Communication Between Schools Nurses and Health Care Providers on Students with Asthma: An Integrative Review

School-based asthma programs have been proven to lessen the burden of pediatric asthma. There is a lack of successful care coordination between school nurses and primary care providers. This review examined strategies to increase communication and identified gaps in the literature. Databases, including PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and The Cochrane Library, were searched to identify relevant articles. This review included 12 articles consisting of randomized controlled trials, quasi-experimental studies, mixed method studies, qualitative studies, and other non-research articles. Four key findings emerged, including limited availability of asthma action plans, inclusion of parents in the communication triad, school nurse outreach to providers, and improved communication leads to positive outcomes for students with asthma including decreased use of emergency medication and increased self-management of asthma. Further research is needed to develop evidence-based interventions that can be implemented to improve communication between school nurses and primary care providers

Anaphylaxis: how to recognise and manage in primary care

Anaphylaxis is a life-threatening emergency. Hannah Kramer and Rebecca Batt explain how correct diagnosis, avoidance and patient education are fundamental in reducing risk Anaphylaxis is a serious systemic hypersensitivity reaction that is usually rapid in onset and can cause death. It is an immune-mediated reaction, which typically occurs when a person is exposed to a trigger, for example a food, drug, or insect sting. This article aims to assist with the recognition of symptoms and to guide management of anaphylaxis in primary care. Beyond the acute, the practice nurse can play a key role in helping patients to manage their allergies in the long-term, particularly for those who are most vulnerable. Patients should be supported in understanding how best to avoid their triggers, in managing their emergency medication, and in the importance of good asthma control.

Effects of a 90-min educational intervention for patients with insect venom allergy: a prospective controlled pilot study

Background Anaphylactic sting reactions need a prompt management. A structured educational intervention for patients with insect sting allergy has not been implemented so far. The purpose of this study was to analyze the effects of a structured 90-min educational intervention for patients with insect sting allergy. Methods Patients with an insect venom allergy were offered to participate in a structured 90-min group education (intervention group (IG)) or to attend a control group (CG). The patients’ subjective self-assurance in using the emergency medication, the willingness to always carry the emergency medication, the mental health status, absolute one-time willingness-to-pay (WTP) for complete cure, a disease knowledge assessment and a simulation test to examine the ability to manage an acute sting reaction were estimated at baseline (t0) and at follow-up (t1) as outcome parameters. Results 55 patients participated in the IG (n = 25, 52.0% female, mean age 55.9 years) or the CG (n = 30, 56.7% female, mean age 52.0 years). Both arms showed a significant gain in self-assurance in using the emergency medication (IG: 6.1 at t0 vs. 8.6 at t1, p < 0.0001 and CG: 7.1 vs. 8.0, p = 0.0062) and ability to manage an acute sting reaction (IG: 6.7 vs. 11.4, p < 0.0001 and CG: 9.0 vs. 10.5, p = 0.0002) at t1. However, trained participants showed a significantly higher gain in the respective parameters. There were no significant changes regarding the remaining examined outcome parameters. Conclusions Patients who are willing to invest 90 min in a patient education intervention benefit significantly by an increased subjective and objective empowerment to manage an acute sting reaction.

Reasons for Delayed Pain Management in Patients With Chronic Migraine: A Qualitative Study

Background: Chronic migraine is often perceived as complex disease and difficult to manage. People with episodic migraine run the risk of developing chronic migraine, leading to great suffering for themselves, their families, and the larger society. The management of each attack may influence the development from episodic to chronic migraine. Aim: The aim of the present study was to explore experiences and management of migraine pain in patients with chronic migraine. Methods: Ten migraine patients participated in open interviews based on functional behavioural analysis within a cognitive behavioural framework. The interviews were analysed using systematic text condensation. Results: Participants’ experiences and management of chronic migraine pain was categorized under four concepts: Migraine pain signal, Hope of false alarm, Guiding assumption, and Delayed medical management. Conclusions: Difficulty distinguishing early migraine pain from other pain signals, neglect of migraine pain signals, and assumption of pain management can lead to delays in initiating emergency medication. Potentially early response to migraine pain signals could alleviate attacks.

