Practical implications
While the legislation provides a welcome opportunity, teachers are likely to have many questions, concerns and considerations regarding their individual school policies and the appropriate use of inhalers.
Some of these concerns may be posed to the pharmacist at the point of supply. It is therefore beneficial to consider a selection of the potential concerns to enable pharmacists to be prepared with a considered and appropriate response.
The following issues may need to be discussed in order to support the safe and effective use of medicines in schools.
What should be included in an asthma kit?
The asthma kit should contain the following:
- Salbutamol metered dose inhaler.
- At least two single use plastic spacers that are compatible with the inhaler.
- Instructions on how to use the inhaler and spacer.
- Instructions for storage and cleaning the inhaler.
- Manufacturer's information i.e. the PIL.
- Checklist of the inhalers that detail the batch number, expiry date and the monthly checks on the kit.
- School process for replacing the inhaler and spacers.
- A copy of the asthma register showing children who can be treated with the emergency inhaler.
How many inhalers does the school need?
The number of inhalers that the school needs will be determined by the number of children diagnosed with asthma, the size and the layout of the school. Schools with more pupils or split over several sites will require more 'asthma kits'. The final number of inhalers should be sufficient to ensure that all asthmatic children are within easy access of the emergency inhaler should they need to use it.
Where and how should the inhaler be stored?
The asthma kit should be stored in a safe and secure central location, such as the school office or staff room. An asthma kit may be required at multiple locations. To ensure easy access in an emergency, the kit should not be locked away. The storage location chosen by the school should be known to all staff and should be an area that all staff have free access to at all times. The inhalers should be kept out of the reach and sight of children. Inhalers should be stored at ambient room temperature not exceeding 30ËšC, protected from direct sunlight and extremes of temperature.
Emergency use inhalers and spacers should be kept separately from any child’s individual inhaler and they should be clearly labelled to avoid confusion.
Who can use the emergency inhaler?
The emergency salbutamol inhaler can only be used by children:
- Who have been diagnosed with asthma and prescribed a reliever inhaler
OR - Who have been prescribed a reliever inhaler
AND - Where written parental consent for the use of the emergency inhaler has been received.
Children who have been prescribed a reliever inhaler that does not contain salbutamol, for example terbutaline, can still use the emergency salbutamol inhaler if their own inhaler is not available as it will help to relieve their asthma symptoms and could save their life.
This principle would also apply to children who would normally use a non pMDI inhaler such as a breath actuated or dry powder inhaler.
There should already be procedures in place to ensure schools are notified of children with specific health needs. This information can be used to compile an asthma register identifying children who have been diagnosed as asthmatic. This register will be essential in larger schools and secondary schools where it would not be feasible for teachers to be aware of every child who suffers from a medical condition. Using the register to record receipt of parental consent for the use of an emergency salbutamol inhaler will enable staff to quickly check whether a child is able to use the inhaler in an emergency.
Consideration should be given to where the asthma register is located, options could include each designated member of staff trained to administer the salbutamol having a copy of the register, a copy could be kept in every classroom or a copy could be kept with each emergency inhaler.