The Implementation and Evaluation of a County-Wide Stock Inhaler for Schools Program in Pima County, Arizona

Abstract

Objective: Professional guidelines specify that children with asthma should always have access to quick relief medication. However, few children have access to such medication while at school. Stock inhaler programs allow schools to have a single, rescue inhaler that can be used by any child who experiences respiratory distress. The Pima County Stock Inhaler for Schools Program was developed by a stakeholder coalition after passage of Arizona H.B. 2208, “Stock Inhalers for Schools” in March 2017. The program provided schools with medication, a standardized protocol for respiratory distress, and technical support for implementation. The objective of this study was to evaluate the implementation of the program among schools across Pima County, Arizona during 2017-2018. Methods: A stakeholder coalition developed program materials including a standardized protocol that instructed trained personnel how to recognize and respond to respiratory distress. Additional template resources were created including a stock inhaler documentation log, a web-based training, and school enrollment forms. All 364 public, charter and private/parochial schools in Pima County, Arizona were invited to participate in the 2017-2018 Pima County Stock Inhaler for Schools Program. Outreach occurred during the summer of 2017 using various methods to inform schools of the program. Schools that enrolled in the program received a program toolkit including the following supplies: (1) 60-dose albuterol inhaler, supply of valved-holding chambers (LiteAire®), signed standing medical order by the Chief Medical Officer of Pima County, standardized protocol for albuterol administration, online training curriculum, template resources and on-going technical support from the program manager. The RE-AIM Framework was used to evaluate the county-wide intervention. Results: We examined program implementation among (n=230) public, charter, private/parochial schools who participated in the 2017-2018 Pima County Stock Inhaler for Schools Program. The program reached 82% of students in Pima County, Arizona. The stock inhaler was administered 1,032 times in 152 schools during the 2017-2018 school year. Eighty-four percent of children returned to class after albuterol administration. Trained personnel reported high confidence with administering the stock inhaler and using the standardized protocol during a respiratory event. Furthermore, 94.3% of trained personnel would recommend this program to other schools and 93.2% felt the stock inhaler program was beneficial to their school indicating high satisfaction with the program. Discussion: The Pima County Stock Inhaler for Schools Program demonstrated feasibility among schools that participated in the program. These findings provide evidence that after the successful passage of stock inhaler legislation, stakeholder coalitions can implement large-scale stock inhaler programs.