Andrea Holka Executive Director Attack On Asthma Nebraska.
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2014 School health conference Andrea Holka Executive Director Attack On Asthma Nebraska
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Transcript of Andrea Holka Executive Director Attack On Asthma Nebraska.
2014 School health
conference
Andrea HolkaExecutive Director
Attack On Asthma Nebraska
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
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348,812 students Nebraska approved/accredited public, non-public & state operated
districts/systems
Over 35,000 asthmatic students
Only 213 school nurses spread out over Nebraska schoolsRecent DHHS survey shows that only 26.5% of Nebraska schools have a nurse in the building 20+ hours a week.
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348,812 students Nebraska approved/accredited public, non-public & state operated
districts/systems
Over 27,000 food-allergic students
Be Prepared
Checklist can be found on page 11 of the “Green Book” and is recommended to assist schools and staff with Rule 59 education and training
TOOLS – Green Book, Primer, Skills Card, Posters, Back to School checklists, Asthma/Allergy Action Plan – UPDATED!
CPR - Family & Friends / CPR Made SimpleThese are abbreviated training courses not designed for those with a duty to respond in a school setting
See AOAN Position Statement online
• Website is full of resources and files for you to download. www.airenebraska.org
Set the Expectation! End of school year – use Back to School checklists, Asthma/Allergy
Action Plan Let parents know what the school needs for their child to be in
school safely with asthma or severe allergy School physicals – right after school ends
Back to School – use Back to School checklists, Asthma/Allergy Action Plan Let parents know what the school needs for their child to be in
school safely with asthma or severe allergy Kindergarten Round-Up – use Back to School checklists,
Asthma/Allergy Action Plan Let parents know what the school needs for their child to be in
school safely with asthma or severe allergy Throughout the school year
Let parents know what the school needs for their child to be in school safely with asthma or severe allergy
Auto-Injectable epinephrineFOUR devices currently on the market:
EpiPen® - ONLY device authorized as Rule 59 medication
Epinephrine auto-injectors
FREE EpiPen® - for schools!
Epipen4schools.comEach eligible school can receive up to four FREE EpiPen®
or EpiPen® Jr Auto-Injectors in the form of two EpiPen 2-Pak® cartons, two EpiPen Jr 2-Pak® cartons, or one 2-Pak of each kind.
In addition…, Mylan Specialty offers a discount program through which schools can purchase, …, EpiPen 2-Pak ® cartons (0.3 mg) and EpiPen Jr 2-Pak ® cartons (0.15 mg) at a discounted price of $112.10 each.
EpiPen® - for patientswww.epipen.com for details
This offer may be used on up to three EpiPen 2-Pak cartons per prescription. This offer can be used an unlimited number of times until the offer expires on 12/31/2014. Patients with questions should call 1-855-859-2971.
Auvi-Q – for patients
www.auvi-q.com for details
This offer is not valid for prescriptions covered by or submitted for reimbursement under Medicaid, Medicare, or similar federal or state programs including any state medical pharmaceutical assistance program.
Most patients pay $0 out of pocket for Auvi‑Q prescriptions through December 31, 2014.
Let’s review…..IF it is not a life-threatening breathing emergency
– the protocol is not necessary Identified student – follow student’s action plan / protocol
is secondary
IF you use the medications out of order – you place both yourself (licensure), the school (liability) and the patient at risk (death)
Civil Liability Immunity - protocol must be implemented correctly!! Medications must be administered in order stated on the protocol!
After Epinephrine…..
“Children with symptoms of anaphylaxis should be placed in a recumbent position with their legs elevated. Because cases of sudden death have been reported in children who stood up during a severe reaction, the recumbent position should be maintained. If symptoms persist or progress, epinephrine can be repeated after 5-15 minutes. In up to 20% of the cases of anaphylaxis, biphasic reactions occur. Therefore children who under-go food-induced anaphylaxis and receive epinephrine should be transported by ambulance to an emergency facility.”
Lancet, July 2013
Please, Please, Please report!Any time a Rule 59 medication is used – according to
the protocol (or not) – please fill out the NEW REVISED Emergency Report Form found online at www.airenebraska.org
Update your files/emergency bags with the one dated May 2013
Psst! I don’t bite, have no regulatory authority or licensing influence – I learn from each of you and hope you learn from me
Please call me, email me or talk to me here!
