ADMINISTRATIVE PROCEDURES

Transcription

1 PROCEDURE NO: A-SE ADMINISTRATIVE PROCEDURES SUBJECT: ASTHMA MANAGEMENT INTRODUCTION Bill 20, Ryan s Law, an Act to protect pupils with asthma, came into effect April 30, This law is intended to protect pupils with asthma by ensuring asthma friendly schools. Ryan s Law requires every school board to establish and maintain an asthma policy and every school principal to develop individual plans for any student with asthma. It also stipulates that school principals must allow a student to carry his or her own asthma medication if the student has his or her parent s or guardian s permission. If the student is 16 years or older, he or she is not required to have his or her parent s or guardian s permission. BASIC UNDERSTANDING Asthma is a chronic inflammatory condition that occurs in the smaller airways of the lungs. People with asthma often have trouble breathing when they are in the presence of what are called "triggers." A trigger is any thing or condition that causes inflammation in the airways leading to asthma symptoms. When someone with asthma has asthma symptoms, it means that the flow of air is obstructed as it passes in and out of the lungs. This happens because of one or both of the following reasons: The lining of the airways becomes inflamed (irritated, reddened and swollen), and may produce more mucous. The muscles that surround the airways become sensitive and start to twitch and tighten, causing the airways to narrow. Both of these factors cause the airways to narrow, making it difficult for air to pass in and out of them. The more inflamed the airway, the more sensitive it becomes and this leads to an increase in breathing difficulty. Sudden narrowing of the airways produces what is often called an asthma attack. Symptoms of Asthma Symptoms of asthma include: Difficulty breathing Shortness of breath Coughing Wheezing Chest tightness Page 1 of 14

2 Symptoms can vary in severity; they can be mild or moderate and affect activity levels, or they can be severe and life threatening. Symptoms can be reversed with medication and by reducing exposure to environmental triggers. Triggers of Asthma There are several types of triggers that can bring on asthma attacks. Schools can identify and manage asthma triggers through environmental awareness and best practices. Inflammatory (allergic) triggers can cause inflammation of the lungs' airways or tightening of the airways' muscles. Inflammatory triggers include: Dust mites Animals Cockroaches Moulds Pollens Viral infections (common colds) Certain air pollutants Symptom (non-allergic) triggers generally do not cause inflammation, but they can provoke "twitchy" airways, especially if they are already inflamed. Symptom triggers include: Smoke Exercise Extremes of temperature (cold or hot and humid) Chemical fumes and other strong smelling substances such as perfumes, markers, paint, art supplies, cleaning products and glue Certain food additives like sulfites Certain air pollutants Intense emotions Treatment of Asthma Treatment of asthma is generally through medications that work to relieve symptoms in one of two ways. They either control or prevent the inflammation and mucous production or relieve the muscle tightness around the airways. Controller/Preventer Medication: (Flovent, Advair, Qvar, Pulmicort, etc.) Used daily, before and after school at home, to prevent asthma attacks (often inhalers are a variety of colours orange, purple, brown, red) Decreases and prevents swelling of the airways Can take days to weeks of regular use to work effectively Reliever Medication: (Ventolin/Salbutamol, Bricanyl, etc.) Used to relieve symptoms of asthma and often called the rescue inhaler (inhalers are usually blue in colour) Needs to be readily accessible at all times Provides relief quickly, within minutes Relaxes the muscles of the airways Taken only when needed or prior to exercise if indicated Emergency Medication refers to a medication that is administered by a staff member to a student at the time of an asthma exacerbation. Emergency Medication is also considered Reliever Medication. Page 2 of 14

