AN ACT Relative to Bronchodilators/Spacers/Nebulizers Administered in Schools
DRAFT 9/17/15
Definitions
1) “Bronchodilators” means any medication used for the quick relief of asthma
symptoms that dilates the airways and is recommended by the National Heart,
Lung and Blood Institute’s National Asthma Education and Prevention Program
Guidelines for the Treatment of Asthma, such bronchodilators may include an
orally inhaled medication that contains a premeasured single dose of albuterol or
albuterol sulfate delivered by a nebulizer (compressor device); or by a pressured
metered dose inhaler used to treat respiratory distress, including, but not limited
to, wheezing, shortness of breath, and difficulty breathing or another dosage of a
bronchodilator recommended in the Guidelines for the Treatment of Asthma.
2) “School Nurse” means a registered nurse (RN) licensed by the New Hampshire
state board of nursing working in the school setting.
3) “Asthma” means a chronic lung disease that inflames and narrows the airways.
It causes recurring periods of wheezing, chest tightness, shortness of breath and
coughing. For the purpose of this section, “asthma” also includes “reactive airway
disease” commonly referred to as RAD.
4) “Administer” means the direct provision of a bronchodilator/spacer/nebulizer
to an individual
5) “Designated unlicensed assistive personnel” means a school employee, agent,
or volunteer of a school designated by the school nurse, who has completed the
New Hampshire School Nurses Association approved training required to provide
or administer bronchodilators/spacers/nebulizers.
6) “Health care practitioner” means a person who is lawfully entitled to prescribe,
administer, or distribute controlled drugs.
7) “Provide” means the supply of a bronchodilator to an individual.
8) “School” means any public or private elementary, junior high, or senior high
school.
9) “Self-administration” means a student or other person’s discretionary use of a
bronchodilator/spacer/nebulizer, whether provided by the student or by a school
nurse or designated school personnel pursuant to this subdivision
Permission for Schools to Obtain, Store and Administer
Bronchodilators/Spacers/Nebulizers
I. Each school board may authorize a licensed school nurse who is employed by
the school district and for whom the board is responsible to maintain a supply of
asthma related rescue medications at the school. The nurse shall recommend to
the school board the quantity of medication the school should maintain.
II. To obtain asthma rescue medications for a school district, a health care
practitioner may prescribe bronchodilators /spacers/nebulizers in the name of a
school district for use in asthma emergency situations.
III. Pharmacists may dispense bronchodilators/spacers/nebulizers pursuant to a
prescription issued in the name of a school. A school, under the direction of the
school nurse, may maintain a supply of bronchodilators/spacers/nebulizers for
use in accordance with this section.
IV. A School may enter into arrangements with manufacturers of bronchodilators
/spacers/nebulizers, third-party suppliers of bronchodilators/spacers/nebulizers
or health care offices to obtain bronchodilators/spacers/nebulizers at no charge
or at fair-market or at reduced prices. School districts may also accept donations
from foundations, organizations and private parties to purchase
bronchodilators/spacers/nebulizers.
VI. A school that possesses and makes available a supply of
bronchodilators/spacers/nebulizers pursuant to this section shall keep a yearly
report that summarizes the use of the stock bronchodilators/spacers/nebulizers.
Bronchodilator/spacer/nebulizer Administration
School nurses and designated and willing unlicensed assistive personnel who have
been trained by the school nurse may:
I. Provide bronchodilators/spacers/nebulizers to students who have been
diagnosed with asthma for use in emergency or other situations as determined by
the school nurse
Parental Permission & Notification
I. In order to receive emergency stock asthma medication each student must
have an Asthma Action Plan filed annually and updated as necessary with the
school that includes:
1. patient specific order for an asthma rescue inhaler from their health care
provider that includes dosage information and an order permitting the
student to use the school’s stock in the event of an emergency
2. The student’s parent/guardian must provide the required annual written
permission for their student to be given the stock
bronchodilator/spacer/nebulizer. This permission can be included as part of
the permission for the student to self-carry asthma medication at school if
applicable.
3. Emergency Contact Information
II. In the event that the stock bronchodilator/spacer/nebulizer is administered to
a student as soon as practicable, the parent, guardian or legal custodian of the
student will be notified in accordance with contact information on file at the
school.
200:44-d Training and School Policies.
I. (a) Designated unlicensed assistive personnel shall complete an asthma training
program prior to providing or administering a bronchodilator/spacer/nebulizer
made available by the school nurse and at least annually following completion of
the initial asthma training program. Such training shall be conducted by the
school nurse based on resources provided by the New Hampshire School Nurses
Association, National Association of School Nurses and the American Lung
Association. Training must be conducted in person and, at a minimum, shall
cover: (DOE does not currently have the capacity to provide resources and
because there are already vetted resources available from national professional
organizations these should be used. DOE will make these available on their
website as will the NHSNA)
 Techniques on how to recognize symptoms of severe respiratory
distress/asthma
 Standards and procedures for the storage and administration of a
bronchodilator with spacer/nebulizer
 Emergency follow-up procedures.
(b) The school nurse who conducts the training shall maintain a current list of
those who have successfully completed the asthma training program.
Guidance Provided to Schools
I. No Later than 90 days following the effective date of this section the
Department of Education, in consultation with the New Hampshire School Nurse
Association/School Health Coordinator and the American Lung Association, will
make available to all schools guidelines for the management of students with
(delete develop-- DOE does not currently have the capacity to develop materials)
asthma. The guidelines shall include, but not be limited to, implementation of the
following by a school nurse: education and training for designated unlicensed
assistive personnel on the management of students with asthma, including
training related to the administration of a bronchodilator with spacer/nebulizer;
procedures for responding to life-threating respiratory distress.
200:45 Immunity
I. No school district, member of a school board, school nurse, designated willing
unlicensed assistive personnel shall be liable in a suit for damages as a result of
any act or omission related to a pupil’s use of a bronchodilator/spacer/nebulizer
pursuant to RSA 200:43, if the provisions of RSA 200:42 have been met, unless the
damages were caused by willful or wanton conduct or disregard of the criteria
established in that section for the possession and self-administration of a
bronchodilator/spacer/nebulizer by a pupil.
II. No school that possesses and makes available , member of its school board,
school nurse, designated UAP , school district employee, agents or volunteers, no
health care practitioner that prescribes a bronchodilator/spacer/nebulizer for a
school, and no person who conducts the training described in RSA 200:44-d shall
be liable for damages as a result of the administration or self-administration of a
bronchodilator/spacer/nebulizer, the failure to administer a
bronchodilator/spacer/nebulizer, or any other act or omission unless the
damages were caused by willful or wanton misconduct.
III. The administration of a bronchodilator/spacer/nebulizer in accordance with
this section falls under the laws of delegation of emergency medication in school.
If delegated the task of bronchodilator/spacer/nebulizer by a school nurse,
administration of a bronchodilator /spacer/nebulizer by designated unlicensed
assistive personnel does not require licensure.
IV. This section shall not be construed to eliminate, limit, or reduce any other
immunity or defense that may be available under state law.
Regulation of Pharmacies; Dealing in or Possessing Drugs. Amend RSA 318:42,
VII-a to read as follows:
VII-a. The possession and administration, with written parental authorization, of
flu vaccine, immunizations, and mantoux tests for the purpose of disease
prevention and tuberculosis screening by registered nurses employed or
contracted by public school systems. The possession, provision, and
administration of a bronchodilator/spacer/nebulizer by licensed practical nurses
or registered nurses employed or contracted by public school systems, or other
school personnel pursuant to RSA 200:44-b and RSA 200:44-c.
Effective Date
This act shall take effect 60 days after its passage