School Health Conference Andrea Holka Executive Director, AIRE Nebraska

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1 School Health Conference 2015 Andrea Holka Executive Director, AIRE Nebraska

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3 Emergency Response to Life-Threatening Asthma or Systemic Allergic Reactions (Anaphylaxis) Rule 59 Protocol Omaha, NE late 1990 s asthma deaths at school Purpose to save the lives of those suffering from asthma and LTA (life-threatening allergy) who are undiagnosed and do NOT have a plan or medications at school This protocol DOES NOT replace a diagnosed child s asthma/allergy action plan or medications

4 Review 75 voluntarily reported incidents + 2 anecdotal reports to include 2 school visitors 0 deaths! 68% (75) had a history of asthma only 53% of these students had a plan/medications at school 16% (75) had no history of asthma/severe allergy 37% (75) had a history of severe allergy only 61% of these students had a plan/medications at school 29% (75) included a medication error 911 not called 3x

5 Student Identification What can be done? looking for suggestions

6 Medication Error What is a medication error? A medication error refers to an error (of commission or omission) at any step along the pathway that begins when a clinician prescribes a medication and ends when the patient actually receives the medication. Agency for Healthcare Research & Quality Usually involves an error in one of the 5 rights: right patient, right drug, right dosage, right time, and right route some articles add right reason

7 Medication Error and Rule 59 Protocol Administered school s albuterol only Administered school s albuterol followed by school s EpiPen Administered the student s auto-injectable epinephrine according to student s action plan and followed by administering school s albuterol Administered epinephrine to self! Administered school s EpiPen and then stopped student breathing fine now

8 WHO?? 59% of medication errors in School nurses Still missing a good chunk of data, but 33% right now for SUGGESTIONS WELCOME!

9 Auto-injectable Epinephrine 1. EpiPen EpiPen4Schools automated Pt coupon online Patient Assistance 2. Auvi-Q Pt coupon online Patient Assistance 3. Adrenaclick 4. Generic (for Adrenaclick) Pt coupon online

10 Don t be Surprised! FDA application for generic EpiPen device in process from Teva Don t know when, but this may affect the FREE EpiPen program.please be prepared!

11 New Kid on the Block! ProAir RespiClick DPI

12 How to Use ProAir RespiClick: 1. OPEN Make sure the cap is closed before each dose. Hold the inhaler upright as you open the cap fully. Open the cap all the way back until you hear a "CLICK". Your ProAir RespiClick inhaler is now ready to use. Do not open the cap unless you are taking a dose.

13 2. INHALE Breathe out through your mouth and push as much air from your lungs as you can. Put the mouthpiece in your mouth and close your lips around it. Breathe in deeply through your mouth, until your lungs feel completely full of air. Breathing in deeply through the mouthpiece will deliver the medication to your lungs. Do not let your lips or fingers block the vent above the mouthpiece. Hold your breath for about 10 seconds or as long as you comfortably can. Remove the inhaler from your mouth. Check the dose counter on the back of the inhaler to make sure you received the dose.

14 3. CLOSE Always close the cap after each inhalation so your inhaler will be ready for your next dose. If you need another dose close the cap and repeat all of the steps. ProAir RespiClick contains a powder and must be kept clean and dry at all times.

15 Common Questions What about the Preschool down the hall? NDE Approved Early Childhood Education Programs found on AIRE Nebraska website SCHOOLS page Our school needs a new nebulizer where do I get one? Nebulizers questions, ordering information, filters on SCHOOLS page

16 EMT s as School Emergency Response Team responders The discussion with the EMS Board was this: Nebraska Out of Hospital Emergency Care providers who respond to an emergency in their role on a school s emergency response team and with the training provided under NDE Rule 59 are doing so as a school employee / volunteer. School employees / volunteers who happen to be licensed as EMS providers are not bound by the limitations of their scope of practice and are not acting under their EMS license and are not responding as a part of their local EMS Service. Rene Tiedt, Program Manager Phone (402) Fax (402) rene.tiedt@nebraska.gov

17 Resources some new and some not so new! Is NOW!

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19 Thank You!

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21 Lincoln Half Marathon finished 71st overall and 11th in age group! Kellan & family Introducing Lindsey Frohn, MS, CCC-SLP