Transcript school health update

SCHOOL HEALTH UPDATE 2012
Division of School Health
Bureau of Community Health
Systems
DIVISION OF SCHOOL HEALTH
• Beth Anne Bahn, Director
• Linda Pavlesich, State School Health
Consultant
• Jill Clodgo, State School Health Consultant
• Mary Taylor, Administrative Officer
• Bureau Administrative Support
• Six Regional School Health Consultants
REGIONAL SCHOOL HEALTH CONSULTANTS
NW – Donna Leffler
724-662-6068
[email protected]
NC – Deb Frey
570-327-3400
[email protected]
NE – Kristen Cheslick
570-826-2062
[email protected]
SC – Sue Templin
717-787-8092
[email protected]
SE – Sheri Mountz
610-378-4352
[email protected]
SW – Joseph Donahue
724-830-2701
[email protected]
ACT 104 of 2010 (HB101)
• Allows CRNP/PA to complete
physicals for:
Teacher Certification
School Staff
Mandated Student Examinations
ACT 104 of 2010 (HB101)
• Epinephrine Auto-injectors (Epi-pens)
Update current policy on asthma
inhalers to include Epi-pens
Student demonstrates competency to CSN
Specify conditions which could cause loss of
privileges
Require annual prescription and parental
approval
ACT 104 of 2010 (HB101)
• PA Guidelines for Management of
Food Allergies in School
Part of Wellness Policy
Development of Guidelines
www.health.state.pa.us/schoolhealth
“What’s New with School Health”
http://www.portal.state.pa.us/portal/server.pt/comm
unity/national_school_lunch/7487/special_dietary_ne
eds_in_school_nutrition_programs_resources/509222
FOOD ALLERGY GUIDELINES
REQUIRED CONTENT
The guidelines shall assist schools in addressing the
following:
• Scope of problem and impact on student health
• Types of policies and protocols to help prevent
allergic reaction emergencies
• Multi-disciplinary team approach needed
• Role and training of school staff in preventing
exposure to allergens
7
FOOD ALLERGY GUIDELINES
REQUIRED CONTENT
• Responsibilities of parent/guardian, school staff,
and primary care provider
• Emergency Response Protocols
• Roles of staff members in care of students with lifethreatening allergies
8
FOOD ALLERGY GUIDELINES
SECTIONS
• Understanding the Disease
• Addressing Student Needs
• Tools for Effective Food Allergy Management in
Schools
• School Responsibilities Under Law
• Appendices
9
STAFF TRAINING: TWINJECT
• Twinject (Epinephrine)
Unlicensed school personnel may only give
the first dose of an auto-injector
Second dose should be administered by a
medical professional
STAFF TRAINING: ANAPHYLAXIS
• Previously Undiagnosed Anaphylaxis
Include in board-approved policy made in
consultation with school solicitor
Standing order if approved by school physician
Order for medical professionals only
Student assessed by nurse and Epi-pen
administered
Unlicensed school staff should not give Epi-pen,
call 9-1-1
STAFF TRAINING: GOOD SAMARITAN ACT
• 42 Pa.C.S. § 8337.1
An officer or employee of a school
In good faith believes that a student needs
emergency care, first aid or rescue
Provides emergency care, first aid or rescue
Shall be immune from civil liability
STAFF TRAINING: EPI-PEN
• According to the PA Board of Nursing
Nurses may train an unlicensed person in
how to respond using an Epi-pen or
rescue asthma inhaler
FOOD ALLERGY MANAGEMENT
RESOURCES
• Additional Resources
• National School Boards Association
• “Safe at School and Ready to Learn: a
Comprehensive Policy Guide for Protecting
Students with Life-Threatening Food
Allergies”
• PA School Boards Association
• Template Food Allergy Management Policy
• Administrative Guidelines
ACT 101 of 2011 (SB200)
• Departments of Health (TBI Program) and
Education (Safe Schools) developing
guidelines for concussion management
Specifically for athletic activities
Removal from play
Return to play
Training for Coaches
• In beginning stages
ACT 101 of 2011 (SB200)
• Traumatic Brain Injury (TBI) Program
website
http://www.portal.state.pa.us/portal/server.pt/
community/grants___funding/14140/traumatic
_brain_injury/666239
• Brain STEPS (Strategies, Teaching, Educators,
Parent, and Students)
Child & Adolescent Brain Injury School Re-entry
Program
IMMUNIZATION REGULATIONS
• FAQs on Exclusion of Students due to end
of provisional period
Sent via PENN*LINK to administrators on
March 9, 2012
Sent through CSN contacts on March 9, 2012
IMMUNIZATION REGULATIONS
• Questions
Authority to exclude students
Exclude now or end of school year
May provision period be renewed
Classification for absence
Provision of homebound instruction
IMMUNIZATION REGULATIONS
• Questions (cont)
May I exclude?