3 Anaphylaxis and Asthma People with asthma who are also diagnosed with anaphylaxis are more susceptible to severe breathing problems when experiencing an anaphylactic reaction. It is extremely important for these asthmatic students to keep their asthma well controlled. In cases where an anaphylactic reaction is suspected, but there is uncertainty whether or not the person is experiencing an asthma attack, epinephrine should be used first. Epinephrine can be used to treat lifethreatening asthma attacks as well as anaphylactic reactions. Asthmatics that are at risk of anaphylaxis should carry their asthma medications (e.g. puffers/inhalers) with their epinephrine auto-injector (e.g. EpiPen). It is important to be aware that allergic and asthmatic individuals report that certain odours, even in small amounts, can trigger an attack. Due to health concerns arising from exposure to scented products, staff and students are asked to be considerate in their use of such products. A scent friendly learning environment is to be promoted in all school settings. Management of Asthma Effective management of asthma enables students with asthma to maintain a normal activity level, prevents symptoms of acute episodes, and minimizes the amount of medications and medication side effects. Managing asthma relies on: Taking medication exactly as prescribed Monitoring students with asthma Recognizing the early warning signs of asthma Avoiding or controlling triggers Intervening with proper therapy when early signs are recognized Forming a partnership among the student, parent(s) or guardian(s), the physician, and school staff The school team plays an important role in helping students manage their asthma by providing support for the development and implementation of an Asthma Management Plan. ADMINISTRATIVE PROCEDURES In support of Ryan s Law: An Act to Protect Asthmatic Pupils, the Lambton Kent District School Board is committed to providing a safe learning environment for all students. In order to work towards this goal, it is necessary for school administrators and staff to take steps to safeguard students with asthma. To that end, where there is a student with asthma, the principal shall prepare a plan that clearly outlines procedures in three key areas: 1.0 Communication 2.0 Strategies to Reduce Risk 3.0 Emergency Response It will be the responsibility of the Board to review the asthma policy as part of its regular policy review cycle and include the asthma policy in the board policies posted on the school and board web sites. Page 3 of 14

4 1.0 COMMUNICATION PLAN 1.1 Identification of Asthmatic Students to School Authorities It is the responsibility of parents with asthmatic children to identify their children to the school principal and provide: information regarding identified asthma triggers; a current Asthma Management Plan, signed by the child s physician/health care provider (Appendix 1); a Consent for Administration of Medication to be completed by the parent/guardian and the physician, and forwarded to the principal for each school year and whenever the physician directs a modification of the prescribed medication. This includes a note from the parent/guardian confirming when administration of the medication is to end; medication labeled with the child s name and the expiry date; renewed medication prior to the expiry date; guidance to their child in developing independent coping skills in the management of his or her medical condition; a medic-alert bracelet/necklace for their child which identifies asthma (available free through No Child Without Program ). It is recommended that identification of students, and student information updates are completed during the school registration process. Parents are also asked to participate in annual reviews of treatment plans. 1.2 Identification of Asthmatic Students to School Personnel It is the Principal s responsibility: to ensure that upon registration, parents, guardians and pupils shall be asked to supply information about asthma; to develop and maintain an Asthma Management Plan (Appendix 1); to ensure that a Consent for Administration of Medication is on file for each student requiring asthma medication while at school; to allow a student to carry his or her own asthma medication if the student has his or her parent s or guardian s permission (If the student is16 years or older he or she is not required to have his or her parent s or guardian s permission); to notify all personnel (including secretaries, custodians, supply teachers, educational assistants, bus drivers, etc.) and others who are in direct contact with students on a regular basis, regarding the presence of a student who is asthmatic; to distribute and familiarize staff with the individual emergency procedures to be followed for students with asthma; to ensure that all staff complete appropriate training; to require the child s classroom teacher to keep a copy of the Asthma Management Plan in a place where it will be highly visible and readily understood by occasional teachers (If not posted in the classroom, it should be kept with the teacher s daybook); to monitor school environment for asthma triggers and take action to reduce exposure to triggers whenever possible (i.e. encourage staff and students to avoid use of strong smelling products). Page 4 of 14

5 1.3 Further Roles and Responsibilities It is the teacher s responsibility: to be aware of the Asthma Management Plan for an individual student with asthma; to become familiar with the emergency plan for handling worsening asthma; to participate in annual training regarding signs, symptoms and emergency treatment of asthma; to monitor for asthma triggers in the classroom environment and take action to reduce exposure to asthma triggers whenever possible; to discuss asthma with the class, in age appropriate terms; to facilitate ongoing communication with parents; to enforce school rules about bullying and threats; to leave medical information in an organized, prominent and accessible format for occasional teachers; to ensure that asthma medication and cell phones are taken on field trips. It is the student s responsibility: to have an age appropriate understanding of his/her asthma and its triggers; to comply with taking medications as required; to know how to use an inhaler (as developmental level permits); to have reliever inhaler with them at all times (with permission of parent/guardian) or know where it is stored and how to get it; to take responsibility as much as possible for avoiding triggers; to learn to recognize symptoms of an asthma episode; to inform an adult as soon as symptoms appear. 1.4 In-Service for Teachers and Other School Staff Regular training is needed to ensure school staff and others who are in regular contact with students understand that asthma can be a medical emergency which requires immediate treatment. The Principal will ensure that: in-service is completed annually for school personnel, occasional teachers and any others in direct contact with students (on: how to recognize and treat asthma attacks; administration policies that deal with asthma; and school protocol for responding to emergencies). 1.5 Sharing Information with Others The Principal will: share information about asthma with the school council; seek the input of the school council in reviewing strategies to provide a safe environment for the asthmatic child; develop a communication strategy to inform parents of the presence of students with asthma in their children s school and the measures being taken to promote a safe learning environment for those students; send reminders or information articles in school newsletters about asthma; Page 5 of 14

