Components ofAsthmaManagementinthe School–SPPS Model

SchoolStaffDesignee/Secretary / LicensedSchoolNurse(LSN)
CaseFinding / CaseFinding
1. Notify LSNofstudentswithasthmaorsymptomsofasthmafollowingestablishedcommunicationprocedure. / 1.Conductcasefindingforasthmabyreviewingdata froma varietyof sourcesincludingthestudent/family, school staff,health/medicalrecords,healthhistoryform,emergencycards,fieldtrippermissionforms.
2.Recordhealthdatainthe Pupil HealthRecordandonCampusHealthConditionListas indicated.
3.Obtainadditionalhistoryasneeded.
DelegatedNursingCare/Procedures / DelegatedNursingCare/Procedures
2. Collectasthmaquestionnaire,medicationauthorization,AsthmaActionPlansorothercommunicationsfromparent/guardianand/orhealthcareprovider. / 1.The LSNusestheAsthmaQuestionnaire(AQ)asatoolto:
a.determineifthestudent’sasthmaisundercontrol
b.helpdetermineseveritylevel
c.develop anappropriateplanofcare(IHP orECP)
2.TheAQis givento:
  • Annually to studentswho haveasthma
  • newlyidentifiedornewlydiscoveredstudentswith asthma
  • studentswithasthmawheremoreinformationisneeded
  • studentswhoseasthma isoutofcontrol
3.InformationfromtheAQissummarized inthenarrativenotesofthepupilhealthrecord.
4.TheAQmaybesenthome withthe student,mailedor giventotheparent/guardian.
5.Documentthatthe AQwas givenor senttoparent/guardianontheasthmatrackingsheetand/orSHOAR.
1.The LSNusestheStudent BreathingQuestionnaire(SBQ)forstudentsingrades 6– 12inconjunctionorinlieuofAsthmaQuestionnaireto:
a.helpdetermine if student’sasthmaisundercontrol
b.determinethestudent’sseveritylevel
c.develop aplanofcare(IHP or ECP)
2.Administer SBQto anystudentin Grades6 –12withasthma:
  • on initialvisitwithasthma symptomsto theHealthOfficeduringthe schoolyear
  • whotakesmedicationson aroutinebasis
  • who is reportedasabsentduetoasthmaor suspicious ofasthma1-daywhofrequentlypresentswithasthmasymptoms
3. Ifthe student’sasthmastatus appearstobechanging,the LSNcan repeatthe SBQifindicated.
(continuedonpage2)

Adaptedfrom:Minneapolis Public Schools Healthy Learners Asthma InitiativeRevised by MDH 6/8/161

DelegatedNursingCare/Procedures(continued) / DelegatedNursingCare/Procedures(continued)
4.AssiststudentwithSBQ if studentcannotreadat 3rdgradelevelorneedsinterpreterservices.
5.Summarizefindings innarrativenotesofthePupilHealthRecord.
6.Documentthatthe SBQwasgivento thestudentontheasthmatrackingsheetand/orSHOAR.
Provideepisodiccaretostudentswith symptomsof asthma. / 1.Provideongoingsupportandmonitoringto schoolstaffanddesigneeregardingasthmacare.
2.TrainDesignee/sonalldelegatedtasksandsuperviseperformance.
Assessment / 1.Performassessments1onstudentswithsymptomsof asthma,whichinclude:
  • PhysicalAssessment:visualinspection,auscultationofbreathsounds(anterior/posterior,skintoskin),respiratoryrate,peakflow.
  • School:learnerperformance,abilitytofunction inphysicaleducation/sports/socially/andattendancepatterns.
  • Resources:insurancestatus,transportation,finances,accesstoHealthCareProvider(HCP).
2.Assessmentcan alsoincludethefollowingareas:
  • Emotional/socialstatus:student’sreactiontoillness,abuse,neglect.
  • Environmental:homeandschoolenvironment
  • Familysupport

AsthmaVisitNotification(AVN)
1.DocumentasthmavisitonDailyLogand/orPupilHealthRecord.
2.CompleteAsthmaVisitNotificationform(AVN)2whenstudentisseenintheHealthOffice withasthmasymptomsand/ordistressandsendhomewithstudent.
3.UsingtheMPSPathwayForSchoolAsthmaCare,provideappropriatelevelofinterventionforstudentswithexacerbationofasthma.
4.Phoneparent/guardianifstudentisseenintheHealthOffice2timesaweekwithasthmasymptoms.
5.DocumentthatAVNFormwassenttoparent/guardianonthe
SHOAR.
6.FileAVNswiththeSHOAR,destroyAVN’sattheendoftheyearoruponstudentwithdrawal.
7.Determineifadditionalmedicalinformationisneeded.Parentalauthorizationcanbeusedfromthemedicationauthorizationform,AsthmaQuestionnaire(AQ)orReleaseofInformationform.

