1st grader and his inhaler

Purple_Scrubs, BSN, RN · Jun 1, 2012

I have never had this situation come up, but my thinking is that if the asthma is that severe, then the classroom teacher and PE teacher should be trained to administer the inhaler. I would not allow a 1st grader to self administer. Maybe that is what Dad is wanting?

As far as field trips, in my district nurses do not generally go on any field trips. If a student is so fragile that they need a nurse with them at all times, they have a private duty/home care nurse as a 1-on-1. Since I am responsible for the entire school, I cannot be off-site for field trips (I can't even leave for lunch without arranging coverage by a neighboring school's nurse). If a student needs meds or other nursing care on a field trip, a teacher or other staff member must be inserviced by me and fully trained to give the med or perform the procedure as necessary.

MinnieMomRN · Jun 1, 2012

The MD does not think the child is self-directed, and cannot self-administer. That's the part I'd cling to. You need to know the medication delegation law for your state, and that will determine how you can handle the situation. Mom/Dad can want what they want, but in the end it's what your state medication delegation law allows. Under IDEA (federal law), no child can be excluded and accommodations must be made at the school's expense. If the MD says the child cannot self-administer, and if your state does not allow delegation of an inhaler to non-licensed personnel, it's cut and dry.

In my experience, whenever I've had to make a call that others didn't like, I've printed put the law and given it as a backup to whomever is asking me for something inappropriate. As always in nursing, CYA...

Jolie, BSN · Jun 1, 2012

Has the dad ever visited the school or met with you in person? I wonder if the reason for his request is that he is unaware of the layout of the building and perhaps mistakenly believes that you can't be present within a minute to provide the inhaler.

Also, if the child's condition is very severe, it seems that a standing order for administration prior to PE would be preferable to a rescue dose during class.

In my state (NE) there is a standardized course taught by nurses that non-licensed personnel must complete to administer meds in school. In our district, all administrators, secretaries, PE teachers, coaches & special ed. teachers MUST take this course, as well as classroom teachers of high-risk students. Other staff members choose to take it. It is taught every summer in preparation for the upcoming school year and then on a 1:1 basis as needed. Once satisfactorily completed, those personnel are able to administer routine and emergency medications and handle most in-school and field-trip situations.

We would not allow a student to self-carry or self-administer without the Dr.'s approval, regardless of the parent's wishes. In my experience, 1st grade is far too young. The earliest I've had a student demonstrate the necessary understanding and responsibility is about 10 years of age.

KelRN215, BSN, RN · Jun 2, 2012

I agree with Jolie. It seems the best course of action would be to have the child come to the nurse's office prior to PE and use the inhaler then.

allnurses Guide · Jun 4, 2012

I have a new 2nd grader who came from a private school. She is allergic to everything under the sun, breaks out in rashes and has had breathing difficulties. She is very self-motivated and the doc wrote orders she can carry the inhaler in her backpack.

Still and all . . . I'd rather have the inhaler in the office.

Jolie, BSN · Jun 4, 2012

Steph, Will you have a back up inhaler (and other meds) in the office? I can see how this young lady may be well versed in inhaler use and capable of self-administration due to her extreme condition. But I still would be concerned about her maturity and level of responsibility in keeping track of it at all times.

I'd like to PM you later today. I had a student with extreme allergies and we had to develop a 3-fold plan to ensure that meds were rapidly available at all times.

Flare, ASN, BSN · Jun 4, 2012

In my state (NJ) the argument would end with the md stating the child is not to self administer. Dad's word does not trump md orders. We typically don't allow student to carry or self admin unil middle school (6th grade) and that's just inhalers, epi pens and insulin (in a pump). Beyond that - nobody but the nurse or parent/guardian can administer meds to a student. This does mean that a nurse need to go on all field trips if a student has an inhaler and the parent isn't going.

100kids, BSN, RN · Jun 4, 2012

thanks everyone. I spoke with another local school nurse and read up on the laws of my state and if she's not self directed (which Dr says she's not) then no one other than the nurse (the parent or another parent that the parent signs off on) can administer any inhaled medication. Guess that makes my answer easy. Going on field trips will be required by myself or a sub hopefully there wont be too many.

mc3, ASN, RN · Jun 4, 2012

We have a new 1st grader entering school next week and her dad wants her to have a rescue inhaler in the nurse's office as well as in his classroom and with the PE teacher. His Dr. indicated on the medical form that he is NOT self directed. Her dad's note says she can self adminster, that the nurse must accompany him on all field trips but that she does not need to see the nurse to administer her inhaler.
I've never had a parent request an inhaler in the classroom or with the PE teacher and my room is close to the 1st grade room. It seems to me that dad thinks I don't need to be there yet he wants it written that I am required to go on all field trips. At this time the student does not have a 504 but that may be coming.
I'm hoping for some info on what you do for your students, especially younger elementary kids regarding inhalers, who has them, who can administer them and who goes on field trips with asthmatic students?

In my school, the nurse doesn't go. That's impossible! What about the other students? Dad can't just say "the nurse has to go" nor can he override an MD order. :banghead: Our teachers are taught by the District Nurse on how to administer an inhaler, epipen and glucagon if the parent cannot go on the field trip.

mc3:nurse: