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Asthma Pumps


anju
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hi all,

 

what do you do about asthma pumps? ours kept at the setting don't have the label from the dispensing pharmacy on so we can't check required dosage etc. also, so you get parents of children with pumps kept at the setting to sign consent every day their child attends in case you need to adminster an emergency dose??

 

A (swimming in paperwork)

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If our don't come in the dispensing bag (although lots do) I ask the parents to write the dosage on a sticky label, sign it and put it on the inhaler. The parents also fill in a form on registration about medical needs and this includes the taking of the inhaler if required. I do always inform the parent if they've needed it though.

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:o Where do I start?

We have had about 5 different version of an asthma plan from a parent all whihc differ and which she insists we follow. I have no managed to establish some boundaries with her and we only follow the asthma plan form the doctor.

You should have a school asthma plan really, it is not realistic to expect a parent to sign or predict when their child will need to have a puff or two.

Look on the Asthma website or call your asthma nurse at the doctors or hospital.

It should have a pharmacists label with all the usual bits on, another problem that we have with our parent, the ones she brings are blank!! (dont ask) xD

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thank you for your reply.

 

but isn't that a 'blanket consent' which is no longer allowed? and is the parent allowed to specify the dose - what if they got it wrong and we subsequently unwittingly admistered the wrong dose? AArghh!

 

A

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I'm pretty sure it's different for asthma because it's an ongoing medical condition - different to calpol. Also there's not a huge amount of damage that can be done buy having an extra puff. It may be different as I'm in a school. But we've always worked on the policy that if we have on file, signed consent then there's not much else we can do. If there is a sticky label in parents writing with signature for dosage as well I'm sure we are covered. There are not many conditions that require this, but if i was to fill in a form every time someone had the'r inhaler, one year I would have filled in about 5 forms a day as I had a child with life threatening brittle asthma.

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In the past, I've had a Care Plan for each child who had on going medical needs, at the present time we have no children which fall into this category. However, I had consent forms pre-filled in to a certain extent and photocopied for one little chap whose need for the asthma pump was fairly constant, so when mum came in all she had to do was sign and date the form each time. I always insist on the pump being supplied by the pharmacist with their written dosage instructions, I sit parent down and go through this with them the first time the child begins with us at pre-school and again if dosage changes etc. and explain our policy on administering medication.

 

We are very happy to come to an arrangement for a child's care plan, but parents must accept our conditions. If you stand firm the parents eventually get the message. You are at risk here, you are taking full responsiblity - not to be done lightly.

 

Get as much information on the products you are being asked to administer (check up on any side effects of the medication particularly) and make it clear under what circumstances you will administer it e.g. if a parent does not bring in the pump, their child does not stay, its that simple. If we have an extra pump at pre-school - we must have an unopened spare in case the medication has run out and it must have pharmacist label on it.

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Asthma inhalers are different to calpol .. and I would argue this with anyone who challenged me on it. Inhalers are not always a regular medication but are administered if needed, and blanket cover is appropriate for this condition.

 

parents need to be told if it has been administered and sign to say they have been told.

 

they aslo should be in easy reach during the session.

 

They should comre in a box with the pharmacy notes on it as to the childs name and frequency etc.. otherwise they should not be used.

 

In addition, please always ensure the covers are on these inhalers and not left open.. I once dealt with a case in a casualty department where the lid had been left off and the child had inhaled a small screw which had been in the inhaler from parents pocket... unseen in an open inhaler whan used...

 

Inge

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The asthma web site is really helpful and you can get leaflets, cards and other stuff about policies. ASTHMA SITE

 

I agree with Inge, asthma shouldnt be dealt with in the same way as calpol or other meds. Its an emergency measure. You cant overdose on salbutamol, too much will merely give the shakes as its also a stimulant. If you ever have to give it and the child doesnt respond to the treatment you can give it every minute or so until it works or until further assistance arrives. If the preventative measures (brown, purple, orange inhalers) are being followed properly you probably wont need the blue inhaler, but if you do it will indicate a trigger and needs to be addressed quickly. An asthma attack can change from just coughing to full blown wheezing and whistling in minutes so dont be afraid to use the inhaler.