6 Sharing Information with Others Principal (continued): communicate through school newsletters, at the beginning of the year, that information on medical consent forms will be shared with board bus operators to ensure the health and safety of all students in the case of an emergency. Medical information will be kept in strict confidence and will be made available in the event of an emergency when the health and safety of a student is in question. If a parent objects to or has questions relative to sharing information, they should contact the principal at their earliest convenience. Identifying children with asthma is more difficult in a secondary school setting. Although parents must still bear the burden of responsibility for reporting the condition to the school, schools may wish to explore ways of encouraging and reminding them to do so, particularly with older students, those who have moved into the system, and those who have been recently diagnosed (Appendix 3). 2.0 STRATEGIES TO REDUCE RISK The goal of the Board s policy is to provide a safe environment for all children. Creating and maintaining an asthma-friendly environment demonstrates that schools recognize and respond to the needs of students and staff with asthma. Asthma-friendly schools allow students to maximize their potential and experience rewarding educational, social, and health benefits. Empowering students in a supportive environment helps students develop life-long skills for controlling their condition and improving their quality of life. The Lung Association of Ontario in conjunction with OPHEA has identified the following steps to help ensure an asthma friendly school. 1) Establish a process to identify students with asthma. 2) Ensure that all students with asthma have easy access to their prescribed reliever inhaler. Encourage students to carry their own inhalers (with permission of parent/guardian). If students are not permitted to carry their inhalers, then the reliever inhaler should be easily accessible at all times. 3) Establish a process for handling worsening symptoms and asthma attacks. Staff need to know how to recognize and manage asthma attacks. 4) Identify and reduce exposure to common asthma triggers. a. Encourage frequent hand washing to prevent the spread of viral infections. b. Use scent-free markers, non-toxic cleaning products and dust-free chalk. c. Discourage staff, students and volunteers from using scented products. d. Regularly maintain and inspect interior surfaces including carpets, rugs, curtains and blinds for dust, detritus and mould e. Consider keeping windows closed during high pollen count or poor air quality days (this can be monitored through local weather forecasts) f. If possible, schedule building repairs and cleaning when students and staff are least likely to be exposed. g. Exclude pets such as rodents and birds; avoid pet supplies such as saw dust h. From May through August consider avoiding activities in areas of high vegetation, i.e. grass, trees, blooming plants. i. Uphold the Smoke-Free Ontario Act make sure students, staff and visitors do not smoke on school property. Page 6 of 14

7 5) Encourage students with asthma to join in all activities to the best of their abilities. With controlled asthma, most students can participate in physical activity. Allow adequate time to warm up. Slowly increasing the intensity of the activity can reduce the chances of having asthma symptoms. Some students may need to use a reliever inhaler (usually blue) minutes before an activity. Avoid locations with higher levels of air pollution (near large roads/highways or idling school buses). 6) Provide staff and students with opportunities to learn about asthma. Schools are encouraged to display Asthma First Aid Posters at various locations around the school. 7) Work together. School boards, schools, day-care centres, teachers, coaches, families and health-care professionals should collaborate to create asthma friendly environments. 3.0 EMERGENCY RESPONSE Instructions for Managing Asthma Attacks (Appendix 2) Mild Episode If any of the following symptoms occur: continuous coughing difficulty breathing chest tightness wheezing Student may also be restless, irritable and/or very tired. Step 1: immediately use fast acting reliever inhaler (usually blue) use a spacer (valved holding chamber) if provided Step 2: check symptoms (only return to normal activities when all symptoms are gone) if symptoms get worse or do not improve within 10 minutes this is considered an Emergency; therefore, follow emergency steps Emergency If any of the following symptoms occur: breathing is difficult and fast lips or nail beds are blue or grey skin on neck or chest sucked in with each breath cannot speak more than 5 words between breaths Student may also be anxious, restless and/or very tired. Step 1: immediately use fast acting reliever inhaler (usually blue) use a spacer if provided Call 911, wait for the ambulance, do not drive the student to medical help Page 7 of 14

