Liability concerns represent roadblock to stocking albuterol inhalers in schools
Click Here to Manage Email Alerts
LOUISVILLE, Ky. — Liability concerns prevent stakeholders from adequately stocking albuterol inhalers in Illinois schools, according to a poster presented at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.
However, these concerns are disproportionate to the legislative language protecting these stakeholders while inhibiting access to inhalers for the children who may need it most, the researchers wrote.
“Stock inhaler laws improve access to asthma reliever inhaler medications in schools for children who experience respiratory symptoms,” Andrea A. Pappalardo, MD, assistant professor of medicine and pediatrics at University of Illinois at Chicago, told Healio.
“This simple policy solution allows for a fail-safe method to having medicine when a child needs it readily available,” she continued.
Current legislation
Also known as “Stock Asthma Rescue Medication in Schools,” Illinois Public Act 100-0726 allows schools to stock and administer designated asthma relievers, namely albuterol, when respiratory distress occurs. Illinois is one of 16 states that permit schools to stock albuterol.
“Although Illinois has had this law in place since 2019, implementation or uptake has been slow,” Pappalardo said. “Through my American Lung Association-funded research, we investigated why stock inhalers aren’t in many Illinois schools, and for those that have it, what helped them the most to do so.”
The researchers began with a legal analysis of the legislation, which says that schools, districts, employees, agents and prescribers who administer these inhalers “in good faith” would not incur any liability or professional discipline due to any injury from use of the medication unless there is willful and wanton conduct.
The researchers called this wording strong and concluded that liability would be extremely unlikely.
Next, the researchers interviewed 20 stakeholders in Illinois including nurses, clinicians and administrators about keeping inhalers on hand. These stakeholders represented state and national advocacy groups; a state government organization; a national advocacy group; a pharmaceutical company; and urban, suburban and rural school districts.
According to the researchers, the most common facilitators for the implementation of stock albuterol policies included finding providers to write prescriptions, “champions” who push for implementation and funding from the district or state.
But seven of these stakeholders said that an inability to obtain prescriptions for these inhalers was a barrier to implementation. Provider concerns about liability, the stakeholders continued, was one of the reasons why these prescriptions could not be obtained.
“These liability concerns came from a variety of places — the clinicians themselves, their malpractice carrier and/or their institution/hospital,” Pappalardo said. “Pharmacies were less concerned with liability, but their lack of knowledge of stock inhaler laws causes many pharmacies to refuse prescriptions that clinicians wrote for schools.”
Meanwhile, school nurses in Illinois generally support stock inhaler laws, Pappalardo said.
“They recognize the rationale and need for greater school-based asthma management support that a stock inhaler can provide. They also see the potential for liability in not having stock inhalers for asthma symptoms relief when a law allows them to,” she said.
“However, we did find that there is some hesitation within school administrators surrounding liability and other concerns regarding any stock medications in schools, whether it be an asthma inhaler, naloxone, epinephrine or glucagon,” she continued.
Need for education
Considering the strength of the legislative language, the researchers said, these concerns about liability are overestimated. Additional regulation and education for providers and their insurers could address these issues, the researchers concluded.
“We need more education that enhances provider and pharmacist knowledge and comfort in prescribing stock medications, like asthma stock reliever inhalers, to schools. We also need to consider additional regulation and education of malpractice insurers to address potential liability concerns,” Pappalardo said.
Knowledge about stock inhaler policy was low among clinicians, nurses, administrators, schools and the public alike as well, she added.
“The logistical concerns of getting a standing order and filling it to the needs of many schools statewide are also something that many stakeholders in Illinois are collaborating to find solutions for,” she said.
Nursing availability is another concern, Pappalardo continued, with nurses ideally assigned to only one school instead of several.
“What we do know is that in the event of an emergency, or with any symptoms of food allergy or asthma, having access to rescue inhalers and epinephrine autoinjectors is standard of care. Schools should be no exception,” Pappalardo said.
“Access is critical. If a child has an allergic reaction, and there is no epinephrine, or has asthma symptoms and doesn’t have the inhaler they would need to calm the symptoms and stop the reaction, this puts a child needlessly at risk,” she continued.
Next steps
Advocacy can mitigate these risks, Pappalardo said.
“Physicians and allied health professionals can be advocates for our children with asthma wherever they may live, learn and play. We can make a difference, and we don’t always realize that,” she said.
“Statewide, county-wide and district-wide approaches are one way to start dissemination of education,” she said.
For example, Pappalardo said, stakeholders could collaborate to create hubs so pharmacies could better understand and dispense stock inhalers while providing easier ways to order them.
Also, Pappalardo said that the creation of an infrastructure that allows for easy training, protocol development, clinician referrals and prescriptions, ordering and distribution as well as the dissemination of knowledge would be critical next steps.
“Further, we need to pilot stock inhalers in key counties in Illinois to demonstrate how stock inhalers affect outcomes at the school and individual level,” she said. “Collaboration among many stakeholders is crucial to the success of increasing uptake of stock inhaler programs in Illinois and across the United States.”