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I have inhaled something from my own inhaler personally and although I was able to cough it up it was very unpleasant, so I echo Inge's caution there.

 

Our policy (although I don't have it written down specifically) is that the medication is detailed in our ongoing medication book and parents sign on any occasion it is administered (that part is written down but better than that!) Being our resident asthmatic I am usually the one who discusses use of the inhalers with parents and then involves the child's keyperson. I always tell parents that I will administer the first dose (two puffs of the inhaler, with six breaths through the air chamber) and that if the child requires more than this dose, the parents will be contacted as the second dose is being given. My reasoning for this is that stress can often be a key to making asthma worse so I would rather the child was with the person they are most comfortable with as soon as possible. On more than one occasion the child's GP has informed us that a child cannot really be given too much of the reliever medication if they are coughing etc and to keep dosing them until they are relieved or they reach medical care. However I will still call parents at the second dose to help calm the child. Sorry I am rambling tonight a lot but I hope that helps a bit.

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When my child was in reception she had to carry her inhaler with her to self-administer and the office had one anyway - you do need to have around 50 puffs from ventolin to OD - we have them at pre-school should a child need it - you can never tell with astma when a attack may happen - I once saw my gp about my daughter and he said she was fine and go home within 30 mins I was at accident & emergency and she had a huge attack - Dot

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We're pretty much the same as Anderspm for inalers and other 'life threatning' conditioms that require medication. I would never accept a child in without their inhaler, also would never accept an inhaler (or any other medication) without a pharmicists label and dosage. We also currently have 2 chidren with epi-pens and it wold be impossible to not have 'blanket; permissions for these. Very different to administering calpol (which we dont) If a parent asks their GP they will give them a spare inhaler to keep at school

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Thanks for sharing the Asthma Attack sheet Cait.

 

Where did you get the advice from? Just interested because on my last paediatric first aid course I was told that staff should never transport a child to hospital in their own car. It can make it very difficult to get help if things go badly wrong on the way. The trainer said that if the child is not well enough to wait for the parents to take them, call an ambulance.

This caused a lot of debate for us as we are a village a fair way from tha nearest towns and it often takes a very long time for ambulances to arrive. We are lucky enough to have community first responders but they are not always on duty.

Edited by AlisonP
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It should have a pharmacists label with all the usual bits on, another problem that we have with our parent, the ones she brings are blank!! (dont ask) :o

 

Usually the dispensers themselves do not have labels, the boxes do though.

We always ask parents to bring in a pharmasy labelled, unopened box, we put name labels on the inhalers and keep them in their own box.

 

Salsa

 

With labels on any volumisers as well.

Edited by Guest
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Usually the dispensers themselves do not have labels, the boxes do though.

We always ask parents to bring in a pharmasy labelled, unopened box, we put name labels on the inhalers and keep them in their own box.

 

 

The parent brings it in the box with the label and then chucks it in the bin which we have had to fish out on several occasions!! ALl the child's medicine is kept in a bag which moves around with him, goes out with him etc.

 

I was at allergy and asthma training last night until 9pm. They advised never giving a child medicine which didnt belong to them. Following your own policies and procedures but advised having an asthma plan which had been written with the GP/Dr parent and school/setting.

The trouble I have is the parent insists that the info she gives us is right and we don't need to see the Dr's plan. This is the same parent who wanted us to give her son the icing off of his birthday cake when he has a severe allergy to egg, so it is not your ususal case. :o

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thanks for more good advice, need to tackle difficult , mum re pharmacist label and create specific asthma policy and separate initial consent form for asthmatic children

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the special initial consent form may need to be used for any child with a chronic condition, not just asthma... diabetes springs to mind as one, and eczema creams, allergies , can be many which need ongoing / emergency medication

 

Inge

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Also it may be worth checking whether your insurance policy stipulates any special measures or procedures about medicines in general and/or asthma inhalers in particular. I remember a Rainbow leader telling a parent that if she put 'has asthma' on her personal details form then the child would not be covered by Girlguiding UK insurance if she didn't bring her inhaler with her to Rainbows each week.

 

Of cours that might just have been a ploy to get the parent to understand the need to bring an inhaler each week, but I couldn't possibly speculate!

 

Maz

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