Students with IEPs and 504s
Students younger than 8
Homeschooled/Private Tutored Students
Immigrant/refugee students
Homeless students
IMMUNIZATION REGULATIONS
• Questions (cont)
Requirements for school year 2012-13
Department of Health assistance
SCHOOL IMMUNIZATION CATCH-UP
PROGRAM (SICU)
• Vaccine provided at no cost to school
districts by the Department of Health
• Hepatitis B, MCV4, Tdap, and Varicella
vaccines for students who are unable to
obtain these vaccines through their
medical homes
Students MUST be VFC Eligible (uninsured,
underinsured, Medical Assistance)
SCHOOL IMMUNIZATION CATCH-UP
PROGRAM (SICU)
• School districts plan, develop, and implement
programs with consultation from their local
Health Department
• Protocols for planning and implementing a SICU
program are available at the Department of
Health, Division of Immunizations
http://www.health.state.pa.us/schoolchildreni
mmunizations
Updated forms will be available on website
approximately May 1 for school year 2012-13
2012-13 SCHOOL FLU INITIATIVE
• Injectable and nasal influenza vaccine
available
• Department of Health provides
Vaccine with supplies
Informational packet for parents
• For more information, visit
http://www.portal.state.pa.us/portal/server.pt/co
mmunity/immunizations/14141/school_children_i
mmunizations/557995
IMMUNIZATION RESOURCES
• Available at “What’s New with School
Health” www.health.state.pa.us/schoolhealth
Updated Immunization Manual
Information on ordering immunization
cards and new rack cards
• CDC Pink Book
http://www.cdc.gov/vaccines/pubs/pinkboo
k/index.html
IMMUNIZATION RESOURCES
• PA- Statewide Immunization Information
System (PA-SIIS)
View-only access for school nurses
http://www.portal.health.state.pa.us/portal/se
rver.pt/community/pa_statewide_immunizatio
n_information_system_%28pasiis%29/14281/school_nurses/556459
Send application to Attention: Frank Caniglia
OFFICE OF HEALTH EQUITY
• Office of Health Equity (OHE)
Provides leadership to increase public awareness of
health inequities and disparities in PA
Creates awareness and proposes actions to address
existence of health inequities and mobilizes
individuals, statewide agencies and communities to
reduce and/or eliminate health disparities in PA
Disparities often caused by societal, economic, or
environmental factors, such as poor housing,
poverty, or discrimination
DIVERSITY
• Diversity
Commitment to recognize similarities and celebrate
people’s differences in order to highlight their
uniqueness and create inclusiveness in a gradually
diverse world community
• Diversity Awareness
Creates respect and appreciation of the mixture of
characteristics that make individuals unique and
groups distinctive from one another
OFFICE OF HEALTH EQUITY
• Health Inequities
Exist when one population or group of people
experience worse health outcomes or a lesser
quality of health care when compared to other
populations
• Intercultural Communication
Form of interpersonal communication where
cultural influences are sufficiently great and may
interfere, distort, or result in miscommunication
and / or lack of understanding
REFUGEE HEALTH
• Partnership
Federal Office of Refugee Resettlement
Department of Public Welfare
Department of Health, Office of Health Equity
Department of Health, Bureau of Epidemiology
• Goal
Ensure all newly arriving refugees receive a
comprehensive health screening as soon as
possible after entering the United States
REFUGEE HEALTH
• Refugee
Defined in international law as a person who is
outside his or her country of nationality and who is
unable or unwilling to return because of fear of
persecution
• Served by Refugee Program
Refugees
Asylees
Cuban/Haitian Entrants
Amer-Asians
Victims of Human Trafficking
Unaccompanied Alien Children
Survivors of Torture
OFFICE OF HEALTH EQUITY
• OHE
http://www.health.state.pa.us/healthequity
• Refugee Health
http://www.portal.state.pa.us/portal/server.pt
/community/refugee_health/19001
AUTOMATIC EXTERNAL DEFIBRILLATOR (AED)
