Stock Inhaler Administration Practices Among School Personnel in Pima County, Arizona

Abstract

Medication administration often takes place at school. These tasks are performed by either a licensed school nurse or unlicensed assistive personnel (UAP) who has been delegated the task of medication administration by a licensed provider. One of the most commonly administered medications by school personnel is albuterol sulfate, a rescue medication that relieves the symptoms of respiratory distress. While all asthmatic children should have access to this life-saving drug, <15% of children have a rescue inhaler at school. Access is even more disparate among low-income minority children. By implementing a Stock Inhaler Program, schools can increase access to albuterol for students. Stock inhalers are a single, albuterol inhaler with a supply of valved-holding chambers that can be used by multiple students. After passage of HB 2208, “Stock Inhaler for Schools”, a Stock Inhaler Program was implemented in in Pima County, Arizona during 2017-2018. Schools were provided with a stock inhaler and materials to assist them with documenting each event.In this dissertation, a systematic review and meta-synthesis provided an in-depth understanding of medication administration tasks in United States’ schools, for both daily medications for chronic conditions and rescue medications for acute, emergency conditions. This review illuminated the numerous barriers school personnel experience when administering medications to students, namely, during health emergencies where a licensed school nurses is not physically present on campus. Next, data from the program was used to examine the relationship between stock inhaler usage and Area Deprivation Index (ADI), and between protocol compliance and administrator experience (nurse, nurse-supervised or UAP). Overall, 228 schools with an ADI value were examined. The low-moderate ADI quartile predicted whether a school ever used the stock inhaler and whether the school reported any use. Middle schools were 2.1 (95% CI 1.3-3.4) times more likely to use a stock inhaler than elementary schools. Private/parochial schools used the stock inhaler 0.4 (95% CI 0.1-0.9) times as frequently as public schools. We then examined the relationship between protocol compliance to a standardized protocol for medication administration and administrator experience. Stock inhaler events were dichotomized into compliant or non-compliant events using the total number of puffs reported by school personnel (=4 or 8 puffs or ≠4 or 8 puffs). A protocol compliance score was calculated using the total number of compliant events divided by the total number of events for each school. Nine-hundred ninety-nine stock inhaler events were examined for compliance to the protocol. Results indicated that 28% of events were compliant to the protocol and 72% were non-compliant to the protocol. After controlling for school organizational type (public schools or charter/private/parochial schools), grades served (elementary, middle, high and multi-grade), and school size (student enrollment), administrator experience was not predictive of protocol compliance. These findings suggest that succinct and consistent policies within and across US states aimed at increasing access to emergency medications in schools remain necessary. While Stock Inhaler Programs ensure equitable access to rescue medication, they further allow children to remain in their learning environment. However, the presence of a licensed nurse did not predict compliance to the standardized protocol for stock inhaler medication administration in Pima County schools.