Abstract 287: Expediency and Accuracy of Identifying the “Resuscitation Line” Using a Visual-Tactile Marker in a Critical Care Setting

Background: Most medications have some type of compatibility conflict with other medications. Emergency medication delivery is time dependent, delays required to identify a saline-only intravenous line may negatively impact patient outcomes. In this study, a tactile/visual IV tubing marker was evaluated for time to medication delivery as compared to standard identification methods. Methods: This was a mixed methods study. Method 1: Prospective randomized crossover study compared the administration of simulated Midazolam IV to a simulated critically ill patient using either the standard tape labeled IV-line or a new visual tactile marker (‘GoTo Tag’) to identify the correct saline IV through which to give the drug. Recorded time began when the participant entered the room and ended when the medication was delivered into the IV line. Subjects then left, and repeated with the opposite identification methods after a minimum 10-minutes. The normal saline IV line was moved to a different location between the attempts. Method 2: An exit questionnaire was utilized to obtain subjective data and to obtain open-ended comments. Results: Twenty-four participants, (4 physicians, 9 nurses and 11 paramedics) were recruited. The mean time to medication delivery was 28.3 ± 15.6 seconds. The visual tactile marker was statistically faster (22 ± 14 sec vs 35 ± 15 sec; p=0.002). The paramedic subgroup was also faster using the visual tactile marker (23 ± 14 sec vs 37 ± 12 sec; p=0.019). Overall, nurses identified the saline line modestly faster (25 ± 18) than paramedics (40 ± 14) or physicians (31 ± 14) regardless of the identification method. Comments by the participants clearly favored the ‘GoTo Tag’ over traditional tape labeled markers in terms of ease of resuscitation line identification and the potential to improve patient safety. Conclusion: The GoTo tag reduced the time to medication delivery, and was a preferred method to identify the resuscitation line by critical care providers.

Food allergy and asthma

Food allergies (FA) and asthma commonly coexist in patients, with asthma affecting 14% of school-age children and with FA affecting up to 8% of children in the United States. Compared with children without FA, children with FA are two to four times more likely to have asthma. The timings of food sensitization and FA seem to be strong predictors of asthma onset in childhood; results of studies show that food sensitization in the first few years of life is associated with increased odds of developing early wheeze. Having multiple FAs as opposed to a single FA further compounds the risk of asthma. Reciprocally, there is a strong association between the presence of food sensitization and/or FA and poor asthma control, including increased asthma-related health-care utilization and emergency medication use. Asthma is a risk factor in ∼75% of fatal food-related anaphylaxis cases. Therefore, besides FA education and management, patients with FA and with asthma should optimize medical therapy of their asthma and receive asthma education, including identifying possible asthma triggers. Furthermore, allergists should ensure that asthma must be well controlled before conducting oral food challenges. Timely administration of epinephrine is lifesaving and remains the first-line treatment during food-induced anaphylaxis, especially in patients with asthma. Among those biologic therapies that have been highly effective in treating asthma, omalizumab and dupilumab are now also being studied as treatments for FA.

Emergency Medication Access and Administration in Schools: A Focus on Epinephrine, Albuterol Inhalers, and Glucagon

Access to emergency medications is a growing concern, particularly regarding the availability, safety, and use of these medications in schools. The purpose of this article is to report results not previously published from a national survey, specifically regarding the emergency use of epinephrine, albuterol inhalers, and glucagon. A nonexperimental, cross-sectional design was utilized for this descriptive study. An online survey was distributed to school nurses in 2015, and data from 6,298 school nurse respondents are presented in the analysis. Findings related to stock and student-specific emergency medication use and storage, epinephrine usage data, and delegation of emergency medication administration to unlicensed assistive personnel are presented in this article. Further development of policies and procedures regarding emergency medication administration in schools is needed. School nurses are a valuable resource for obtaining knowledge in this area and keeping students safe at school.