Do you have albuterol standing orders or a respiratory distress protocol?

[great_lakes_expat]

Hi nurses! Does your district have a respiratory distress protocol, with standing orders for albuterol or other emergency meds? Would anyone be willing to share your district's policy? I would love to have some examples to show my administrators.

We don't have albuterol orders, and I would say 99% of the EMS calls I make are for respiratory distress from asthma. Often they are known asthmatics and sometimes I even have their inhaler on hand, but it's not enough. I've worked to get neb orders for some of my worst asthmatics, but I have 150 asthmatics in my school and I can't possibly predict who's going to have a flare next. And then there are the kids who I don't even know have asthma until they walk into my office wheezing. I'm tired of calling 911 to get a kid a neb treatment. Or calling a parent and then crossing my fingers they get here in time.

Thank you in advance!

[OldDude]

I wish we did...but we don't have a medical director

[JenTheSchoolRN, BSN, RN]

I don't have standing orders for albuterol, though I have debated it with my school's physician. I don't have a neb machine and wonder if I get one, how I can ensure I can clean it well enough for multiple student use. I also have had multiple students doing a neb in my office at once, so wondering if I'd need more than 1 machine if we went this route. (I welcome input from folks that have one and how they manage this, though. I'm talking beyond mouth pieces.)

If a neb is part of the asthma action plan, I can start there re: orders for neb/inhaler.

So now my protocol is that I'll call 911 if I need to. (I also don't have O2 and the fire department around the corner can get me 02 in less than 2 minutes.) I just did for one of my severe asthmatics as she needed a neb now vs later and she did not bring her neb to school with her like she usually does.

[SaltineQueen]

We do. Send me your email.

[JenTheSchoolRN, BSN, RN]

We do. Send me your email.

Do you also have your own neb in office?

[great_lakes_expat]

Awesome, thank you! But, it seems that Allnurses has not granted me the power of private messages- I wonder if you can message me instead? Or am I missing something? Argh.

[great_lakes_expat]

I have a neb machine, it was donated to me by another school nurse. But they're not terribly expensive- I think I saw one for $50 on schoolhealth.com.

I have used it for different students (though not at the same time!) Each student has their own tubing, cup and mask. Since all the machine does is essentially blow air through the tubing, I'm not too concerned about cross contamination.

I wish I had a 2 minute response time for EMS! It's taken up to 15 minutes when I've called.

[dinorn92]

We have a neb machine in each nurses office and also have each student bring their own tubing, mask, mouthpiece etc. I don't have the room in our MS office to store multiple neb machines which is why we ended up buying our own. I have had a few people donate unopened tubing neb kits so I keep those for emergency or if someone's supplies end up with "missing" pieces.

[amoLucia]

You can get neb machines and delivery kits (masks or 'pipes') from most any surgical supply store. Inexpensive.

I have 2 - one for home and one I kept in my car for my use only. I could never guarantee that there'd be an extra one avail while at work if I needed it. So I brought my own equip. Needed it once when I visited somewhere. I always carried spare rx'd Duo-Nebs for me.

[River Song, RN]

My district does. It began as a partnership between a Judge and other government officials at the county level who partnered with a University and a local children's hospital as we have a higher incidence of asthma.Several districts in our county now have implemented a program in the school. Each campus has a nebulizer and supplies (an agreement was worked out with our local children's hospital and they are footing part or perhaps most of the bill for the supplies) and we have a standing order from a local pediatrician. Basically the standing order, I can give a treatment whether they are a known asthmatic or not (in most cases for me it is someone who "used" to have asthma so we don't have an MDI on hand) After treatment, we then assess response and SpO2 levels to determine what to do next but it is clearly spelled out whether we call 911, have the parent pick them up and take them to the doctor or urgent care or if we are able to just continue in school. The consent to do this (as well as give Epi for allergic reactions) is part of their enrollment paperwork and is added in with the consent to obtain emergency medical treatment.

It's really cut down on EMS calls since being implemented for our District. Here's a website describing it: Asthma 411 Home | Fort Worth, Tarrant County, Texas

Edited to add: the website talks more about the pilot study program that was then used to implement this program in a broader way across the county. I know that my standing order is different from the one in their resources as mine lists specific SpO2 levels in regards to interventions. I can't remember all of the details off the top of my head but know if SpO2 is 85% or below I call 911 regardless. If after treatment SpO2 isn't at a certain level, 911 is called. I can repeat under some parameters. It's a nice protocol to follow but I've never had a really bad situation, the worst I had was a kid who was hanging out 87-88% but with a treatment came up to 95-96% and it was in the afternoon so was good until end of school day when it became parents' responsibility.

[GdBSN, RN]

^^^This^^^ Every school district should have standing orders and supplies just like this. Whoever got these policies in place should be applauded. As school nurses we should have these tools available to us to save lives at school.

[Jolie, BSN]

It's state law here:

Rule 59 – Regulations for School Health and Safety – Nebraska Dept of Education