1UsetheMPSPathway for AcuteAsthma Careinmakingdecisions regardingtheprovisionofacuteasthmacareintheschoolsetting.

2Ifyoumakea phonecallin lieuofsendingtheAVN, completethe formanyway. Thecallisdocumentedonthedaily logorontheAVNform.

Adaptedfrom:Minneapolis Public Schools Healthy Learners Asthma InitiativeRevised by MDH 6/8/161

DelegatedNursingCare/Procedures(continued) / DelegatedNursingCare/Procedures(continued)
1.CompletetheSchoolHealthOfficeAsthmaRecord(SHOAR)onall studentswithasthmamedicationorasthmasymptoms.
2.TheSHOARisusedto:
  • Recordasthmamedication
  • Documentasthmasymptoms
/ SchoolHealthOfficeAsthmaRecord(SHOAR)
1.Complete orinitiatetheSchool HealthOffice AsthmaRecord(SHOAR)on all studentswithasthmamedicationand/or studentswhoneeddocumentation of PeakFloworEducation.(SeeinstructionsunderpeakflowandSHOARinstructions).
1.TheSHOARisanasthmamanagementtoolusedto:
  • Documentasthmamedicationadministration
  • Recordpeakflowreadings
  • Documentasthmasymptoms
  • Documentstudenteducation
  • Documentnursinginterventions
  • Documentstudentoutcomes

AsthmaMedicalRequest(AMR)
1.TheAsthmaMedical Request form(AMR)isusedforcommunicationbetweentheHealth CareProvider(HCP)andtheLSN.
2.CompletetheAMRorcontacttheHCPwhenthereareasthmacontrolormanagementconcerns.AttachSHOARasappropriate.
3.TheAMRshouldbe senttotheHCP onlyafterparent/guardianconsentisobtained,exceptintheeventofanemergency.
4.Whenastudent istransported byambulancetotheEmergencyDept.(ED),theAMRform shouldbesentalongwiththe student.Faxcopyto HCP(ifknown).
5.Whenastudent needsimmediatecare(based on theMPSPathwayforAcuteAsthmaCare)and he/sheisgoingtotheirprimaryclinicorurgentcare,the LSNshould calltheHCPtoinformthemofthereferral.TheAMRshouldbesentwiththestudentandfaxedtotheHCP.
6.Forsituationsnot requiringimmediateattention,theLSN shouldfaxthe AMRtotheclinicwithoutcallingthe clinic. TheLSNshouldcalltheparent/guardianorsendtheAVNformhomeinformingparent/guardianofAMRfaxedtoclinic.
7.TheLSN willsendtheAMRwhen:
  • Student isseeninthe HealthOffice2or moretimes a weekwithasthmasymptoms.
  • Medication/peakflowmeter/spacerareneededatschool.
  • Thereareotherquestionsaboutmedications.
  • Studentexperiencesanacuteasthmaepisoderequiringimmediatecare.
  • Studenthasmissed 5ormoredaysofschooldueto asthmawithinthecurrent schoolyear.
8.DocumentontheSHOARand/orthenarrativenotesofPupilHealthRecordthatthe AMRwassenttotheclinicor HCP.Fileoriginal/copywiththeSHOAR.

Adaptedfrom:Minneapolis Public Schools Healthy Learners Asthma InitiativeRevised by MDH 6/8/161

DelegatedNursingCare/Procedures(continued) / DelegatedNursingCare/Procedures(continued)
IndividualHealthPlan(IHP)
1.Develop Individual HealthPlan(IHP)forstudentswithmoderatetosevere asthmawho requirenursingcare (see IHP instructions).
2.ReviewandmodifyIHPasneeded.
3.Summarizeprogresstowardsgoals/education on IHPformannuallyoruponstudent’swithdrawalfrom school.
AsthmaActionPlan(AAP)
1.SendrequestforAAP onstudents:
  • whose asthma isoutofcontrol
  • withmild,moderateandseverepersistentasthma
  • who takeasthma medicationsatschoolonadailybasis
  • who havehadED orhospitalvisitswithinthe lastyear
2.ReviewnewAAPsonaweeklybasis.
3.PlaceAAPsinwithSHOARform.
4.EnterAAPtreatmentcode(329)underappropriatehealthconditioncodeinCampus.
Campus
1.Review/addappropriatehealth conditioncodeincampus.
2.ReviewAQ,SBQ,AVNForm,andAAPtodeterminestudent’scurrent levelof control3 and asthmaseveritylevel andenterinCampus.
3.EnterAAPtreatmentcode(329)underappropriatehealthconditioncodeinCampus.

