Is a physician's order required?
Yes. A 'qualified supervisor of health' (including, but not limited to, a credentialed school nurse) shall obtain from an authorizing physician and surgeon a prescription for each school for stock albuterol inhalers (and spacer). Usually, a school district has a Memorandum of Understanding (MOU) with a community provider to write the prescription.
If a local educational agency does not have a qualified supervisor of health, an administrator at the local educational agency (LEA) shall carry out the duties described above.
Does the ordering provider need to be a physician?
Yes. An “Authorizing physician and surgeon” may include, but is not limited to, a physician and surgeon employed by, or contracting with, a local educational agency, a medical director of the local health department, or a local emergency medical services director.
How do we find a physician to fill out the prescription?
Currently, schools will need to continue the process they have been following to acquire stock epinephrine (prior to the implementation of a statewide standing order). This may involve collaborating with the physician who prescribed your stock EpiPen. Additionally, you can seek assistance from a physician in your community, such as one affiliated with a School-Based Health Clinic (if available), or reach out to the County Public Health Officer or local asthma organization. While the California Department of Public Health (CDPH) is in the process of developing a statewide standing order, there is no set timeline for its availability at this time.
Who is responsible for stocking/restocking stock albuterol inhalers?
A 'qualified supervisor of health' (including, but not limited to, a credentialed school nurse) shall be responsible for stocking the stock albuterol inhalers and spacers and restocking them when used/depleted or expired.
How soon does the albuterol medication need to be restocked?
If the stock albuterol inhaler is used/depleted, it shall be restocked as soon as reasonably possible, but no later than two weeks after it is used/depleted. Stock albuterol inhalers shall be restocked before their expiration date.
Who can may administer stock albuterol in an emergency?
A credentialed school nurse or volunteer (unlicensed assistive personnel - UAP) may administer a stock albuterol inhaler to a person exhibiting potentially life-threatening symptoms of respiratory distress at school or at a school activity.
Where do we access stock albuterol inhalers?
A prescription may be filled by local or mail-order pharmacies or stock albuterol inhaler manufacturers. For more information about where to get albuterol inhalers see 'Obtaining Albuterol Medication' on the Resources page
Are spacers for the inhalers acceptable? Where to find disposable spacers?
Yes, may include single-use disposable holding chambers. For more information about where to get disposable spacers see 'Disposable Spacers' on the Resources page
Can the local educational agency (school/school district/county office of education) be liable for administering stock albuterol?
No. A local educational agency electing to utilize stock albuterol inhalers for emergency aid shall not be liable for any civil damages resulting from any act or omission, other than an act or omission constituting gross negligence or willful and wanton misconduct, in the emergency administration of an albuterol inhaler by any of its school nurses or trained volunteers who have volunteered.
Can a school nurse or volunteer be liable for administering stock albuterol?
No. An employee who volunteers shall be provided defense and indemnification by the local educational agency for any and all civil liability, in accordance with, but not limited to, that provided in Division 3.6 (commencing with Section 810) of Title 1 of the Government Code. This information shall be reduced to writing, provided to the volunteer, and retained in the volunteer’s personnel file.
Can a prescribing provider be held liable?
No. An authorizing physician and surgeon shall not be subject to professional review, be liable in a civil action, or be subject to criminal prosecution for the issuance of a prescription or order pursuant to this section, unless the physician and surgeon’s issuance of the prescription or order constitutes gross negligence or willful or malicious conduct.
Are donations acceptable?
A state agency, the department, or a public school may accept gifts, grants, and donations from any source for the support of the public school carrying out the provisions of this section, including, but not limited to, the acceptance of stock albuterol inhalers from a manufacturer or wholesaler.
Who can administer the stock albuterol inhalers?
A school nurse or, if the school does not have a school nurse or the school nurse is not on site or available, a trained volunteer may administer a stock albuterol inhaler to a person exhibiting potentially life-threatening symptoms of respiratory distress at school or a school activity when a physician is not immediately available.
Are the stock inhalers reusable? And if yes, what is the protocol/policy to cleaning them?
The albuterol inhalers contain around 200 metered doses and are reusable. It is recommended that disposable spacers are used to keep inhalers clean. Follow the package insert or manufacturer's website for cleaning instructions for the inhalers that your school district uses.