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TRANSCRIPT
School Health
Conference 2015 Andrea Holka
Executive Director, AIRE Nebraska
Emergency Response to Life-Threatening Asthma or
Systemic Allergic Reactions (Anaphylaxis) Rule 59 Protocol
• Omaha, NE – late 1990’s – asthma deaths at school
• Purpose – to save the lives of those suffering from asthma and LTA (life-threatening allergy) who are undiagnosed and do NOT have a plan or medications at school
• This protocol DOES NOT replace a diagnosed child’s asthma/allergy action plan or medications
2013-14 Review • 75 voluntarily reported incidents + 2 anecdotal reports to
include 2 school visitors
• 0 deaths!
• 68% (75) had a history of asthma – only 53% of these students had a plan/medications at school
• 16% (75) had no history of asthma/severe allergy
• 37% (75) had a history of severe allergy – only 61% of these students had a plan/medications at school
• 29% (75) included a medication error
• 911 not called 3x
Student Identification
What can be done? – looking for suggestions
Medication Error
• What is a medication error?
• A medication error refers to an error (of commission or
omission) at any step along the pathway that begins when a
clinician prescribes a medication and ends when the patient
actually receives the medication. Agency for Healthcare Research & Quality
• Usually involves an error in one of the 5 rights: right
patient, right drug, right dosage, right time, and right
route – some articles add right reason
Medication Error and
Rule 59 Protocol
• Administered school’s albuterol only
• Administered school’s albuterol followed by school’s
EpiPen
• Administered the student’s auto-injectable epinephrine
according to student’s action plan and followed by
administering school’s albuterol
• Administered epinephrine to self!
• Administered school’s EpiPen and then stopped…student
breathing fine now
WHO??
• 59% of medication errors in 2013-14…
• School nurses
• Still missing a good chunk of data, but 33% right now
for 2014-15
SUGGESTIONS WELCOME!
Auto-injectable Epinephrine
1. EpiPen
• EpiPen4Schools
• automated
• Pt coupon online
• Patient Assistance
2. Auvi-Q
• Pt coupon online
• Patient Assistance
3. Adrenaclick
4. Generic (for
Adrenaclick)
• Pt coupon online
Don’t be Surprised!
• FDA application for generic EpiPen device in process
from Teva
• Don’t know when, but this may affect the FREE
EpiPen program….please be prepared!
New Kid on the Block!
ProAir
RespiClick
DPI
1. OPEN
Make sure the cap is closed before each dose.
Hold the inhaler upright as you open the cap fully.
Open the cap all the way back until you hear a "CLICK".
Your ProAir® RespiClick inhaler is now ready to use.
Do not open the cap unless you are taking a dose.
How to Use ProAir RespiClick:
2. INHALE
Breathe out through your mouth and push as much air from
your lungs as you can.
Put the mouthpiece in your mouth and close your lips
around it. Breathe in deeply through your mouth, until your
lungs feel completely full of air.
Breathing in deeply through the mouthpiece will deliver
the medication to your lungs.
Do not let your lips or fingers block the vent above the
mouthpiece.
Hold your breath for about 10 seconds or as long as you
comfortably can.
Remove the inhaler from your mouth.
Check the dose counter on the back of the inhaler to make
sure you received the dose.
3. CLOSE
Always close the cap after each inhalation so your
inhaler will be ready for your next dose.
If you need another dose close the cap and repeat all of
the steps.
ProAir® RespiClick contains a powder and must be
kept clean and dry at all times.
http://www.myproair.com/respiclick/asthma-resources/respiclick-usage.aspx
Common Questions
• What about the Preschool down the hall?
• NDE Approved Early Childhood Education Programs found on
AIRE Nebraska website – SCHOOLS page
• Our school needs a new nebulizer – where do I get one?
• Nebulizers – questions, ordering information, filters – on SCHOOLS
page
EMT’s as School Emergency
Response Team responders
“The discussion with the EMS Board was this:
Nebraska Out of Hospital Emergency Care providers who respond to an
emergency in their role on a school’s emergency response team and with the
training provided under NDE Rule 59 are doing so as a school employee /
volunteer. School employees / volunteers who happen to be licensed as EMS
providers are not bound by the limitations of their scope of practice and are not
acting under their EMS license and are not responding as a part of their local EMS
Service.”
Rene’ Tiedt, Program Manager
Phone (402)471-0547 Fax (402)471-3577
Resources – some new
and some not so new!
Is NOW!
www.allergyasthmanetwork.org
Thank You!
Introducing
Lindsey Frohn, MS, CCC-SLP
Kellan & family
Lincoln Half Marathon –finished
71st overall and 11th in age group!