly on the floor. Children's bed linens, personal blankets and toys, are washed weekly in hot water. Fabric items (stuffed toys or "dress up" clothes) are washed weekly in hot water, to kill dust mites. Furniture surfaces are wiped with a damp cloth. Soft mattresses and upholstered furniture are avoided. Beds and pillows that children sleep or rest on are encased in allergy-proof covers. Curtains, drapes, fabric wall hanging and other "dust catchers" are not hung in child care areas. If light curtains are used they are washed regularly in hot water. If window shades are used, they are wiped often with a damp cloth. Books, magazines and toys are stored in enclosed bookcases, closed boxes, or plastic bags. Supplies and materials are stored in closed cabinets; piles of paper and other clutter are avoided.

8 Animal substances: (both pets and pests shed dander, droppings and other proteins which cause allergic responses and trigger asthma symptoms) Furry or feathered pets are not allowed anywhere on the premises (cats, dogs, gerbils, hamsters, birds, etc.). Cockroaches and mice infestation are aggressively controlled, using preventive practices and least toxic extermination methods. Feather-stuffed furnishings, pillows or toys are not used. Mold and mildew: Exhaust fans are used in bathrooms, kitchens and basement areas to help remove humidity. Wet carpeting and padding are removed if not dry within 24 hours to prevent mold growth. Mats that are placed on carpeted floors (especially in basement areas) are vinyl-covered, and wiped regularly with diluted chlorine bleach and water (1/4 cup bleach in 1 gallon water). Mildew growth in bathroom and other damp areas (such as refrigerator drip pans) is prevented by regular wiping with diluted chlorine bleach and water. Indoor houseplants and foam pillows, which can develop mold growth, are not used. Outdoor pollen and mold spores: If ventilation is adequate, windows are kept closed during periods of high pollen count Air conditioners with clean filters are used during warm seasons, if possible. Outdoor yard and play areas are kept clean of fallen leaves, compost piles, and cut grass. Latex: (products made with natural rubber) Avoid latex gloves. If gloves are used, only non-powdered, non-latex gloves. Avoid latex balloons, pacifiers, koosh balls and other latex products (if child or staff member has latex sensitivity). Avoiding or Controlling Irritants Tobacco Smoke: (triggers asthma symptoms; causes children to have more respiratory and ear infections, and to need more asthma medication) Smoking is not allowed anywhere on the premises. This rule is strictly enforced. Staff and parents are encouraged to participate in smoking cessation programs, and given referrals and assistance.

9 Chemical Fumes, Fragrances, and Other Strong Odors: Arts and crafts materials with fragrances or fumes are avoided (e.g., markers, paints, adhesives). If they are used, extra ventilation is provided. Staff does not wear perfume or other scented personal products. (Use products labeled "fragrance-free" whenever possible.) Personal care products (such as hair spray, nail polish, powders) are not used around the children. Air fragrance sprays, incense, and "air fresheners "are not used. (Open the windows and/or use exhaust fans instead.) New purchases (such as pressed-wood furnishings or plastic laminated products) are checked for formaldehyde fumes, and aired out before installation. Cleaning supplies and home repair products with strong smells are not used when children are present; indoor spaces are carefully ventilated during and after their use. Office equipment that emits fumes (e.g., photocopy) are in vented areas away from children. Other Irritants: Fireplaces and wood or coal stoves are not used. Policies and Practices Asthma Management and Care: All staff are trained to watch for symptoms of asthma, warning signs that asthma is flaring up, and how to recognize emergency situations. New staff receive this training when hired. Every child with asthma has a written plan on file, listing allergies and asthma triggers, medication schedule, and emergency instructions. Staff is trained to administer medication, and in the use and care all of nebulizers, inhalers, spacers and peak flow meters. Parents and providers communicate regularly about child's asthma status. Outdoor time is adjusted for cold-sensitive children, and alternative indoor activities are offered (after an asthma episode or viral infection, they are also more sensitive.) Staff and children wash hands frequently; toys and surfaces are wiped often, to prevent the spread of viral infections that can trigger asthma. This checklist was developed by the Asthma & Allergy Foundation of America, New England Chapter, with the support of a grant from the U.S. Environmental Protection Agency, Region. I.

10 General Physical Site/Space: Ventilation provides good air flow in all rooms and halls in every season. There is no stale or musty smell. Outdoor intake and inside supply vents are checked for blockages. Heating or cooling system filters are properly installed and changed often; other service guidelines and routine maintenance procedures are followed. Heating or cooling ducts are professionally cleaned once a year. Outdoor fumes (such as from car exhaust, idling vans or buses, or nearby businesses) are prevented from entering the building through open windows or doors. The building is checked periodically for leaks and areas of standing water. Plumbing leaks are fixed promptly. Humidity level is monitored, using a humidity gauge, if possible. Humidifiers are not used; dehumidifiers are used if necessary. (Dust mites and mold thrive on humidity.) Wet boots and clothing are removed and stored where they don't track wetness into activity space. Doormats are placed outside all entrances, to reduce tracking in of allergens. Cleaning and Maintenance: If rugs or carpets must be used, they are vacuumed frequently (every day or two). High efficiency vacuum cleaner (ideally with the "HEPA" filter) is used. (Others blow tiny particles back into the air.) Dusting is done often, with a damp cloth, to avoid stirring up the dust. Vacuuming and other cleaning is done when children are not present. Integrated pest management techniques are used, to limit amount of pesticide needed (e.g., seal all cracks in walls, floors and ceilings; eliminate clutter; keep food in air tight containers). Pesticides are applied properly, with adequate ventilation, when children are not present. Garbage is kept in tightly covered containers, and removed promptly to outdoor enclosed trash area that is not accessible to children. Painting, repairs or construction work is done when children are not present. Indoor spaces are protected from construction dust, debris, strong odors and fumes. Shampooing of rugs and upholstery is done with low emission, fragrance-free products. They are dried thoroughly to prevent growth of mold and dust mites. This checklist was developed by the Asthma & Allergy Foundation of America, New England Chapter, with the support of a grant from the U.S. Environmental Protection Agency, Region. I.

11 STUDENT PHOTO ASTHMA EMERGENCY CARE PLAN For School Use Only Location of Medication: San Francisco Unified School Distirct Student, Family, and Community Support Department School Health Programs 1515 Quintara Street San Francisco, CA Tel: Fax: TO BE COMPLETED BY PARENT/CAREGIVER Name: Date of Birth: School: Grade: Homeroom Teacher: Room: Parent/Caregiver Name: Phone (home): (cell): Address: Phone (work): TO BE COMPLETED BY THE HEALTH CARE PROVIDER Health Care Provider Treating Student for Asthma: Ph: Other asthma medication used at home: Does student require inhaler before exercise: No Yes If yes, please specify: medication to be given and # minutes before exercise Reduce exposure to the following asthma triggers: Dust/dust mites Cockroaches Pollen Animal fur Smoke Strong smells Temperature changes Having a cold/being sick Mold Air pollution ACTIONS TO TAKE Stay with student, remain calm and speak softly. Seat student in an upright position. Encourage slow and deep breaths. Assist with quick-relief medication: (name of the medication) If symptoms resolve completely, student may return to class. Call parent/guardian to inform. Difficulty speaking Flared or enlarged nostrils Rapid or shallow breathing Struggling or gasping for breath Continuous spasmodic coughing CALL 911 if student has Skin pulling in around neck with breathing Gray, dusky or bluish color around mouth or under nails I authorize school personnel to implement this Asthma Emergency Care Plan as described. I have completed a medication form for the quick relief medication. Administer CPR if Breathing Stops! Continue Until Paramedics Arrive! Health Care Provider Signature Date I give my consent for school authorities to take appropriate action for the safety and welfare of my child. I give my consent to communicate with the authorized health care provider when necessary. Parent/Caregiver Signature Date School Health Manual SFUSD Student, Family, and Community Support Department

12 San Francisco Unified School District - Student, Family, and Community Support Dept. Dear Parent/Guardian/Caregiver: MEDICATION FORM (One Medication Per Form) California Education Code provides that students required to take medically prescribed or over-the-counter medications during the school day MAY be assisted by school personnel ONLY if the school district receives a specific written statement from the health care provider AND the parent/guardian/caregiver of the student. Please complete this entire form and return it to the Principal.,, IF POSSIBLE, PLEASE SCHEDULE MEDICATION OUTSIDE OF SCHOOL HOURS. P l e a s e p r i n t l e g i b l y i n a l l s e c t i o n s Student Name: Last First Middle Date of Birth (Month/DayNear) I HEALTH CARE PROVIDER SECTION Health Condition for which medication is prescribed: Medication : Dose: Frequency : Duration: How is medication to be given? LI By mouth LI Inhalation CJ Injection LI Topical About what time does medication need to be given at school? LI Other: The medication is to be continued as above until : (please be as specific as possible about date) Any precautions that school personnel need to know? Contraindications? AM / PM What are possible reactions/side effects? What should be done in the event of reaction/side effect? Check annronriate boxes below: 0 I authorize this student to self-administer the above medication. 0 I authorize designated school personnel to administer the above medication. Print name, address & phone number of Health Care Provider Signature of Health Care Provider PARENT I GUARDIAN I CAREGIVER SECTION Parent/Guardian/Caregiver Name Home Language Daytime Phone ( ) Address -Number and Street Apt No. City Zip Code Evening Phone ( ) School School Hours Children's Center I Elementarv I Middle I Hi2h Check annronriate boxes below: 0 I permit my child to give himself7herself the above medication. 0 I permit designated school personnel to give my child the above medication. 1. I agree to hold the San Francisco Unified School District (SFUSD) and its employees harmless from any and all liability for the results of taking the medication or the manner in which the medication is given. 2. I will reimburse the SFUSD and its employees for any liability arising out of these arrangements. 3. I will notify the Principal of the school immediately if there is a change in my child's medication. 4. I understand it is my responsibility to send the medication to school in the original pharmacy container labeled with my child's name and the health care provider's instructions. s. I understand that this form automatically expires at the end of each school year. 6. I give my consent for school authorities to take appropriate action for the safety and welfare of my child. Parent/Guardian/Caregiver Signature Date SFUSD-SFCSD MEDICATION FORM Revised June 2010 http ://health jersf.org/fonns/index pdp SFUSD Student, Family, and Community Support Department c School Health Manual

13 STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY NEBULIZER CARE CONSENTNERIFICATION CHILD CARE FACILITIES CALIFORNIA DEPARlMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION This form may be used to show compliance with Health and Safety Code Section before a child care licensee or staff person administers inhaled medication to a child in care. A copy of the completed form should be filed in the child's record and in the personnel file. A separate form must be filled out for each person who administers inhaled medication to the child. I, -,-- _, give my consent for _ (PRINT NAME OF AUTHORIZED REPRESENTATIVE) (PRINT NAME OF LICENSEE OR STAFF PERSON) who work{s) at (PRINT NAME AND ADDRESS OF CHILD CARE FACILITY) to administer inhaled medication to my child, provider. (PRINT NAME OF CHILD),and to contact my child's health care In addition, I certify that I have personally instructed the above-named licensee or staff person on how to administer inhaled medication to my child. I have also provided the child care facility with written instructions from my child's physician, or from a health care provider working under the supervision of my child's physician {for example, a physician's assistant, nurse practitioner or registered nurse). These instructions include: Specific indications {such as symptoms) for administering the inhaled medication in accordance with the physician's prescription. Potential side effects and expected response. Dose form and amount to be administered in accordance with the physician's prescription. Actions to be taken in the event of side effects or incomplete treatment response in accordance with the physician's prescription. This includes actions to be taken in an emergency. Instructions for proper storage of the medication. The telephone number and address of the child's physician. SIGNATURE OF AUTHORIZED REPRESENTATIVE DATE ADDRESS OF AUTHORIZED REPRESENTATIVE HOME TELEPHONE NUMBER WORK TELEPHONE NUMBER UC 9166 (2/01)