Best Practice

Stocking emergency inhalers in school

Legislation and guidance Government policy Pupil wellbeing
A year ago, the law changed to allow schools to buy emergency inhalers without prescription. However, anecdotal evidence gathered by the British Journal of School Nursing and SecEd shows that some schools are unaware of the changes or have encountered challenges in implementation. Caroline Voogd explains

A snapshot survey of schools by SecEd and our sister title, the British Journal of School Nursing, has shown that some are still unaware of their right to hold an emergency reliever inhaler on the premises without prescription

In October 2014, an amendment to the Human Medicines Regulations came into force, allowing all primary and secondary schools in the UK to buy salbutamol inhalers for use in emergencies.

According to figures from Asthma UK, one in 11 children in the UK is receiving treatment for asthma, an estimated 75 per cent of hospital admissions for asthma are avoidable, and as many as
90 per cent of deaths from asthma are preventable.

Every year, children die from asthma and “a worrying 86 per cent of children have said that they have been without their own inhaler at school because they have run out, forgotten, lost or broken it”, according to Asthma UK. Having a spare inhaler for emergency use could help to reduce unnecessary trips to hospital and could save lives.

Government guidance

In England, updated guidance for schools was published in 2015. The guidance recommends that a protocol should be established for the use of the emergency inhalers and spacers, and that this should be incorporated into schools’ wider medical conditions policies.

It states that emergency kits should contain the following:

  • A salbutamol metered dose inhaler.
  • A minimum of two compatible spacers.
  • Instructions on using the inhaler and spacer.
  • Instructions on cleaning and storing the inhaler.
  • The manufacturer’s information.
  • A checklist of inhalers (identified by batch number and expiry date, and with monthly checks recorded).
  • A note of arrangements to replace the inhaler and spacers.
  • A list of children allowed to use the inhaler.
  • A record of administration.

The guidance also recommends that: “Inhaler and spacers are kept in a safe and suitably central location in the school, such as the school office, or staffroom, which is known to all staff, and to which all staff have access at all times, but in which the inhaler is out of the reach and sight of children. The inhaler and spacer should not be locked away.”

Wales and Northern Ireland have also issued separate guidance. Scotland has not yet issued its own guidance (see further information).

Implementation challenges

While some schools have welcomed this change and embraced this opportunity by having a number of spare emergency inhalers and spacers throughout the school premises, others have not.
One of the main barriers identified in our snapshot survey was a lack of awareness among the school leadership of the regulation changes and the new guidance.

One headteacher told us: “We’ve just had an asthma training update from our school nurse and staff were surprised that we didn’t have a spare inhaler. We are rectifying this and are in the process of obtaining parental permissions for this to be used by students in the event of an asthma attack.”

Another headteacher in Wales was unsure whether the change affected their school, while a third told us that the information had not yet “cascaded down” to the school.

One school leader said they were aware of the changes but had “decided against” having an emergency inhaler: “We never had a spare emergency inhaler on the premises. The teachers let the first aid admin member of staff know straight away if a child forgets and we contact the parents. We decided against it.”

Another challenge was the implementation of the new kit and staff responsibilities – such as checking the expiry dates of the equipment and ensuring it remains stocked and up-to-date – something one headteacher acknowledged can be easily overlooked. “We will need to ensure this inhaler is in date so that it is effective – a simple task yet one that could be overlooked in schools with all that there is to do.”

Cost was also a consideration, with one head saying that the inhalers and associated storage equipment could be expensive: “We have a spare asthma inhaler and spacer now in school. We have always tried to have a spare one here and staff and I feel more reassured that we can have a spare again.

“We have bought a large first aid-type storage kit, clearly marked for asthma use and stored centrally. This was pricey, but something we felt we should have. Everyone knows where this kit is.”
The head also raised another issue: “A challenge is making (the inhaler) accessible to staff while keeping medicines locked up as per the guidance.”

Parental consent has also proved to be a challenge to effective implementation for some, as one school’s matron explained: “The new legislation requires every child recorded as asthmatic to have a consent form for the use of the emergency inhaler.

“We have approximately 170 children in school recorded as asthmatic. The majority of these children carry an in-date, working reliever inhaler in their school bag and their parents have returned the consent forms. I have had difficulty obtaining consent forms from a small percentage of parents.”

While these challenges or a general lack of awareness about the new regulations mean that some schools have not yet acquired a spare emergency inhaler, others have persisted and have recognised the positive impact that having the emergency inhaler can have.

One headteacher said: “We have inhalers in all first aid kits and additional ones available in the medical centre. They have been used during games/PE. It has been well-received by staff who have received training in asthma care. We are also currently providing disposable spacers for use with them to ensure they are effective.”

Meanwhile, another head told us: “With the significant numbers of asthmatics this was felt as a reasonable step forward. All spare inhalers are clearly labelled and we follow the guidance. Fundamentally, this has been seen as a positive move.”

Further information