Vol. 15 •Issue 4 • Page 12
Managing Asthma at School
Training nurses to assess and treat flare-ups during the day keeps students in class.
Missing class for a visit to the doctor or emergency room after an asthma flare-up isn’t the kind of classroom trip that students look forward to. So St. Clare’s Hospital in Schenectady, N.Y., partnered with a local asthma coalition to find ways to reduce asthma-related absenteeism.
Instead of children leaving school upon suffering an asthma exacerbation, what if the school nurse could administer treatments, monitor their response, and safely send them back to class?
That’s what Leslie A. Bristol, RRT, AE-C, school asthma specialist, St. Clare’s Hospital, decided to find out. She helped to form a school-based asthma management program to provide nurses with the training and resources they needed to assess and treat children during the school day.
The program started at Schenectady City School District, a logical target given the urban district’s high asthma rates. At first, though, the district’s nurses were skeptical.
“They’ve seen a lot of programs come and go,” Bristol said. Her challenge was to make sure that this wasn’t another well-meaning initiative that fizzled out due to lack of commitment.
It took lots of coordination to get the asthma program running. The school district’s chief physician and superintendent needed to sign off on the project, plus district and hospital lawyers had to hammer out liability issues.
Schools received free equipment, including nebulizers, spacers and peak flow meters, as well as an albuterol prescription for each student.
All students with physician-diagnosed asthma were eligible to participate, though they needed written authorization from their doctor and a parent or guardian.
Under the new protocol, if a child’s asthma acts up, he goes to the nurse’s office, where the nurse performs an evaluation, checks his peak flow and compares it with a baseline measure recorded when the student entered the program.
Depending on how bad the child’s numbers are, the nurse treats him with either an inhaler or nebulizer, O’Brien said.
The program is funded partially by a bequest given to the hospital and partially by the hospital’s state grant-supported partner, the Greater Capital District Asthma Coalition.
For a large program like this to succeed, St. Clare’s and the coalition worked together. “You need people on the ground who are passionate,” said Maryann Cornell, MS, the coalition’s regional coordinator. “You need someone who is doing the nitty-gritty.”
Of the children who have visited the nurse’s office during the program’s history, more than 97 percent were sent back to class.
Additionally, the program has expanded. At the end of its first year, it had 96 students enrolled from two school districts. Now in its third school year, it has 202 participants from five districts.
The lessons learned
The nurses and asthma educators began to identify children with poorly controlled asthma simply by the frequency they went to their school health office for rescue treatments.
As a result, the program added a second component in 2004 to provide one-on-one case management. Fifty students have been referred to it so far.
John Crawford is a freelance writer based in Philadelphia.