Asthma according to the recent presentation at the school’s annual meeting, coordination of child care can be improved through a school-based asthma program involving the child’s school, family, and clinicians. American Academy of Allergy, Asthma and Immunology, held almost this year.
“Partnerships between schools, families and clinicians can be powerful agents in improving the recognition of childhood asthma symptoms, asthma diagnosis and, in particular, treatment ” Sujani Kakumanu, MD, clinical associate professor of allergy and immunology at the University of Wisconsin – Madison, said in her presentation. “Emergency treatment plans and asthma action plans, as well as comprehensive education for all school staff and school environmental mitigation plans, are crucial to controlling asthma symptoms in schools “.
Kakumanu explains that the school is a unique place where families and doctors can affect asthma outcomes due to the constant amount of time a student spends there each day, but all the people involved in caring for · Allergic of a child should be aware and try to reduce environmental exposures. and triggers that can be found in schools that can make asthma worse, such as irritants, cleaning solutions, dust mites, pests, air pollution, and indoor air quality.
In 2016, the AAAAI and the National Association of School Nurses provided financial support for the School Asthma Management Program (SAMPRO). “The impetus for this initiative was the recognition that coordination with schools was essential to control pediatric asthma care,” Kakumanu said. Initially focused on asthma, SAMPRO has since expanded to include resources for allergies and anaphylaxis and is known as the asthma, allergy and anaphylaxis management program at school (SA3MPRO).
The first principle of SA3MPRO is the need for a committed support circle that includes families, schools, and clinics of children with asthma. “Establishing and maintaining a healthy circle of support is a key component to a school-based asthma association. It requires an understanding of how care is provided in clinics, hospitals, and schools,” Kakumanu said.
School nurses have a unique position to help address care gaps in children with asthma during the school day by administering medications and limiting the number of student absences caused by asthma. “In addition, nurses and school staff often provide key information to the health care system about a student’s health status that may affect their prescriptions and medical care,” she noted.
Establishment of an action plan
The second principle of SA3MPRO is the development of an action plan against asthma by schools for situations in which a child presents urgent asthma symptoms that require prompt action. The SA3MPRO Asthma Action Plan describes the severity of a child’s asthma, the known asthma triggers and what medications can be given at school and how clinicians and schools can share protected information. for HIPAA and FERPA.
Some programs allow school nurses to access electronic medical records to share information, Kakumanu said. UW Health, of the University of Wisconsin, developed the project, led by Kakumanu and Robert F. Lemanske Jr., MD, in 2017, which gave access to EMRs to nurses in the Madison metropolitan school district. Prior to the COVID-19 pandemic, the program was related to declining steroid prescriptions among pediatric clinicians, he said.
“This program allowed for the rapid and effective delivery of asthma action plans to schools, along with the necessary authorizations, prescriptions, and consent to share information electronically. With this information and subsequent authorizations, nurses were able to update the school health record, manage school symptoms, as outlined in the Individualized Asthma Action Plan, and coordinate school resources needed to address asthma symptoms during the school day, ”Kakumanu said. .
“This program also addressed a common barrier with school-based partnerships, which was the lack of efficient asynchronous communication, and it did so by including the capacity of school nurses and physicians. to address messages to each other within a protected EMR, “he added. “To continue our support for families, steps were also taken to include families with the corresponding ones [EMR] messaging and telephone communication “.
Barriers to the UW Health program included the need for annual training, maintaining momentum for organizational support and interest, controlling infrastructure, and maintaining documents. Other challenges were the management of systems that facilitated messaging and the need to obtain additional electronic consents separately from written consents.
The third principle of SA3MPRO is training, which should incorporate recognition and treatment of asthma symptoms among school staff, students and families; appropriate inhaler technique; how medical care will be provided at school and by whom; such as emergency asthma symptoms; and a plan to take the child to an emergency medical center. “Regardless of the program chosen, asthma education should address health literacy and multiple multicultural beliefs and be taught in the language appropriate for that school and for that body of students,” he said. dir Kakumanu. “Teachers, janitors, school administrators and all levels of school staff should be educated on how to recognize and treat asthma symptoms, especially if a school nurse is not always available on site. “.
The marathon is not a sprint
The ultimate principle of SA3MPRO is to improve air quality and reduce environmental exposure to triggers, which involves “the use of environmental recognition and mitigation plans to minimize the effect of allergens, irritants and indoor and outdoor air pollutants that can affect a child with asthma during the school day. “
While these measures may seem daunting, Kakumanu said the communities that have successfully implemented an SA3MPRO plan are those that prioritized up-to-date and accurate data, developed a team-based approach, and secured long-term funding. for the program. “The important lessons for all of us in this work are to remember that it is a marathon and not a sprint, and that effective care coordination requires constant, consistent resources,” he said.
This article originally appeared on MDedge.com, which is part of the Medscape professional network.