Asthma and Field Trips

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I did search through old threads on field trips and got some great ideas on things to send with the teachers, so thank you to the community for that!

My specific question is that in my student population, asthma is the big concern. For those who have provided an inhaler and spacer to the school and doctor's orders, it's all good. I send it along with the teacher, give the teacher a refresher on how to administer and include printed instructions, my cell phone number and a place to document if they administer. I also assess the kiddos before they leave building.

Next week, I have a kiddo going to the zoo who only has a PRN nebulizer order and the parents only have one machine so they have been keeping it at home :/ I have suggested to the Mom that she talk to the allergist about an inhaler and spacer for school if they don't want to worry about transporting the nebulizer but she has not been responsive. I do have my own nebulizer and stock albuterol in the office for emergencies (mom doesn't know this) so the normal school day hasn't been stressing me out too much... but now we have a field trip to the zoo and I can't send the school's equipment along and leave me without. Sidenote, this kiddo generally likes to come talk to me at lunchtime and I listen to him and so far this school year we have have no breathing difficulties and he has told me he hasn't been getting treatments at home other than his controller meds.

I was definitely going to assess him before they leave the campus and in talking to the prior school nurse she generally gave everyone their inhaler or nebulizer prophylactically before field trips regardless of assessment.

Thoughts on how you would handle this?

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Specializes in School Nursing.

I don't necessarily like approaching things this way but I have been told that if the parent has not provided meds then 911 has to be called if the med becomes necessary. We can only help up to a point. Once we have provided information and the opportunity to step up it's really the parents responsibility. We do not exclude from field trips and we only administer inhalers prior to field trips if the field trip involves a lot of running and the child specifically has a "prior to exercise" parameter on their order.

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We do not exclude from field trips and we only administer inhalers prior to field trips if the field trip involves a lot of running and the child specifically has a "prior to exercise" parameter on their order.

Thank you for your comment! I do have several kiddos with inhaler orders that specifically allow PRN prior to exercise and hadn't thought of that. I was just feeling uncomfortable with administering a PRN that says "for wheezing, cough SOB" when none of those are present but the ones with exercise orders is very helpful!

The trip I'm really concerned about isn't until Spring and that's when an entire grade does an all day trip to an outdoor camp which is asthma trigger heaven :)

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If your field trip is not until spring, you and the parent have plenty of time to plan (parent could make plans to be off work and accompany their student on that field trip and lug along the nebulizer if they have not gotten an inhaler yet…) just sayin

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If your field trip is not until spring, you and the parent have plenty of time to plan (parent could make plans to be off work and accompany their student on that field trip and lug along the nebulizer if they have not gotten an inhaler yet…) just sayin

Oh sorry that might have been confusing, the field trip to the zoo for this particular student is this coming week and it's a half day trip.

The one where I have a whole group of asthmatics going all day is Spring. I'm at a field trip galore school, I have two this week, one last week and two more in October. Each grade from 1st to 5th takes at least 4 a year and in our population parents do not generally come along.

As for the child my original post was about, that Mom won't respond to my calls and emails and she doesn't do drop off or pick up so I can't easily run into her” either. The previous nurse had the same issues so at least it's not just me :)

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Specializes in ICU/community health/school nursing.

Parent has to provide a portable nebulizer or preferably a pocket inhaler. This cannot be your problem. Make sure all your administration team and the teachers know what you've tried in order to make it safe for sweet baby to attend this field trip. As an aside....if the kid actually needs nebs at school, the kid needs a tune-up with his asthma provider. No chance you have a doctor's name and can call? Our asthma action plans and even the med forms have a provider's name on them. Good luck!

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Specializes in Pediatrics Retired.

I realize there are some exceptions so let me preface with that - Yes I know...but otherwise NOBODY prescribes albuterol neb nowadays. The easiest thing would be to get the parent to ask the MD for an inhaler and spacer. On the flip side, you are taking on a degree of liability by providing the nebulizer for this student. Good luck with defending yourself if there is ever an allegation a child's condition was worsened by a faulty medicine delivery system, which you,or the school, owns.

I'm totally fine with a parent picking up "their" nebulizer every day from school. Because, for me, prn albuterol neb prescription needs a nebulizer to administer.

