Guidance for Schools on the Management of Asthma in DoncasterSchools

Introduction

Introduction3

Summary of key messages4

Asthma 5 – 7

Key guidance for managing asthma in schools

SECTION ONE8

1.1 School asthma health care plan 9

1.2. Asthma medication

1.2.1 Preventer inhalers 9

1.2.2 Reliever inhalers10

1.3 Access and storage of inhalers in school11

1.4 Roles

1.4.1 School asthma lead12

1.4.2 Class teachers12

1.4.3 School nurse team

1.5Asthma, activity and exercise in school

1.5.1 School sports staff

1.5.2 Children and young people with asthma

1.6Residential and education trips

1.7Overview of legal issues

1.7.1 Emergency situations

1.7.2 Non-emergency situations

1.8 Record keeping

1.8.1 Asthma health care plan

1.8.2 School asthma directory

1.8.3 Consent to administer medicines in school16

1.8.4 Recording administration of medicine in school16

1.9Staff training17

SECTION TWO

The asthma policy18

Dealing with an asthma attack (flowchart)19

APENDICES

  1. School asthma health care plan21 – 22
  2. Request for a child to carry their own medication 23
  3. Example letter to accompany school asthma health care plan24
  4. Parental agreement for school to administer medicines25
  5. Record of medicine administered to individual child26 – 27
  6. Consent for use of emergency salbutamol inhaler28
  7. Specimen letter to inform parents of emergency inhaler use29
  8. Record of staff training30

Asthma is one of the most common long term conditions and is serious and potentially life threatening. Children with asthma can lead an entirely normal life, as long as they are supported by the adults who care for them.

This guidance aims to provide practical advice and support around the management of asthma in schools within the Doncaster area. The document is based upon guidance produced by Telford & Wrekin and Shropshire County and is informed by a steering group and information gained from local schools as noted below. The key messages and recommendations contained within the guidance are for head teachers, asthma leads and school staff. The guidance should be used in developing your School Asthma Policy. The document is to be used in conjunction with help and advice offered by the school nurse.

For Further information or support please contact a member of the steering group

Lynne Schuller Clinical Lead HCP 5-19

Gemma Faulkner Community Staff nurse

Barbara Symonds 1st contact practitioner

Sylvia Holmes Paediatric Liaison Health Visitor

Dr M. Kurian

Alex Bonser

Acknowledgements

Doncaster School Nurse Team

One in ten children in the UK has asthma, 3 -4 children in every classroom. Children with asthma can lead entirely normal lives if supported appropriately

Children with asthma should have a School Asthma Healthcare Plan completed at entry to school and regularly updated

All child / young person with diagnosis of asthma children should have their relieving medication with them at all times in school. Relievers should never be locked away.

Relievers are medicines which can be taken immediately when asthma symptoms start. They quickly relax the muscle surrounding the narrow airways, making it easier to breathe

Spacers are the most effective way to deliver inhaled medicine to the lungs, especially during an attack

When children use their reliever inhaler in school, this should be recorded and shared with parents. This information is important for their asthma review. If this is not always possible in secondary schools, young people should be encouraged to record this information.

Nebulisers and steroids are not normally required in school

Every school should have at least one asthma lead within the staff. The lead should have additional training to expand upon medical conditions training. They should have liaison with the school nurse on a termly basis.

All staff; especially those involved in physical activity should know what to do in the event of an attack.

All parents should be asked; on enrolment to school, if their child has any medical conditions, including asthma.

If school staff have any questions or concerns about a pupil’s asthma medication and / or inhaler, they should discuss this with the pupil’s parents or the school nurse as soon as possible

ALL school staff should attend an annual asthma awareness session

Every school should have an asthma policy; assisting children to be safe and healthy within the school environment.

Asthma is the most common long-term condition for children and young people (CYP) in the UK and the impact the condition has on the lives of 1.1 million CYP is significant.

At a national level, asthma has a major impact on children in the UK:

  • 7,000 children visit their GP each week
  • Every 16 minutes a child is admitted to hospital because of their asthma
  • More than 1 in 4 young adults report missing out on things at school or college; while 1 in 10 feel their asthma has affected their education.

However, with the right management, there is nothing to stop the vast majority of CYP leading normal, full and active lives.

School nurses in Doncaster requested information from 68 schools; 30 responding with the following information

Do you have a policy / guidance in place for the management of asthma in school?

Some had both some had neither.

Do you have a designated lead in school for child / young person with diagnosis of asthma?

Do you have directory of child / young person with diagnosis of asthma child in school?

Do all children in school who suffer with asthma have a care plan?

Additionally schools were asked if families provide school with a spare inhaler;

53% said yes whilst 47% said no.

