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!

[SaltineQueen]

Do you also have your own neb in office?

Yes, I do.

[SaltineQueen]

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.

Sorry...we had a snow day. I'll PM you in a bit.

[ohiobobcat]

I have an albuterol MDI. I do not have a nebulizer. I use the paper one-person-only spacer with the MDI, and I clean it with an alcohol wipe in between uses. I would say I use it 4-5 times a year, if that? We do have a protocol, which states we can administer the albuterol MDI for a student who presents with asthma symptoms with no personal inhaler with them. I have a repeat order x 1 in 15 minutes if necessary.

I like having albuterol on hand, just in case. I work in a high school, but this policy is district wide. I wonder what the nurses do for the younger kiddos who might not be able to use the MDI effectively? I will ask at the our next meeting.

[ruby_jane, BSN, RN]

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.)

The machines are between $50-$80. One year when I had extra budget money I bought masks and tubing at about $2 each. I rinse and dry those and put them in a large Zip Loc bag with the student's name on the outside. The neb is a closed system so it should be fine with individaul tubing. Is this something that PTA would help you with?

[AdobeRN]

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

We have basically the same policy. It has cut our EMS calls down for the district. I have had to use the emergency albuterol at least 4-5 times thru the year since implemented. I like having it available. Each campus has their own nebulizer machine - we have extra tubing, masks, medicine cups supplied by our main office - so I don't have to use my budget money for that. If I have to use the emergency albuterol for someone I will save the tubing, mask etc and label with their names in case it happens again - at the end of the school year I will either throw it out or send home with the student if the parents wants it.

[JenTheSchoolRN, BSN, RN]

The machines are between $50-$80. One year when I had extra budget money I bought masks and tubing at about $2 each. I rinse and dry those and put them in a large Zip Loc bag with the student's name on the outside. The neb is a closed system so it should be fine with individaul tubing. Is this something that PTA would help you with?

Not the PTA directly at my school, but I do have some options.

Last year I switched to the school providing Epi-pens vs families bringing them in. So many families do not and I have a large number of low income families so this has been great. We got a new school physician on board and doc was very supportive of that. We have talked standing order albuterol. I wonder if that is the first option prior to neb? The students that has used a neb with me at school all have different medication orders for the neb vs. the typical inhaler order that fits most. Either way, I think I can afford one of these options.

(Side note: my school is doing a ton of construction on our building as we inhabit it and I am very concerned about asthma flare-ups, especially for students who are managed well and therefore don't have an inhaler or have only one they have at home for emergencies that I will never see at school.)

Those of you that stock it, where do you actually order the meds from? This is newer territory for me, so I welcome input.

[ohiobobcat]

Those of you that stock it, where do you actually order the meds from? This is newer territory for me, so I welcome input.

We fill our albuterol Rx at a local (not a chain like Wal-greens) pharmacy. I submit the receipt and the school then pays the pharmacy.

[Farawyn]

No, we don't, but we also have a 2 minute response time for EMS.

[JenTheSchoolRN, BSN, RN]

No, we don't, but we also have a 2 minute response time for EMS.

Similar for me, although last repsiratory 911 call I made had a 10 minute response time due to overwhelming number of calls at once that day. But firemen on site with O2 in 2 minutes.