Any tips to help my student remember to carry inhaler?

[squidbilly]

I have a very sensitive asthmatic student that is responsible for carrying her own inhaler. Up until recently she has only had one inhaler for use at home and at school, due to financial reasons and minimally involved parents. Her asthma is not well controlled, and she often forgets to bring her inhaler to school. I have called EMS for her on one occasion when she had a severe attack, no inhaler, and parents could not be contacted. I almost had to call a second time but a parent was able to make it to school with an inhaler and nebulizer. Her parents FINALLY provided a second inhaler to be kept in the school office recently, but I still expect this student to carry an inhaler with her. I feel very strongly that due to the severity of her asthma and the fact that her parents are not helping her to remember her inhaler that she get in the habit of carrying it EVERYWHERE. She is old enough and smart enough to understand the importance of this matter. I have had countless talks with both student and parents regarding this issue, and I check in with her DAILY and she still is not consistently carrying it. I am at a loss. Any tips?

[nurseprnRN, BSN, RN]

How about a behavior contract? Sit down with the student, teacher, and parent to discuss this. Say you're all interested in having the student safe, recognize that the student is old enough to begin to take responsibility for this self-care, praise the student for other signs of growing up--include the times she had it with her and was able to use it, and say you'd like to write this all up so everyone can sign it and have a copy. Everyone who signs has a responsibility, maybe something like:

Child: To see that she carries her inhaler in a specific pocket in her backpack every day

Parent: To check before she leaves the house that it's in that pocket-- perhaps a new backpack of her choice with a specific pocket would be a good inducement to adherence

Teacher: To ask if it's there by a subtle signal the two of them can agree on-- a wink, a touch the left ear, something the other kids won't pick up on, and she acknowledges it

You: You'll keep track of her health and fewer emergency trips to the school to bring a new one.

Check back in a week, then in two weeks, then in a month... Some sort of reward might be in order-- an outing with the parent, a bye on a homework assignment?

[Jolie, BSN]

Do I understand correctly that this student has (finally) brought an inhaler to be kept at school, and you are concerned that she is traveling back and forth to school without her second inhaler on her person?

Certainly a valid concern, but are you certain that the inhaler you now have at school is actually a second one, and not just the one from home? Maybe she doesn't have a second one to keep with her at all times.

[Lanesmama]

So you want this kid to have 3 inhalers? (1 for home, 1 for office, 1 to carry at school?... or maybe you meant to as in bring the home one to school... which isn't smart because she will likely forget it at school and then have nothing at home.) Do you know how much they cost a piece? And that insurance (if she has) doesn't just pay for 3 because the school nurse wants her to have 3. And if she doesn't have insurance, they are over $100 a piece... so coming from someone who was in a similar situation as that kid, except my parents told me to carry mine, maybe you are missing something?

I totally get it that you want her to carry it with her everywhere. You can somewhat control what she does at school but not at home. Just like the diabetic nurse can tell her pt til she is blue in the face about the importance of self testing... and bg control. And yeah, yeah, we know. Yes, nurse/doctor, I have kept my sugars under control- A1C 10. yeah right.

So if you nag her, what do you think she is going to do? Start lying to make you hear what she thinks you want to hear. So focus on what is happening at school. Why can't you require her to pick it up from the office in the morning and a. take it to her teacher or b. carry it like a necklace or c. have a plan of action for getting it from the office if she needs it? She needs to return it at the end of the day. In addition, if she is that in need of a rescue inhaler, her asthma isn't controlled, so maybe some info on maintenance inhalers rather than rescue?

[sks0730]

Does she have a cell phone? Try suggesting that she set a reminder alarm on her cell phone that will go off 5-10 min before she leaves to go to school.

[Jolie, BSN]

What kind of inhaler costs $100 a piece?

[NutmeggeRN, BSN]

I guess I have a couple of questions

1) How old is the student-is a sticker system a reasonable approach?

2) Does she need more of a maintenence (flovent/serevent) approach? If parents are not addressing theis is DCYS an option?

3) Can her phys provide a sample (smaller number of doses) to have a school?

Good Luck!

[squidbilly]

Do I understand correctly that this student has (finally) brought an inhaler to be kept at school, and you are concerned that she is traveling back and forth to school without her second inhaler on her person?

Certainly a valid concern, but are you certain that the inhaler you now have at school is actually a second one, and not just the one from home? Maybe she doesn't have a second one to keep with her at all times.

Yes, I have personally seen the two inhalers, one of which I then was placed in the health office.

[squidbilly]

So you want this kid to have 3 inhalers? (1 for home, 1 for office, 1 to carry at school?... or maybe you meant to as in bring the home one to school... which isn't smart because she will likely forget it at school and then have nothing at home.) Do you know how much they cost a piece? And that insurance (if she has) doesn't just pay for 3 because the school nurse wants her to have 3. And if she doesn't have insurance, they are over $100 a piece... so coming from someone who was in a similar situation as that kid, except my parents told me to carry mine, maybe you are missing something?

I totally get it that you want her to carry it with her everywhere. You can somewhat control what she does at school but not at home. Just like the diabetic nurse can tell her pt til she is blue in the face about the importance of self testing... and bg control. And yeah, yeah, we know. Yes, nurse/doctor, I have kept my sugars under control- A1C 10. yeah right.

So if you nag her, what do you think she is going to do? Start lying to make you hear what she thinks you want to hear. So focus on what is happening at school. Why can't you require her to pick it up from the office in the morning and a. take it to her teacher or b. carry it like a necklace or c. have a plan of action for getting it from the office if she needs it? She needs to return it at the end of the day. In addition, if she is that in need of a rescue inhaler, her asthma isn't controlled, so maybe some info on maintenance inhalers rather than rescue?

I am not suggesting she have a third inhaler. I am suggesting she begin to assume responsibility for ensuring she has access to her inhaler at all times. Student, Teacher, Principle, Parent, District RN, and myself have all verbally agreed that we would still like her to be carrying an inhaler on her person. I have suggested that it live in the front pocket of her backpack, and that it be returned to this place after every use. Obtaining a second inhaler to be kept in the office was a battle, but it had to be done because this student could/would not bring her inhaler daily. The office inhaler is an emergency/back-up option, not to be relied on. This student is a bus rider, and often stays with a neighbor until her parents come home from work, so if she forgets to carry her inhaler to school, she also (often) is without it for several hours after school.