When asked if they inform parents of children’s reliever use in school 63% of schools said no whilst 37% said yes; this is of concern as this may be indicative of poor control or need to change preventer medication.

Families and young people were asked; via questionnaire or focus groups about asthma also. Parents were asked about what affects their sending a child / young person with diagnosis of asthma child to school, if they their child has had an absence due to asthma and if they are made aware of inhaler use at school.

Of the 18 families asked, 39% had had an absence from school within the last 9 months due to asthma. 44% reported that their child did not have a care plan in school re their asthma whilst 39% were never informed if their child used their inhaler during the school day. Some parents; 11% did not know if their child had access to their inhaler throughout the day.

Focus groups with Young People; in secondary school highlighted greater needs, with 12 from the 25 asked stating they do not carry an inhaler with them as they have not had a recent asthma attack. None of the Young People could identify a lead person in school with whom to discuss their asthma all though it would be beneficial to have a named person in school to talk to.

The Doncaster school nurse team have run a pilot of 6 months, to provide the following benefits

  • Identification and support
  • Improved partnership working of CYP&F, Health and Education therefore offering improved outcomes and greater safety
  • Education and training
  • Empowered educationalist improving knowledge and ability to support a vulnerable group and therefore reduce vulnerabilities
  • Guidance and asthma leads within schools
  • Empowers education partners to support and reduce vulnerability

A task and complete group of school nurses, 1st contact practitioner and paediatric liaison nurse worked in partnership consulting with Dr Matthew Kurian (paediatrics).

The following guidance is designed to address the identified gaps in service provision

  1. Identification of children within school nurse caseloads with a diagnosis of asthma
  2. Information and advice for children identified on school entry questionnaire
  3. Children in schools have relieving medication with easy access in schools; at all times
  4. Information and advice for young people on transition to secondary school

Asthma is a condition that affects the airways. The airways are the small tubes that carry air in and out of the lungs. Children and young people with asthma have airways that are often red and sensitive (inflamed). When they come into contact with an asthma trigger, their airways become narrower, making it more difficult to breathe.

Not every child’s trigger is the same, but the common triggers are cigarette smoke, coughs and colds, house-dust mite, pollen, furry or feathery animals, exercise, pollution, chemical fumes, cold air, excitement and stress.

Asthma symptoms include:

  • Coughing
  • Wheezing
  • Tightness in the chest
  • Shortness of breath
  • Being Unusually quiet/ sitting out

Please be aware that not all children will get the same symptoms. They may say things like:

“It feels like someone is standing on my lungs”

“It feels like I am being squashed”

“When I’m having an attack, it feels like a rope is being slowly tightened around my chest”

Younger children may say that their tummy hurts

1.1School Asthma Healthcare Plan

The School Asthma Healthcare Plan (Appendix 1) is adapted from Managing Medicines in Schools and Early Years Settings (DfES, 2005). The plan is used to record important details about individual children’s needs, their triggers, signs and symptoms and any medication they may need.

1.2Asthma Medication

1.2.1Preventer inhalers

Most children with a diagnosis of asthma require inhalers called preventers that are taken every day, in order to control asthma and prevent asthma symptoms. They are not used to treat an asthma attack. Preventers are expected to be administered at home, outside of normal school hours. Preventer inhalers are usually brown but can be orange, green or purple. See picture below

1.2.2Reliever Inhalers

1.2.3Reliever inhalers:

  • Are essential in relieving the symptoms of an asthma attack
  • Come in different shapes and sizes; they are usually blue
  • Are very safe and effective and have few side effects – some children get a faster heart rate and may feel shaky if they take a large dose
  • If the device is like the one pictured below, it should be used with a spacer
  • If asthma is well controlled, the use of reliever medication should be minimal.

-Using a reliever inhaler more than twice a week may be a sign of poorly controlled asthma.

1.3Access to and storage of inhalers in school

Parents have primary responsibility in ensuring that their child has an in date inhaler which is prescribed and labelled for their child.

Children with asthma must be able to access their own relieving medication:

  • Children who are able to use their inhalers themselves; without assistance, should be allowed to carry them.
  • If a child is too young or immature to take responsibility for their own inhaler, staff should make sure the inhaler is provided to school then stored in a safe, accessible place
  • Inhalers should NEVER be locked away
  • Inhalers should be easily available during physical exercise, sport activities and education visits.
  • All asthma medicines taken in school should be clearly labelled with the pupil’s name.
  • Staff should ensure that children only receive their own medication, or school’s emergency medication. Children’s inhalers should not be used for other children.
  • All medication should be stored in the original container.
  • All medication should be sent home with pupils at the end of the school year and should not be stored in school during the summer holidays.
  • Out of date medication should be returned to parents, who should be asked to return items to pharmacy for safe disposal
  • When a pupil leaves the school, their medication should be returned to parents.