3DEFINITIONOFCONTROL:Complete or total control ofasthma can be defined as (1) no asthma symptoms; (2)no rescue bronchodilator use; (3) no nighttime or earlymorning awakening; (4) no limitations on exercise,work, or school; (5) complete control of asthma bypatient and physician assessment; and (6) normal orpersonal best PEF or FEV1. (Excerpted from: Attaining optimal asthma control: A practice parameter.; developed by the Joint Task Force on Practice Parameters, AAAAI,ACAAI & Joint Council of AAI 2015)

Adaptedfrom:Minneapolis Public Schools Healthy Learners Asthma InitiativeRevised by MDH 6/8/161

Components ofAsthmaManagementinthe School

DelegatedNursingCare/Procedures(continued) / DelegatedNursingCare/Procedures(continued)
PeakFlow Meter
  • Checkpeakflowonstudents:
  • withpersistentasthma
  • withasthmasymptoms
  • todetermine if medicationisneededperAAP
  • Periodicevaluationforstudentsreceivingpre-exercisemeds.
  • Documentpeakflowreadings,signs, symptomsandmedicationsgiven on SHOAR form4:“a”=peakflowreadingbeforemedication,“p”=peakflowafterprn medication.RecordactualPF numberabove“a” or“p”ongraphsectionofSHOAR.
  • If studentreturnswithsymptomsasecondtimeonthatsamedateand requiresrepeatpeakflowmonitoring,thefollowingadjacentvertical columnisusedto documentthepeakflow(IfAAPisnotavailable,calculatestudent’spredictedpeakflowusingthetable:“AveragePeakFlowRateForHealthyChildren.”

1. AdministermedicationsperLSNdelegationand/orHealth CareProvider(HCP)order. / Medication
Assess,monitor,and/oradministermedications.
  • Documentmedicationinthesameverticalcolumn,thatpeakflowisrecordedontheSHOAR form,inthefirstavailableboxcorrespondingtothemedication given.5
  • If studentreturnswithsymptomsa secondtime onthatsamedateandreceivesPRNmedication and/orrequirespeakflowmonitoring,thefollowingadjacentvertical column isusedtodocumentthepeakflowandmedicationgiven(useonelineonlyfor PRN medication).
  • Useonelinefor eachmedication unlessamedicationisroutinelygiventwiceduringtheeach schoolday.Inthiscase,useaseparatelineforeach administrationtime.

PupilHealthRecord
1.Documentall911callsonthepupilhealthrecord.
2.Documentallmedicationordersonthepupilhealth recordwhenmedisreceived.
3.Documentotherpertinentinformationinnarrativenotesper LSNjudgement.
4.At endofyearorupon studentwithdrawal,fileSHOAR,AMR,AQ,SBQ,IHP/ECP,AAP,andmedicationauthorization inthepupilhealthrecord.

4PeakFlowreadingsmayberecordedontheDailyLogorthenarrativenotesofthePupilHealthRecordifstudentisnotcheckingpeakflowsonanongoingbasis.

5Donotdocumentstudentscominginforroutinepre-exerciseasthmamedicationsontheDailyLog.StudentscomingforPRNmedicationsbecauseofsymptomsshouldbedocumentedontheDailyLog.

Adaptedfrom:Minneapolis Public Schools Healthy Learners Asthma InitiativeRevised by MDH 6/8/161

