Policies

Procedures

Applying Best Practices to Medication Administration:

Peer-to-Peer Discussion

Aric J. Warren, PhD, LAT, ATC, CSCS, CES, TSAC-F

Jennifer Volberding, PhD, LAT, ATC, NREMT

What do your OTC practices look like currently?

• Small Break out groups
• Discuss
• Report

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What needs to change or be modified?

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What barriers need to be addressed?

• https://www.nata.org/news-publications/pressroom/statements/position

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Asthma – EAP in your P&P Manual?

• “athletic trainers should have pulmonary function measuring devices (such as peak expiratory flow meters [PFMs] or portable spirometers) at all athletic venues for athletes for whom such devices have been prescribed and should be familiar with how to use these devices.”
• have an extra rescue inhaler for each athlete for administration during emergencies.
• a nebulizer should also be available

NATA Position Statement. J Athl Train. 2005;40(3):224-245.

• Green Zone= Stable
• PEF > 480 (80% personal best)
• PEF 80-100% of patient’s personal best
• Asthma is under control
• Take preventative meds as usual
• Yellow Zone = Caution
• PEF 300-480
• PEF 60-80% personal best
• Symptoms likely present (wheezing, coughing,
• Use of medication required
• Recheck PEF after each dosage
• Red Zone = Danger
• PEF <300
• <60%
• Use rescue medication
• Emergency situation – Go to Emergency Room

Asthma – Written Plan

What do your Asthma management practices look like currently?

• Small Break out groups
• Discuss
• Report

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What needs to change or be modified?

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What barriers need to be addressed?

• Each athlete with diabetes should have a diabetes care plan for practices and games.

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• Blood glucose monitoring guidelines [frequency of monitoring; before, during, and after exercise
• 1. Measure blood glucose levels 2 to 3 times before exercise at 30-min intervals to determine directional glucose movement.
• 2. Measure glucose levels every 30 min during exercise if possible.
• 3. Athletes who experience postexercise late-onset hypoglycemia should measure glucose levels every 2 h up to 4 h postexercise. Athletes who experience nighttime hypoglycemia should measure blood glucose values before going to sleep, once during the night, and immediately upon waking.

Journal of Athletic Training 2007;42(4):536–545

• Carbohydrate supplementation
• Discuss specific carbohydrate quantities and types with his or her physician
• Before exercise-
• In general, when the blood glucose level is 100 mg/dL (5.5 mmol/L), carbohydrates should be consumed.
• During Exercise
• Additional carbohydrate supplementation may be needed for practices or games lasting 60 min when the pre-exercise insulin dosage has not been reduced by at least 50%.
• Athletes who are exercising at the peak of insulin activity may require additional carbohydrates.
• Post Exercise
• Athletes should eat a snack and/or meal shortly after exercise.

Treatment Guidelines for Mild and Severe Hypoglycemia

Hyperglycemia Guidelines

• Do you know how to check for ketones? [urine or blood]

• Ketones in blood
• Follow the physician orders of the individualized plan for when to test for ketones (blood glucose levels)
• In general
• Ideal <0.6 mmol/L
• 0.6 – 1.0 mmol/L is typically normal for people with diabetes
• 1.0 – 1.5 mmol/L = call the physician
• 1.5 – 2.9 mmol/L = risk for ketoacidosis. Call physician immediately
• >3.0 mmol/L = go to Emergency Department / 911

• What are your policies after insulin injection?

• What are your policies for the ‘individualized insulin regimen’ in the Diabetes Care Plan based on activity levels?
• Only made by Physician

What do your Diabetes management practices look like currently?

• Small Break out groups
• Discuss
• Report

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What needs to change or be modified?

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What barriers need to be addressed?