1.4Roles of the School Asthma Lead, Class Teacher and the School Nurse

1.4.1Role of the School Asthma Lead

Every school should identify one or more members of staff to take the lead role for asthma.

  • Attend a half day awareness training session every three years
  • Compile and maintain a directory of children / young people with a diagnosis of asthmas in school, and share this with the school nursing team.
  • Ensure that all parents/carers are asked every year if their child has asthma
  • Ensure a covering letter (Appendix 3) and health care plan (Appendix 1) is sent to all parents/carers of children with asthma. The parents/carers should complete this and return it to school. (If parents/carers feel that a meeting in school to complete this is preferable, this should be accommodated).
  • Review the School Asthma Health Care Plan in conjunction with the child’s parent/carer
  • Ensure that all children with an asthma care plan have provided school with a reliever inhaler and spacer device.
  • Ensure that all parents/carers are asked to complete the agreement for the school to administer medicine in school (Appendix 4)
  • Raise awareness throughout the school about the school’s asthma policy and guidelines
  • Liaise; via the central point of contact, with the school nurse about individual children, especially where there are concerns that a child’s asthma may be getting worse.
  • Liaise with teachers who look after children with asthma to ensure they are aware of these children and their care plan, and that they have access to their relieving inhalers.
  • Support school staff to understand and manage asthma within the school setting
  • Take responsibility for gaining an emergency inhaler and spacers to be kept in school (school nurse can support with this. This is optional, but we would encourage you to do so)
  • Ensure consent is gained from parents for the school’s emergency inhaler to be used on their child (Appendix 7)

1.4.2 Role of the class teacher

  • Be aware of any children who have asthma in their class and ensure the child’s Asthma Healthcare plan is fully implemented
  • Ensure ease of access for children to their relieving inhalers
  • Ensure parents /carers are aware of use of relieving inhalers and asthma attacks during the school day.
  • Liaise with the School Asthma Lead and or refer to the school nurse if there are concerns that the child’s asthma is unstable or worsening
  • Encourage a positive attitude to children with asthma within the classroom
  • Attend the annual update delivered by the school nurse team; Medical conditions training at Mary Woolett Centre.

1.4.3 Role of the School Nurse Team

  • Fully support the school asthma lead and teachers in fulfilling their roles
  • Be the point of clinical contact for school professionals providing care for children.
  • Provide school with a school health plan including the incidence of asthma within school
  • Provide yearly training for school staff; including the management of an acute attack.
  • Cascade relevant updates to schools in the management of asthma in school.

1.5Asthma, Activity and Exercise at school

Children with asthma may experience asthma symptoms during exercise. However, children and young people with asthma, like everybody, benefit from regular activity. The health benefits of exercise are well documented and this is true for all

1.5.1 School Sport staff should

  • Involve pupils with asthma as much as possible in their lessons and encourage they be involved in after schools clubs and sporting activities as any other child would
  • Be aware of the potential triggers for pupils with asthma when exercising and should know what to do to minimise these triggers
  • Make time to speak to parents/carers to relieve their concerns or fears about the child participating in PE.

1.5.2 Children and young people with asthma should

  • Always warm up and down thoroughly
  • Stop exercise if they start experiencing asthma symptoms. They should then take their reliever inhaler waiting until they feel better (at least five minutes). They should be encouraged to ensure they tell a member of staff how they are feeling.
  • If relatively unfit, gradually increase their exercise levels.

1.6 Residential and educational trips

There are some extra measures that should be taken when a child with asthma is attending an educational or residential visit. The asthma lead should discuss these measures in conjunction with the child, parents/carers and class teacher.

  • Ask the parents/carers about their child’s asthma and current treatment and check if the school Asthma Health Care Plan is up to date; a copy should be taken on the visit.
  • Complete a full risk assessment for each trip or residential visit.
  • Ensure the staff member who will be responsible for the child is aware of, and understands the child’s medication; for residential visits this includes the preventer inhaler.
  • Ensure that any support staff / supervisors accompanying the visit have received basic asthma training.
  • Ensure that all inhalers are readily available to the pupil at all times during residential visits.
  • Ensure any child who requires support / supervision in taking inhalers has a

named person to access.

1.7 Overview of legal issues: Administration of Medications in school

1.7.1Emergency situations

In an emergency situation; e.g. a severe asthma attack, school staff are required under a common law duty of care to act like any reasonably prudent parent or guardian. This may include administering medications

1.7.2Non-emergency situation

  • There is no legal or contractual duty for school staff to administer medicine or supervise a pupil taking medicines unless they have been specifically contracted to do so.
  • Administering medicines is a voluntary role and one that many school staff are happy to perform
  • Employers are responsible for providing indemnity for those staff who agree to administer medicines.

1.8Record Keeping