• Check battery & pads for expiration
dates
Potentially greater liability than not
having an AED
• Grants/funding - Kiwanis, Lions,
Rotary, PTA, booster clubs,
http://aedgrant.com/
AED PRODUCTS
• Schools eligible to receive state pricing
for Zoll products, as a COSTAR
• For information on specific products and
pricing, contact Michael Chalifoux at:
[email protected]
800-242-9150 ext. 9565
Cell phone: 804-240-4388
SCHOOL HEALTH SERVICES
SCHOOL HEALTH SERVICES
PART TIME CSN
• Part-time CSN
Who is covering when CSN not in
district?
Students must be added to covering CSN
caseload
Students are to be under CSN caseload at
all times
SCHOOL HEALTH SERVICES
SUPPLEMENTAL STAFF
• Supplemental Staff
Can’t carry a caseload
Function under their own license
Under the direction of the CSN
CSN must go to all assigned buildings
on regular basis
Can’t cover caseload you never see
SCHOOL HEALTH SERVICES
CHIROPRACTORS
• Provision of services by:
Chiropractors
Scope of practice limited to the neuro-muscular
system
May write excuses for PE and school if within scope
of practice
Not in their scope of practice to:
Complete student or staff physicals
Write prescriptions for medications
Sign medical exemptions for immunizations
Write dietary restrictions
SCHOOL HEALTH SERVICES
EMTs
• Provision of services by:
EMTs
28 PA Code, § 1003.23
Scope of practice performed under medical
command or Statewide BLS medical
treatment protocols
Scope of practices does not include
Routine administration of medications
Supervising students self-administering
medications
SCHOOL HEALTH SERVICES
ATHLETIC TRAINERS
• Provision of services by:
Athletic Trainers
Act 123 of 2011
Management and provision of care of injuries to a
physically active person
Use of modalities such as mechanical stimulation,
heat, cold, light, air, water, electricity, sound,
massage and the use of therapeutic exercises,
reconditioning exercise and fitness programs
Shall not include administration of any controlled
substance
SCHOOL HEALTH SERVICES
AGENCY STAFF
• Provision of services by:
Agency Staff
CSN still responsible for students receiving
1:1 nursing care while under school
jurisdiction
School needs medical orders to provide care
in case agency nurse is absent
SCHOOL HEALTH SERVICES
• Licensed Private Academic
• Non-public/Non-licensed
• Career and Technology Centers
Full-time
Part-time
• Intermediate Units
• Alternative Education
DELEGATION
• Delegation
Nurses may not delegate per PA Nurse
Practice Act
Principals may not delegate per CSPG
#95
Non-medical school staff shall not be
directed to engage in health-related
activities per CSPG #101
DELEGATION
• Delegation
“in loco parentis” pertains only to
conduct and behavior
• Waiver of Liability
Possible violation of federal laws
Office of Civil Rights (OCR) - Berlin
Brothersvalley SD (1988)
SCHOOL HEALTH SERVICES
• Suggestions
Routinely monitor school board policies
CSN should be part of the discussion when
policies are reviewed and updated
Concern with policy or administrative
directive
Put concerns in writing
Contact School Health Consultant in your
district
DOCUMENTATION
SUSPECTED CHILD ABUSE
• Child Abuse
Document in health record
Statement made by student
Assessment and treatment of injuries
Notification of ChildLine
Copy of CY-47 form in file with note of
outcome of investigation
Photos of injuries
Part of school district policy
DOCUMENTATION
FERPA
• Sharing Health Information
Expectation of privacy
FERPA - educational need to know
Health Concern Lists
PA Public School Code, § 14-1409 Confidentiality,
transference and removal of health records
All health records established and maintained pursuant
to this act shall be confidential, and their contents shall
be divulged only when necessary for the health of the
child or at the request of the parent or guardian to a
physician
DOCUMENTATION
• 49 Pa. Code § 21.18
Standards of nursing conduct, require a
registered nurse to safeguard the
patient’s dignity, the right to privacy and
the confidentiality of patient information.
