Practical implications cont.
What training is required for school staff?
Any staff member can volunteer to take on the responsibility of administering salbutamol in an emergency but they cannot be forced to do so. Schools will need to ensure that there are sufficient numbers of staff trained to ensure there is no delay in pupils receiving treatment. The exact number will depend upon the size and layout of the school, the number of pupils and the number of children with asthma.
Pharmacists are in an ideal position to be able to provide appropriate training on recognising the symptoms of an asthma attack and the administration of salbutamol inhalers. Provision of this training will enable pharmacists to build an on-going professional relationship with their local school and teaching staff.
Each teacher should:
- be able to recognise the symptoms of an asthma attack and distinguish them from conditions with similar symptoms.
- be aware of the school's asthma policy.
- understand how to check if a child is on the asthma register and has parental consent for administration of salbutamol.
- be aware of how to access and administer the inhaler according to the school's policy.
- be comfortable with the use of the inhaler and spacer device.
- know who the designated members of staff are and how to access their help.
- be able to respond to requests for help from other designated members of staff.
What is the correct procedure for the care of a child after an asthma attack?
It is important that any teacher who administers emergency salbutamol is able to identify when the child requires further medical support and an ambulance should be called. Teachers should be advised that any child who is displaying signs of an asthma attack and has a blue/white tinge to the edge of their lips, is going blue, has collapsed or appears exhausted, requires prompt treatment and an ambulance should be called immediately. An ambulance should also be called if a child does not respond to treatment or the teacher becomes worried or concerned while administering the salbutamol.
What are the record keeping requirements for schools?
Each use of the inhaler should be recorded to show who the salbutamol was administered to, when and where it was administered, how much was given and by whom. "Supporting children" legislation requires that these records are in writing.
In addition, the child’s parents must be informed in writing so that they can pass the information to the child's GP. This contact with the parents could be used by the school to reinforce the need for the child to have their own inhaler available while at school. One of the concerns raised during the consultation was that availability of emergency inhalers in schools may make parents more complacent over ensuring availability of their child's own inhaler.
Records of administration will also allow the school to monitor how many doses of salbutamol have been administered from any one inhaler.
At each maintenance check, staff should calculate how many doses remain in the inhaler as salbutamol inhalers do not incorporate dose counters and the school will need to ensure medication is always available.
Are there any implications over individual liability and insurance?
Schools should already have in place appropriate levels of insurance to cover staff, including liability cover, for the administration of medication in schools. Department of Health guidance advises that local authorities may provide schools who are administering inhalers with appropriate indemnity cover; however schools should confirm this cover directly with the local authority or relevant department. An asthma protocol that details how and when inhalers should be used will help to protect staff by ensuring they are aware of how and when to use the inhalers safely.
What maintenance does the asthma kit require?
Every school should have at least two named members of staff who will be responsible for maintaining each asthma kit.
Routine checks of the kit should be undertaken monthly to ensure:
- The inhalers and spacers are present and in working order.
- The inhaler has sufficient doses available.
- Replacement inhalers are obtained when the inhaler approaches its expiry date.
- Sufficient replacement spacers are available.
- The plastic inhaler housing has been cleaned, dried and returned to the storage area.
In order to avoid cross-infection plastic spacers should not be re-used. The inhaler itself can be re-used provided it is washed thoroughly after each use.
Teachers should be advised that to clean the inhaler they should remove the canister and wash the inhaler housing and cap in warm running water and allow to air dry in a clean, safe place. Once the housing is dry replace the canister and return the inhaler to its point of storage. However, if there is any risk of contamination with blood, for example if the inhaler has been used without a spacer, it should not be re-used but disposed of. Good practice for disposal of spent inhalers would be to return them to the pharmacy. Legally the used inhaler is classed as "waste for disposal" and the school should be registered as a lower tier waste carrier in order to transfer stock to the pharmacy. This can be done quickly and freely online at https://www.gov.uk/waste-carrier-or-broker-registration.