8 Step 2: if symptoms continue, use reliever inhaler every 5-15 minutes until medical help arrives While waiting for medical help to arrive: have student sit up with arms resting on a table (do not have student lie down unless it is an anaphylactic reaction) do not have student breathe into a bag stay calm, reassure the student, and stay by his/her side notify parent/guardian or emergency contact Location of Inhalers All students with asthma should have easy access to their reliever (rescue) inhalers. Ideally this is either on their person or in an agreed upon location where ease of access has been considered. Review Process Asthma Management Plans for each asthmatic student should be reviewed annually with staff and parents. In the event of an emergency response, an immediate evaluation of the procedure is recommended. Resources See Appendix LEGAL IMPLICATIONS Ryan s Law stipulates that employees of a board may be preauthorized to administer medication, or supervise a student while the student takes medication, in response to an asthma exacerbation, if the school has the consent of the parent, guardian or student. If an employee has reason to believe that student is experiencing an asthma exacerbation, the employee may administer asthma medication, even if there is no preauthorization to do so. The Bill provides that no action or other proceedings for damages shall be commenced against a board employee for an act or omission done or omitted by the employee in good faith in the execution or intended execution of any duty or power under this Act. Implementation Date: January 18, 2016 Revised: March 23, 2016 Reference: Ryan s Law Page 8 of 14

9 Procedure No. A-SE Appendix 1 INDIVIDUAL STUDENT ASTHMA MANAGEMENT PLAN School Board Logo Place Student Photo Here Student Name Date of Birth Ontario Education Number Grade Teacher Emergency Contacts (list 1n pnonty of contact) Age Name Relationship Daytime Phone Alternate Phone 1. ~ ~ ~ KNOWN ASTHMA TRIGGERS D Colds/flu/illness D Physical activity/exercise D Pet dander D Cigarette smoke D Pollen D Mould D Dust D Cold weather D Strong smells D Allergies (specify): D Anaphylaxis (specify allergy): D Other (specify): Asthma trigger avoidance instructions: RELIEVER INHALER USE AT SCHOOL AND DURING SCHOOL-RELATED ACTIVITIES A reliever inhaler is a fast-acting medication (usually blue in colour) that is used when someone is having asthma symptoms. The reliever inhaler should be used: D When student is experiencing asthma symptoms (e.g., trouble breathing, coughing, wheezing). D Other (explain): Use reliever inhaler -----~-~~~~~----- (Name of Medication) Spacer (valved holding chamber) provided? a Yes CJ No Place a check mark beside the type of reliever inhaler that the student uses: in the dose of (Number of Puffs) D Ventolin D Bricanyl D Other (specify): Page 1 of 3 Page 9 of 14

10 D Student requires assistance to access reliever inhaler. Inhaler must be readily accessible by teacher/supervisor. Reliever inhaler is kept: D With teacher/supervisor - location: D In locker#: Locker combination: Other location (specify): Student will carry his/her reliever inhaler at all times including during recess, gym, outdoor and off-site activities, and field trips. Reliever inhaler is kept in the student's: D Pocket D Backpack/fanny pack D Case/pouch D Other (specify): Does student require assistance to administer reliever inhaler? [] Yes Cl No D Student's spare reliever inhaler is kept: D In main office {specify location): In locker#: Locker combination: Other location {specify): CONTROLLER MEDICATION USE AT SCHOOL AND DURING SCHOOL-RELATED ACTIVITIES Controller medications are usually taken regularly every day to control asthma. Usually, they are taken in the morning and at night, so generally not taken to school (unless the student will be participating in an overnight activity). Use/administer in the dose of at the following times: (Name of Medication) Use/administer in the dose of at the following times: (Name of Medication) Use/administer in the dose of at the following times: (Name of Medication) CONSENT FOR STUDENT TO CARRY AND SELF-ADMINISTER ASTHMA MEDICATION VVeagreethat -...~,, {Student Name) D can carry his/her prescribed medications and delivery devices to manage asthma while at school and during school-related activities. a can self-administer his/her prescribed medications and delivery devices to manage asthma while at school and during school-related activities. [] requires assistance with administering his/her prescribed medications and delivery devices to manage asthma while at school and during school-related activities. D \/Ve will inform the school of any change in medication or delivery device. The medications cannot be beyond the expiration date. Parent/Guardian Name: Parent/Guardian Phone # : Daytime: Evening: Cell: Alternate: Parent/Guardian Signature: Student Signature: Date: Page 2 of 3 Page 10 of 14

