Field Trips

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Specializes in School Nursing.

Had a student last week that had an asthma attack on the bus on the way back from a field trip that went unnoticed. Trying to think of ways to prevent this. The teacher had her inhaler and the student even had an inhaler in her backpack that mom sent her with, which she took 1 puff of and did not help her. If there some kind of check off that any of you use so that the teachers can document that they have laid eyes on the kid every hour? Mom ended up having to take her to the ER and I know this could have turned out much worse.

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Specializes in Med-surg, school nursing..

Scary situation for sure. I would make sure the kiddo has a buddy to sit with them and the buddy can help alert a teacher if need be. I'm conflicted about the check-list... A lot can happen in an hour. The only other solution would be for high-risk students to sit with teachers, but then you have the problem of high-risk students outnumbering the teachers.

How old is this kiddo? I would work on teaching her that she HAS to advocate for herself. If she isn't feeling right she needs to let someone know. It just isn't possible for the teacher to have eyes on them the whole time, so having her speak up will go a long way. So glad it wasn't worse.

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8 minutes ago, OyWithThePoodles said:

How old is this kiddo? I would work on teaching her that she HAS to advocate for herself. If she isn't feeling right she needs to let someone know. It just isn't possible for the teacher to have eyes on them the whole time, so having her speak up will go a long way. So glad it wasn't worse.

This ^^^^^.

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Specializes in School Nursing.

She is a 4th grader. I'm sure she had a buddy on the way, but lost of kids went home with parents. She wasn't necessarily even high risk. She must have been exposed to something where they went, because she has never had a problem at school where she needed to use her inhaler.

Parents want us to come up with a solution where this doesn't happen again. I totally agree she needed to speak up. Maybe it hit her really fast and she panicked. She was crying when she got off the bus. I know teachers can't have eyes on them at all times, but more for CYA, it would be nice to show that she was monitored and did appear fine at certain times of the day.

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Specializes in School Nurse, past Med Surge.

Even if you have an hourly checkoff, that's a lot of time in between when something could potentially happen. She has GOT to know that she needs to find her teacher, or ask a kid to get the teacher - first step of the plan. If she and parents are OK with it, talk to the class about asthma and how they might be able to help her if they notice something. But that's still secondary to her notifying someone. I like the idea of buddies, but hate the idea of buddies. That's a lot of pressure to put on kids...to be "responsible" for someone else. I'd say she should always be in the teacher's group on trips and sit by her on the bus. Or parents go.

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The only check-off we do here is to initially train the teacher in med administration. I always talk about what s/s to watch out for before and after administration. If the teacher successfully return demo'd the med and I documented that, I personally wouldn't assume any liability in an off-campus event. I agree that this shouldn't happen again, but more planning needs to be done on the teacher's end. Maybe another teacher needs to chaperone to ensure adequate monitoring of all students? What more are you to do, other than go on the field trip with them (and we know that's not likely)?

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Specializes in school nursing, ortho, trauma.

since she is apparently already permitted to carry and self administer her own inhaler, then the rest of it is educating the student in administration procedures (2 puffs is generally standard, not 1) as well as advocating for herself. I agree that while hourly check-ins may make the parent feel better, it is merely security theater. What happens when the child checks in a 10 am and has an asthmatic event at 10:20 where she doesn't seek help?

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Agree with all the above that the real solution, short- and long-term, is working with the student to learn to advocate for herself. Does the student have trouble with speaking up generally?

Maybe you could make her something like the "flip card" that we make for ED kids to signal their teacher that they are getting frustrated and need a behavioral intervention.....like a small laminated card with a picture of lungs, or some other symbol, that could be velcroed to her inhaler or her student ID, and she could just show it to the teacher to signal that she needs help?

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Specializes in ICU/community health/school nursing.

This is super-easy because she carries her own medication (and I am assuming you signed her off that she can use it correctly, which is policy in my district).

"Sweet Pea, when you administer two puffs of your inhaler, wait 10 minutes. If you're not better, tell the teacher."

Covers everything. Field trips, class time, whatnot.

If she is unwilling/unable to do this then she does not need to self-administer.

Having a check-off sheet seems unnecessarily burdensome because the teachers cannot legally assess the student....

Incidentally, if she had enough air to be crying....what would they have done differently? Stop the bus? EMS? Teachers don't have nursing judgment.

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