Management of Toxicological Emergencies in the School Setting: An Overview for School Nurses Part 1

School nurses may encounter a variety of poisoning and overdose scenarios in the school setting. Younger students are more likely to experience unintentional exposures that are usually lower in toxicity, with the risk for harm increasing with age for reasons including substance abuse, self-harm, and exposure to more toxic ingestants. Poison control centers (PCC) are uniquely qualified to assist the public and health professionals, including school nurses, with poisoning and overdose incidents and are available 24 hours per day. This article is Part 1 of a series of three articles and introduces the management of toxicological emergencies in the school setting. In addition, this article provides information including expected clinical effects, potential for serious injury, and a reasonable approach to manage exposures for the following objects and substances of potential harm: button batteries, emergency medications, first aid products, magnets, nontoxic (inedible) products, and therapeutic error. Parts 2 and 3 of the series will continue the discussion focusing on substances of abuse and addiction, social media challenges, and environmental hazards.

Pharmacology Update: Emergency and Controller Medications for Treatment of Asthma

Asthma is the most common noncommunicable chronic childhood disease, affecting more than 5 million children in the United States. Asthma is the leading cause of school absenteeism. Treatments for asthma are divided into fast-acting medications that are used to relieve symptoms and slower acting (controller) medications that prevent symptoms. Albuterol is the most common fast acting medication for asthma, and it exists in multiple forms, including metered-dose inhaler and nebulized therapy. The use of spacers and holding chambers can further improve medication deposition in the airway. The cornerstone controller therapy for asthma is inhaled corticosteroid. Other medications for asthma include long-acting beta agonists, long-acting antimuscarinics, and antileukotrienes. The newest agents for controller asthma therapies are biologics.

Pharmacology Update: Emergency Medications for Hypoglycemia in Diabetes

Children and adults with Type 1 and Type 2 diabetes are at risk for severe hypoglycemia, an unpredictable and potentially life-threatening situation. Severe hypoglycemia creates low blood glucose levels in which a person has an altered mental status or physical symptoms that require assistance from another individual to treat the hypoglycemia. Treatment of severe hypoglycemia is a medical emergency and prompt treatment is important for the well-being of students with diabetes. If left untreated, severe hypoglycemia can lead to death. Glucagon is a medication used to treat severe hypoglycemia outside of a healthcare facility. Recently, more stable and easier to use formulations of glucagon have become available. The purpose of this pharmacology update is to describe two new formulations of ready to use glucagon: an intranasal and subcutaneous, autoinjector formulation.

School Nurses Perceptions on Managing Asthma in Alabama Schools

Asthma is the most common chronic condition in children under 18. In Alabama, 11% of children report a diagnosis of asthma compared to the United States with 9.5%. Childhood asthma is the leading cause of school absenteeism due to a chronic disease, and Alabama children with asthma miss approximately 10 days of school each year for uncontrolled asthma. Managing children in the school system with asthma can often be challenging for school nurses. In this cross-sectional study, perceptions of Alabama school nurses on managing asthma in the school were explored. School nurses feel prepared to manage asthma but identify lack of certain resources and supportive policies, especially access to medications as barriers to optimum care. Implications for statewide advocacy at the policy level and broadening educational activities are supported by the survey results.

Implementation of a standardized process for ordering and dispensing of high-alert emergency medication infusions

OBJECTIVES

Pharmacies encounter challenges when ensuring safe, timely medication dispensing to patients in the pediatric intensive care unit, when high-alert medications are needed in emergent situations. Removal of these medications from nursing stock presented challenges to providing timely administration to critical patients. The project's purpose was to develop a new method for reducing dispensing time while improving patient safety in pediatric intensive care units.

METHODS

A committee of physicians, nurses, a clinical pharmacist, and pharmacy administration collaborated for process development. The process established a list of compounded, ready-to-use infusions stored in the pharmacy, immediately available for dispensing. The dispensing mechanism includes ordering and dispensing processes using an "Urgent Drip Request" form. Most frequently ordered infusions (dopamine, epinephrine, norepinephrine) were added to automated dispensing cabinets in critical care units in concentrations that could be safely infused centrally or peripherally.

RESULTS

During the initial 4 months, 71 "Urgent Drip Request" sheets were processed. Drug utilization evaluation demonstrated a dispensing time of less than 1 minute for drip medications leaving the pharmacy after the form was received. No sheets processed exceeded the institutional 30-minute turnaround time, nor were errors or delays documented. Limited turnaround time data existed preimplementation but was not robust enough for analysis. It was not ethically feasible to perform a head-to-head comparison with the previous method, as it might have resulted in delay of therapy and negative patient outcomes.

CONCLUSIONS

This program allows high-alert medication infusion availability in an expedited manner, removes potential for compounding errors at the bedside, and assures clean room preparation. This has improved pharmacy efficiency in provision of safe patient care to critically ill pediatric patients.