Nebraska data tells us:that the majority of incidents happen in the beginning of the
school year – Aug, Sep, Oct, Nov CONCLUSION – front-load school year with education &
trainingCONCLUSION – share student’s health information & set
the expectation!
that the greatest number of incidents occur in conjunction with activity CONCLUSION – educate & train PE teachers, coaches,
recess staff CONCLUSION – share student’s health information &
ensure immediate access to emergency medications
Nebraska data tells us:that the greatest number of incidents occur in students with a
history of asthma CONCLUSION - identify students, share student’s health
information & set the expectation
2010-11 - 10% of emergency events at school ALLERGIC reactions
2011-12 – 27% 2012-13 – 21%
• CONCLUSION – identify students, share student’s health information
CONCLUSION – educate & train all staff coming into contact with this student
Answers4families.orgSchool Nurse 101 [Recording] – click on last line for MORESchool Nurse (special): Rule 59 Protocol in
Nebraska Schools - A in-depth look at the Rule 59 protocol and some common questions and scenarios
A in-depth look at the Rule 59 protocol and some common questions and scenarios
School Nurse (special): Rule 59 Protocol General Staff Education
This is a webinar version of the Gen Ed PowerPoint for all staff
Education for Coaches, PE staff
FREE, online video training designed for physical education teachers and coaches
Winning with Asthma
www.winningwithasthma.org
Identified studentIdentified student – with action plan and meds at school
EMERGENCY – use personally prescribed meds according to their plan Is student using inhaler correctly? Can you assist student in
correct usage? Takes 10 minutes or so for quick-relief medication to provide relief. Most plans allow for another dosage after 10 minutes. Show them belly breathing and work with them.
Patient getting worse If you decide the patient is not getting relief from their action
plan, the Rule 59 protocol is next – starting with the EpiPen® and then moving to nebulized albuterol – having someone dialing 911 at the same time.
Self-Management
Let parents know HOW to do this the RIGHT way! (action plan, parental consent & waiver, physician authorization)
Parents don’t know what they don’t know
Make this information easy to find – on school website, in newsletters throughout the year, etc.
Talk to your 7-12 students whom you know carry an asthma/severe allergy diagnosis - are they carrying?
Set the expectation!
Disclosing Student Health Information
Have you ever wondered about how or what you can or should share about a student’s health condition?
You need to know that this can be done and should be done for student’s identified with chronic and other health conditions (asthma, life-threatening allergy, diabetes, etc).
For detailed information, please see document:Sharing Student Health Information
http://www.nasn.org/Home/NASNRadio - Martha Bergren podcast
Unidentified student/staff
Unidentified student/staff = no action plan, no meds
EMERGENCY! – if this IS a LIFE-THREATENING BREATHING EMERGENCY you use the Rule 59 protocol - starting with the EpiPen® and then moving to nebulized albuterol – having someone dialing 911 at the same time.
So, what if….
A student identified with severe allergy comes in to the health office and they are having a reaction. You know this student has an epinephrine auto-injector, so you pull that out and administer.
Secretary is calling 911, then Mom, you nebulize albuterol. The student is improves, EMS arrives, the student is transported. Student’s outcome is great!
So, what if….
A student identified with severe allergy comes in to the health office and they are having a reaction. You know this student has an epinephrine auto-injector, so you pull that out and administer.
Secretary is calling 911, then Mom, you nebulize albuterol. The student is improves, EMS arrives, they decline transportation, or parent signs off?
Nebraska EMS
AIRE Nebraska is working with Nebraska EMSApril – largest tele-health call EVER at Children’s
Hospital & Medical Center!ConferencesState EMS board meetingsWorking on discounted epinephrine auto-injectors
What can YOU do?Contact your local EMS – form a relationshipEducation, training, do they carry epi, do
they carry albuterol
Things to consider…
Allergy action plans rarely, if ever, come with instructions to nebulize albuterol. If you have a student with both meds, then the medication should be stored together.
Store a copy of the student’s action plan WITH their medications – makes it handy to refer to rather than fumbling with files – digital or paper – in an emergency.
Medication organization
Visualize with me ~ Epi 1st
Emergencies Something to think about:• Can you, in a brief period of time, pull your
identified kids’ medications together for an emergency situation – fire, shelter-in-place, tornado, etc?
• Don’t forget the protocol meds and first aid/emergency bag too?
THINK ABOUT IT!
Medication Organization
July 2013
January 2014
April 2014
Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs
The CDC guidelines seek to protect the physical and emotional health of students with food allergies by providing practical information and strategies for schools while reinforcing federal laws and regulations. The guidelines are intended to support the implementation of school food allergy management policies in schools and early childhood programs, and guide improvements to existing practices. Implementing these guidelines may help schools reduce allergic reactions, improve response to life-threatening reactions, and ensure current policies are in line with laws that protect children with serious health issues.
FOUND on our NEW website!!
Coming this summer…
Updated will be:Asthma/Allergy Action Plan – to allow for
immediate epi regardless of symptoms, to allow for two doses epi, to allow for other health care providers to sign (PC for PA’s)
Education – Gen Ed PowerPoint Training – ERT PowerPointNDE – Medical Statement Form to Request
Special Meals and/or Accommodations
Watch your email inbox for updates!
Visit AIRE Nebraska online!
Check out our NEW website:
www.airenebraska.org
Sign up for the AIRE Nebraska newsletter at my table and pick up some new materials.
HELP! What would you like to see on the SCHOOL NURSE page? Tell me!
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Andrea Holka Board Members: Executive Director, Karen Boehm, NSNAPhone: (402)616-9600 Susan Puckett, CNSNA
NOW: [email protected] A WHILE:[email protected]
Please join us on the AIRE Nebraska board of directors!
Thank You Karen Boehm!
Thanks for being a Nebraska School Nurse!!