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Specializes in School nursing.
I realize there are some exceptions so let me preface with that - Yes I know...but otherwise NOBODY prescribes albuterol neb nowadays. The easiest thing would be to get the parent to ask the MD for an inhaler and spacer. On the flip side, you are taking on a degree of liability by providing the nebulizer for this student. Good luck with defending yourself if there is ever an allegation a child's condition was worsened by a faulty medicine delivery system, which you,or the school, owns.

I'm totally fine with a parent picking up "their" nebulizer every day from school. Because, for me, prn albuterol neb prescription needs a nebulizer to administer.

Same. Neb only vs. inhaler? Does the student not know how to use an inhaler properly? And if so, is there room for education? A neb on a field trip is not practical. It likely needs power and the student needs to be able to sit in one place to complete it. Is there a spot or the staff available to do this?

I don't have a neb or standing orders for administering treatment via one at school, which I am totally fine with. If student with asthma progresses to needing an immediate neb after inhaler use I'm calling 911 unless I have that student's neblizer and orders for it in my office.

(In fact, I actually did this last week for a student. No neb orders. Just back from field trip in the woods. Inhaler was not effective. EMS gave a standing order neb in my order prior to packing student up for transport.)

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Specializes in Cardiology, School Nursing, General.

A lot of my kids know to use inhalers, so I don't worry, but most of them are PRN, so even if they don't need them, it's there.

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Specializes in school nursing, ortho, trauma.

So most of my students have inhaler orders. Occasionally my form (which is a standard form provided by the asthma coalition here's the link, enjoy: http://pacnj.org/wp-content/uploads/2016/02/Asthma-Treatment-Plan-STUDENT-MAY-2017.pdf ) will have a nebulizer checked off too. Most of the time the parents won't bother to bring it in. I have one little guy that I would love to have the neb for since he chronically sounds crummy, gets better for a bit after his inhaler then right back to crummy. He is being followed by a pulmonologist - sent him out of school and right there last week with o2 sats in 80's and horrible sounding lungs (mom refused ems) they (the dr's office) sent me back a very snippy toned doctor's note with a note that his o2 sats were 98%. yeah ooookkkkk. His fingernails are clubbed and he's 4. i don't think he's EVER 98%.

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So to answer the questions, my best guess as to why this kiddo has an albuterol neb order is that it's written from a family practice doc vs. a pedi or an asthma doc. My own asthmatic was never on nebs and we have used an MDI with spacer and mask since he was in kinder. The prior nurse was administering it daily because "that was what the mom wanted" but as my order says "PRN wheezing, cough, SOB" and this kiddo was never presenting to me with any of those symptoms, I stopped that practice right away.

I have a handful of kids who seem to have their asthma "treated" only by PRN albuterol when a controller really would be a good idea but I just do my best to educate as I can. This particular kiddo the mom is about as unresponsive as possible, I might try to call the office myself and ask about an MDI/spacer for school but I have been told that in general most docs around here won't talk without a release signed by the parent. It's definitely worth a shot however, I was trying to explain to the Mom how much easier it would be for him to have an MDI/spacer at school for rescue but I honestly don't think she cares.

Thanks for all the good ideas! I assessed him prior to the field trip, asked about whether he had any treatments at home over the weekend (No) and if he had been doing any coughing. The teacher had my cell phone number and knew that if he had breathing problems, 911 would be our only option. In talking with other local nurses, having families not provide what is needed for asthma isn't uncommon.

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Also wanted to add, all of the schools in our district have been provided nebulizers by the home health agency run by our local children's hospital. We have standing nebulizer orders and a protocol for when we can use it. Our enrollment form includes a consent for obtaining emergency medical services and treatment of severe allergic reactions (use of our stock EpiPens) and treatment of respiratory distress.

It was trialed last year in a handful of our schools and decreased 911 calls dramatically for respiratory distress but we are in a super high asthma community and have a university that helped develop the program. I've already used the protocol twice, once for a known asthmatic and parents had not yet provided an inhaler and once for a child who allegedly had outgrown their asthma two years ago. In both cases, I had a good response and the parents went back to the doctor and brought in inhalers with orders for me to have ;)

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