CareCoordination / CareCoordination(LSN)
1. Communicate regularlywithLSNregardingconcernsand careofstudentswithasthma. / 1.RequestAAPonstudents:
  • whose asthma isoutofcontrol
  • withmild,moderateandseverepersistentasthma
  • who take asthma medicationsatschoolonadailybasis
  • who havehadED orhospitalvisitswithinthe lastyear
2.Documentrequestsent innarrativenotesofPupil HealthRecordoronSHOAR.
1.ReviewIHPandAAP
2.Develop ormodifyplanfor care coordinationasneeded.
1.Determineifstudentshaveinsurance.
2.Assessfamily’sunderstandingofhealth caresystemandabilitytoaccesspreventiveandemergencycare.
3.Forstudentswhohaveno insurance,refertoCommunityResources.
1.Assist withtransportationand interpretersforstudentsasappropriate.
1.Consistentcommunication withparents/guardiansandprovidersregardingasthmacare, needformedication,supplies,Release ofInformationConsents,asthmaepisodes.
2.Refer students toHealthCareProvidertoensureconsistentasthmacareandfollow-upaccordingtoNHLBI/NAEPPguidelines.
Initiatereferralsto:
  • communitybasedasthmaprograms,
  • asthmacasemanagementservices@healthplan,hospitalorclinic,
  • homevisitingservicesfor f/u coordination,educationorhomeenvironmentassessment
  • otherservicesasneededi.e.asthmacamp

EmergencyCare / EmergencyCare
1.Providefirst aid in accordancewith FirstAidforAsthmaandBreathingTroubleorEmergencyMedicalCareFlipchartfoundinStudentWellnessSitePlanorindividualizedstudentEmergencyCarePlan.
2.NotifyLSN,parent/guardianandHCPofemergencycareasneeded. / 1.Atthebeginningoftheyear.LSNreviewsFirstAidforAsthmaandBreathingTroubleandEmergencyCareFlipChartwithschoolstaffanddelegateddesignees.
2.EnsureBuildingSitePlaniscompletedandincludesFirstAidforAsthmaandBreathingTroubleEmergencyMedicalCareFlipChart.
3.ProvidefirstaidinaccordancewithMPSPathwayforAcuteSchoolAsthmaCare,FirstAidforAsthmaandBreathingTrouble,EmergencyMedicalCareFlipchartorindividualizedstudentEmergencyCarePlan.
4.CompleteEmergencyCarePlan(ECP)onstudentifthefollowingconditionsapply:
  • previousICUadmissionorintubationforasthma
  • extremelabileasthma(asthmasymptomsthatcomeonsuddenlyandrapidlyworsen).
  • Poorlycontrolledmoderateorseverepersistentasthma.
(continuedonpage7)

Adaptedfrom:Minneapolis Public Schools Healthy Learners Asthma InitiativeRevised by MDH 6/8/161

EmergencyCare(continued) / EmergencyCare(continued)
5.FileECPwithSHOAR,subfolder,andsiteplan.
6.DocumentdevelopmentofECPonSHOARnarrativenotes.Whenpossible,includetheparentandtheHealthCareProviderindevelopingtheECP.
7.ProvidecopiesofECPtoOfficeStaff,PEteachers,coaches,classroomteachersandotherpersonnelworkingwithstudentperLSNjudgment.
StudentEducation/Counseling / StudentEducation/Counseling
1.ReviewcorrectinhalerandpeakflowmetertechniqueswithstudentswhocomeintotheHealthOffice;dopre/posttestoftechnique.
2.Providecounselingandeducatestudents,familiesandschoolstaffonkeycomponentsofasthmaself-management.
3.DocumenteducationonSHOARorIHP.
4.DetermineneedforAsthmaEducationmaterials.
AsthmaEducationProgram / AsthmaEducationProgram
Thisisaseriesof6classsessions,30minuteslongusingacurriculumdevelopedbySPPSStudentWellness.Theobjectives/studentperformancestandardsare:
  • Thestudentproducesevidencethatdemonstratesunderstandingofasthmaandtherespiratorysystemtriggersofasthmaattacks,theimportanceofpeakflowmeters,theirownindividualasthmaactionplanandtheroleofmedications.
  • Thestudentusestechnologyandtoolstogatherdataandextendthesensesbydemonstratingcompetencewithhis/herinhalerandspacerandpeakflowmeter
  • Thestudentshowsorexplainssomethingclearlyenoughforsomeoneelsetobeabletodoit.
TheLSNorinconjunctionwithaPNPorasthmaresourcenurse:
1.Identifiesstudentswhowouldbenefitfromattendingclass:
  • Thosewithmedicationsinschool
  • Thosewithfrequentexacerbationofasthmasymptoms
  • Thosewhoseasthmaisoutofcontrol
  • Thosewhohademergencies(911)duringschoolduetoasthma.
2.Coordinateswithschoolstafftime,placeanddatesforclasses.
3.Coordinateswithschoolstafftime,placeanddateforparentmeeting.
4.Attendandhelpfacilitateeachclassandparentmeeting.

Adaptedfrom:Minneapolis Public Schools Healthy Learners Asthma InitiativeRevised by MDH 6/8/161