11 PLAN REVIEW Optional review by health-care provider (e.g., Pharmacist, Respiratory Therapist, Certified Asthma Educator, Certified Respiratory Educator, Nurse, Medical Doctor, or other clinician working within their scope of practice): Attach prescription labels here Health-Care Provider's Name: Profession: ~ ~ Signature: Date: Names of staff with first aid training Principal's Name: Signature: Date: This publication is available in Accessibility for Ontarians with Disabilities Act (AODA) electronic format at Funded by the Government of Ontario fy>ontario G'phea THE :I: LUNG ASSOCIATION I Ontario Healthy Schools Healthy Communities Lung Health Information Line: LUNG (5864) Staffed by Certified Respiratory Educators info@on.lung.ca September 2015 Catalogue #2820 Page 11 of 14 Page 3 of

12 Managing Asthma Attacks Procedure No. A-SE Appendix 2 If any of the following occur: TAKE ACTION Continuous coughing Trouble breathing Chest tightness Wheezing (whistling sound in chest) Student may also be restless, irritable and/or very tired. If any of the following occur: Step 1: Immediately use fast-acting reliever inhaler (usually a blue inhaler). Use a spacer if provided. Step 2: Check symptoms. Only return to normal activity when all symptoms are gone. If symptoms get worse or do not improve within 10 minutes, this is an emergency follow steps below. EMERGENCY Breathing is difficult and fast Cannot speak in full sentences Lips or nail beds are blue or gray Skin on neck or chest sucked in with each breath Student may also be anxious, restless and/or very tired. Step 1: Immediately use fast-acting reliever inhaler (usually a blue inhaler). Use a spacer if provided. Call 911 for an ambulance. Follow 911 communication protocol with emergency responders. Step 2: If symptoms continue, use reliever inhaler every 5-15 minutes until medical help arrives. While waiting for medical help to arrive: Have student sit up with arms resting on a table (do not have student lie down unless it is an anaphylactic reaction). Do not have student breathe into a bag. Stay calm, reassure the student, and stay by his/her side. Notify parent/guardian or emergency contact. This publication is available in Accessibility for Ontarians with Disabilities Act (AODA) electronic format at To learn about asthma call The Lung Association Lung Health Information Line at LUNG (5864) or visit September 2015 Page 12 of 14

13 APPENDIX 3 A SAMPLE LETTER FOR SECONDARY SCHOOLS Dear Parents/Guardians: In order for the school to provide a safe and nurturing learning environment for our students and to act in the best interest of your son or daughter during an asthma episode, we invite and welcome your cooperation and support by providing the following: Inform the school if your son/daughter has asthma and their triggers. Encourage your son/daughter to carry their inhaler with them at all times or to have their inhaler in close proximity at all times (e.g. field trips). Ensure your son/daughter knows how and when to use their reliever medication properly prior to coming to school. Consider providing your son/daughter with a medic alert identification. At the secondary level students are at a stage (physical and intellectual conditions permitting) where they are able to take on more responsibility for their asthma condition. Please go over the following student responsibilities with your son/daughter. To carry or have in close proximity their inhaler medication at all times (e.g. at school, during physical activity, off site on field trips). To know how and when to use their reliever medication safely. To know the triggers to their asthma, and avoid where possible, To inform relevant teachers/coaches/supervisors that they have asthma, especially if they have exercise induced asthma or they are experiencing asthma symptoms. To tell their friends about their asthma and how they can help. To never remove themselves to a secluded spot (e.g. washroom) when they are experience asthma symptoms. Inform a teacher/staff member or responsible adult. To inform their parents if they are using the reliever inhaler more than 4 times per week (other than before exercise). Your support is greatly appreciated. Sincerely, Page 13 of 14

14 RESOURCES APPENDIX 4 Asthma Society of Canada and (toll free number ) No Child Without Canadian Medical Alert Foundation Ontario Ministry of Education, Prevalent Medical Conditions, Asthma: Ryan s Law OPHEA s, Asthma Friendly Schools Online Community OPHEA s, The Basics of Asthma, Allergies and Anaphylaxis (This poster is located in each school s Anaphylaxis Resource Kit). Additional resources are available at OSBIE Ensuring Asthma Friendly Schools: Bill 20, Ryan s Law, May 19, 2015, Mark Cunliffe, Risk Analyst Public Health School Asthma Program (This website contains many resources including fact sheets that can be used to educate school communities about asthma.) The Lung Association s Asthma Action Helpline: LUNG (5864) or visit Page 14 of 14