Inhaler Use--Is this a reasonable expectation?

[sKris]

I am about to write a letter to our principle or maybe higher level administration, but I want to make sure I have a valid concern.

Preface--My 3rd grader has very well controlled asthma but I have a rescue inhaler at the school just in case. Last year when I went to pick up his meds the health aid could not find them. After 10 minutes of searching she found it in a field trip backpack. When I expressed concern she dismissed the incident saying that they would have "found it eventually" if my son had needed it. I considered addressing this problem last year, but let it go as a one time oversight.

Today I went to pick up his inhaler from the health room and luckily this time she was able to immediately locate it. When we were going over the paperwork it indicated that my son had used the inhaler on two occasions. When I checked the dose counter it was on 60 which is the first number. Then I realized that she had never primed the inhaler before administrating it. When I brought this to her attention she seemed shocked. She said no one ever told them that inhalers must be primed. I was very polite and took the time to show her the directions on the box that state the inhaler must be primed down to 60 before the first use and then primed again if it is unused for more than two weeks.

To me this seems like basic medicine administration which would be covered in a MAT course. Am I wrong? I know my kid is not the only one with an inhaler so it seems like lots of kids are probably getting incorrect doses from improperly primed inhalers. Between this incident and the one last year (as well as more minor problems through the year) I'm really questioning the training the health aids are receiving.

[Purple_Scrubs, BSN, RN]

I think you have a valid concern. Depending on the size of the district and who oversees the health room, you might take your concerns to Health Services or Student Services as well as the principal. In a large district like mine, the principal has actually very little input into and control over the health room, although he/she does need to know what is going on in the school.

[Flare, ASN, BSN]

sounds like the health aid needs a little more guidance in learning how to give meds. Is there a nurse in the office as well or just a health aid? I would get in touch with whomever over sees that office and voice your concern. In many cases, health aids are given a brief class to learn how to give the medications, lots of content covered in a short period of time. This person may need a refresher. If this was a nurse, perhaps she may also need some sort of refresher.

[sKris]

Thank you very much for the helpful comments. I looked up the county health services office and contacted the community liaison. Her assistant spent over 20 mins on the phone taking detailed notes about everything that happened. She asked lots of questions and was very thorough. Within 1/2 an hour I had a call back from the RN over my son's elementary school. She oversees 5 schools in the area. She assured me she would meet one-on-one with the health aid and also make sure that HFA inhaler issue is thoroughly covered in the fall refresher before school starts.

[Jolie, BSN]

Thank you for taking the time to calmly and rationally provide constructive feedback to the school so that improvements can be made. It sounds like they are taking your input seriously. I would suggest that you check back with the school a week or two before classes start in the fall to visit the health room, see where your son's medication will be stored and review administration with the nurse/health aid and anyone else who may be called upon to provide it to your son. That will go a long way toward reinforcing their education and reassuring yourself that the staff has been properly trained in the use of your son's inhaler.

I'm not attempting to make excuses for the school staff, but there are literally dozens, if not hundreds of different inhalers on the market. Each has its own unique features regarding preparation, administration, storage, etc. It is helpful to have the actual product insert along with the original packaging so that a staff member who must administer many different types of inhalers can be certain of the actions needed with each one, including the frequency of priming. I would also suggest that parents open new inhalers, prime and give a few "test" puffs to make sure they are working properly before taking them into school.