Peak flow meters

[RNTadaaaa]

I have received several asthma action plans so far. Each of them discuss the peak flow ranges (green yellow and red)

I ask families for a peak flow meter (until I get my own) and the inhaler so that I can follow the order.

Families ask why do I need a peak flow meter.

Honest question: Should I NOT be using a peak flow meter with an asthma action plan?

Do you use a peak flow meter when you receive an asthma action plan?

To be honest I never had to use them in my previous school bc no one ever completed an asthma action plan, only the order for the resuce inhaler.

[KKEGS, MSN, RN]

I have never used one either to be honest. If a student comes in complaining of SOB I listen to their lungs and give them their inhaler no matter what I hear. As an asthmatic myself if a student says they need their inhaler I hand it over. I know when my chest is tight even if I sound ok through a stethoscope. If a student sounds particularly tight or wheezy I may alert a parent and definitely if I am seeing them multiple times or several days in a row I alert a parent since an exacerbation could be brewing.

[RNTadaaaa]

Thank you KKEGS.

I do the same. No delay. I haven't ever used a peak flow meter.

However, the order has parameters according to the student's peak flow. Im not following it if I am not checking what it is.

I think I will leave it up to the parents. If they don't want to provide a peak flow meter then they should provide a traditional order.

[RNTadaaaa]

Thank you KKEGS.

I do the same. No delay. I haven't ever used a peak flow meter.

However, the order has parameters according to the student's peak flow. Im not following it if I am not checking what it is.

If I am not misunderstanding something, I think I will leave it up to the parents. If they don't want to provide a peak flow meter then I can return the form that requires its use and use the traditional PRN form.

[ruby_jane, BSN, RN]

One time at (band) camp, we did peak flows on one little dude before treatments. There was an algorithm related to peak flow and when to nebulize versus use the "puffer." (Because let's send our highly allergic asthmatic to camp in the Texas Hill Country where the mountain cedar blooms like wildfire).

That is the one and only time I've ever used a peak flow. I do one yearly for my asthma doc and it's written in my plan BUT I do not have a meter, nor does my doc care whether I do this.

However - if in doubt....clarify with the Doc and document the pants off the fact that you don't have one.

[Feral.Cat.Herder, RN]

I've used peak flow meter with one student, he actually had MD orders stating to do pre and post peak flow with inhaler. If there is no direct order to use peak flow meter I do not. 99% of my orders simply say to use said inhaler 2 puffs q 4-6h prn.

[AdobeRN]

I have used it once for about 3 weeks on a kid - request from parent for physician info. Mom supplied the the peak flow meter and the paperwork for it.

Other than that I follow the action plan without the use of it. I am like one of the others posted above - I never deny a kid use of inhaler, if they request it I give it. If I feel it is being abused/not needed/or if it is an issue of not well controlled asthma I have a talk with the kid and call parent.

[PeakRN]

You should always be using a peak flow meter unless the patient is too sick to do so (in which case you should be calling 911) in kids that can participate, and I've used them on kids as young as three.

All asthma action plans should have a peak flow measurement, those that do not are falling short of the best medical practice.

Peak flow is a measure of a patient's ability to expire volume from their lungs, and listening to breath sounds or a subjective symptom do not adequately measure that. They should also be trended over time both during the event and over longer periods to measure the effectiveness of treatment and potential need for changing their medical management. Many kids may also present with green or yellow type subjective complaints but have a red peak flow which typically requires more aggressive treatment than a prn albuterol neb.

[RNTadaaaa]

11 hours ago, ruby_jane said:

One time at (band) camp, we did peak flows on one little dude before treatments. There was an algorithm related to peak flow and when to nebulize versus use the "puffer." (Because let's send our highly allergic asthmatic to camp in the Texas Hill Country where the mountain cedar blooms like wildfire).

That is the one and only time I've ever used a peak flow. I do one yearly for my asthma doc and it's written in my plan BUT I do not have a meter, nor does my doc care whether I do this.

However - if in doubt....clarify with the Doc and document the pants off the fact that you don't have one.

LOL! People look at me so funny when I use the band camp reference. I guess they had to be there huh?

Definitely documenting. Today mom told me she doesn't want the peak flow meter and I am ok with that! Dr wrote a different order and we are clear.

[RNTadaaaa]

4 hours ago, PeakRN said:

You should always be using a peak flow meter unless the patient is too sick to do so (in which case you should be calling 911) in kids that can participate, and I've used them on kids as young as three.

All asthma action plans should have a peak flow measurement, those that do not are falling short of the best medical practice.

Peak flow is a measure of a patient's ability to expire volume from their lungs, and listening to breath sounds or a subjective symptom do not adequately measure that. They should also be trended over time both during the event and over longer periods to measure the effectiveness of treatment and potential need for changing their medical management. Many kids may also present with green or yellow type subjective complaints but have a red peak flow which typically requires more aggressive treatment than a prn albuterol neb.

Ohhhhh myyyy goodness! Thank youuu Peak! Here I was thinking I was being too particular about the peak flow meter and you confirmed I was headed in the right direction.

I have several other Asthma Action Plans and I will see if I can get my own reusable peak flow meter because I am having significant parent resistance to bringing a meter in.

It seems as if this isnt being discussed in the Drs office. I even had one physician ask me what I needed a peak flow meter for when I called to clarify. Inside I was thinking, well you wrote the order!

Do you suggest a reuseable meter (with disposable mouth pieces) or should each child have their own? Do you use it before and after treatment ? I am going to look up some videos on how to use it.

Again thank you so much!

[UrbanHealthRN, BSN, RN]

Not in the school setting, but in the clinic setting I worked with a pediatrician who was a big fan of peak flow readings. Several of our kids had poorly controlled asthma, and their families weren't always the best reporters of their symptoms. Once we started doing peak flows, the pedi had really concrete information to go off of in terms of managing her patients' asthma. I had never done peak flows before then, but I was sold on them after that time! I don't know that they're needed for every kid, but they definitely have their place.

[PeakRN]

On 8/21/2019 at 9:06 PM, RNTadaaaa said:

Do you suggest a reuseable meter (with disposable mouth pieces) or should each child have their own? Do you use it before and after treatment ? I am going to look up some videos on how to use it.

In every hospital I've worked in the purchasing decision was made by respiratory therapy, and I've only used single patient ones. We send them home with the kids and I don't have to worry about regulatory compliance regarding cleaning them, but that probably doesn't matter as much for your situation.

We use them before and after treatments as well as scheduled times during their care. It really helps to establish if our treatments are effective or not.