Managing respiratory emergencies at school: A county-wide stock inhaler program

Lowe, Ashley A.; Gerald, Joe K.; Clemens, Conrad J.; Stern, Debra A.; Gerald, Lynn B.

doi:10.1016/j.jaci.2021.01.028

Cited by 13 publications

(12 citation statements)

References 26 publications

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“…Because albuterol is a safe and potentially life-saving medication that is recommended by guidelines, it is important that schools make quick-relief medications available to all school-aged children, both with and without a documented asthma diagnosis. This failsafe measure can prevent exacerbations, reduce emergency service calls to schools, and enable children to return to class ( 29 ). Stock albuterol legislation is imperative to aiding in adoption and implementation, and key policy inclusions can lay the groundwork for success.…”

Section: Discussionmentioning

confidence: 99%

“…Alternative mechanisms include product or monetary donations from interested organizations (e.g., pharmaceutical companies, patient advocacy groups, hospitals), discounts or reimbursements from pharmaceutical companies, or fundraising through existing stakeholders, such as parent–teacher groups. Current programs cost less than $85.00 (in 2020 dollars) for an albuterol inhaler and needed supplies for a school ( 29 ). Program expenses may be affected by the number of inhalers needed at the school.…”

Section: Components For Implementation Of Stock Albuterolmentioning

confidence: 99%

“…Medical consultants who sign the standing medical order should have the ability to modify existing protocols on the basis of their clinical practice and guideline-based care. For example, in Arizona, a protocol using a standardized number of inhaler actuations (instead of a dose range) stratified by the initial presentation of symptoms was widely adopted ( 29 ). Importantly, treatment for any child who requires stock albuterol should follow the standardized protocol and prescription instructions specified on the standing medical order, regardless of whether they have an asthma action plan on file at school.…”

Section: Components For Implementation Of Stock Albuterolmentioning

confidence: 99%

“…Over the past decade, stock albuterol policies have increased across the United States, with at least 15 states passing such legislation and a few states with experience implementing such policies. One state reports that 84% of respiratory events treated with a stock inhaler resulted in the child returning to class ( 28 , 29 ). Because these policies are relatively new, further data are not available on the impact of stock albuterol.…”

Section: Introductionmentioning

confidence: 99%

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Ensuring Access to Albuterol in Schools: From Policy to Implementation. An Official ATS/AANMA/ALA/NASN Policy Statement

Volerman

Lowe²,

Pappalardo

et al. 2021

Am J Respir Crit Care Med

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Rationale: For children with asthma, access to quick-relief medications is critical to minimizing morbidity and mortality. An innovative and practical approach to ensure access at school is to maintain a supply of stock albuterol that can be used by any student who experiences respiratory distress. To make this possible, state laws allowing for stock albuterol are needed to improve medication access. Objectives: To provide policy recommendations and outline steps for passing and implementing stock albuterol laws. Methods: We assembled a diverse stakeholder group and reviewed guidelines, literature, statutes, regulations, and implementation documents related to school-based medication access. Stakeholders were divided into two groups—legislation and implementation—on the basis of expertise. Each group met virtually to review documents and draft recommendations. Recommendations were compiled and revised in iterative remote meetings with all stakeholders. Main Results: We offer several recommendations for crafting state legislation and facilitating program implementation. 1 ) Create a coalition of stakeholders to champion legislation and implement stock albuterol programs. The coalition should include school administrators, school nurses and health personnel, parents, or caregivers of children with asthma, pediatric primary care and subspecialty providers (e.g., pulmonologists/allergists), pharmacists, health department staff, and local/regional/national advocacy organizations. 2 ) Legislative components critical for effective implementation of stock albuterol programs include specifying that medication can be administered in good faith to any child in respiratory distress, establishing training requirements for school staff, providing immunity from civil liability for staff and prescribers, ensuring pharmacy laws allow prescriptions to be dispensed to schools, and suggesting inhalers with valved holding chambers/spacers for administration. 3 ) Select an experienced and committed legislator to sponsor legislation and guide revisions as needed during passage and implementation. This person should be from the majority party and serve on the legislature’s health or education committee. 4 ) Develop plans to disseminate legislation and regulations/policies to affected groups, including school administrators, school nurses, pharmacists, emergency responders, and primary/subspecialty clinicians. Periodically evaluate implementation effectiveness and need for adjustments. Conclusions: Stock albuterol in schools is a safe, practical, and potentially life-saving option for children with asthma, whether asthma is diagnosed or undiagnosed, who lack access to their personal quick-relief medication. Legislation is imperative for aiding in the adoption and implementation of school stock albuterol policies, and key policy inclus...

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Section: Discussionmentioning

confidence: 99%

Section: Components For Implementation Of Stock Albuterolmentioning

confidence: 99%

Section: Components For Implementation Of Stock Albuterolmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Ensuring Access to Albuterol in Schools: From Policy to Implementation. An Official ATS/AANMA/ALA/NASN Policy Statement

Volerman

Lowe²,

Pappalardo

et al. 2021

Am J Respir Crit Care Med

Self Cite

View full text Add to dashboard Cite

show abstract

“…When breathing difficulties occur at school, emergency medication (e.g., albuterol sulfate) may be necessary to quickly relieve the child's symptoms. Often, children with access to this medication return to their learning environment and the need for an emergency medical system may be obviated (Gerald et al, 2016;Lowe et al, 2021). However, schools experience numerous challenges with emergency medication administration regardless of their ability to staff a full time, licensed nurse (Morris et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Medication Administration Practices in United States’ Schools: A Systematic Review and Meta-synthesis

Lowe

Gerald

Clemens

et al. 2021

The Journal of School Nursing

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Schools often provide medication management to children at school, yet, most U.S. schools lack a full-time, licensed nurse. Schools rely heavily on unlicensed assistive personnel (UAP) to perform such tasks. This systematic review examined medication management among K-12 school nurses. Keyword searches in three databases were performed. We included studies that examined: (a) K-12 charter, private/parochial, or public schools, (b) UAPs and licensed nurses, (c) policies and practices for medication management, or (d) nurse delegation laws. Three concepts were synthesized: (a) level of training, (b) nurse delegation, and (c) emergency medications. One-hundred twelve articles were screened. Of these, 37.5% (42/112) were comprehensively reviewed. Eighty-one percent discussed level of training, 69% nurse delegation, and 57% emergency medications. Succinct and consistent policies within and across the United States aimed at increasing access to emergency medications in schools remain necessary.

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