• ANA Code of Ethics for Nurses
Nurse safeguards patient’s right to
privacy
Duty to maintain confidentiality
DOCUMENTATION
ELECTRONIC
• Electronic vs. paper records
May keep health record electronically
Not necessary to maintain paper record
If student transfers, print copy of record
to send to receiving school
Security: who has access
Keep track of changes to record
DOCUMENTATION
• Health logs
Sign-in logs okay (name, time of arrival,
time of departure)
Individual record for each student for
assessment and treatment
• Medical plans of care
Standard of nursing practice
DOCUMENTATION 101
• Documentation 101:
Timely Charting
Use of abbreviations
Didn’t chart it, didn’t do it
Don’t use white out
Cross out error with single line and
initial, date and time
CORRESPONDENCE
• E-mails are not secure
Be careful about sending identifiable health
information
• Division of School Health
Remove identifiable information on students
before sending e-mail
Don’t have “educational need to know”
• Right to Know policies
MEDICATION ISSUES: FIELD TRIPS
• Field Trips (Section VIII in medication
guidelines)
Can’t refuse student attendance on field trip
because nurse not available (IDEA/504)
May not request waiver of liability from parent
(Berlin Brothers Valley SD-1988)
Advance notice to nurse for planning
Limit # of field trips from building per day
MEDICATION ISSUES: FIELD TRIPS
• Field Trips (cont)
Invite parent or parent designee
Utilize licensed nurse from sub list
Licensed volunteer
Need clearances
Approval as district volunteer
Provider permission required to change
dosage time or skip a dose of medication
MEDICATION ISSUES: FIELD TRIPS
• Out of state field trips
Check with Board of Nursing
Obtain in writing
• Delegation to student by parent not
allowed
Student under school jurisdiction
Zero tolerance drug policies
• Self-administration by student
Emergency medications only
MEDICATION ISSUES
• Extracurricular activities
Same rules as field trips
• Early Intervention Programs
School District responsibility
Integral part of school program
Located in school district building
Medications, immunizations & emergency care
Screenings for baseline (optional)
EMERGENCY MEDICATION ISSUES
• Emergency Medications
PA Public School Code
Students may self carry and administer
asthma inhalers / epinephrine autoinjectors (Epi-pens)
Nurses may train unlicensed staff to
assist with the administration of rescue
inhalers and Epi-pens
MEDICATION ISSUES
• Require licensed medical professional
to administer
Intranasal Versed
Diastat
Glucagon
NATIONAL PRESCRIPTION TAKE-BACK DAY
• April 28, 2012
• 10:00am – 2:00pm
• Sponsored by Drug Enforcement
Administration (DEA)
www.dea.gov
• Smart Moves, Smart Choices (NASN)
prevention of prescription drug abuse
http://smartmovessmartchoices.org
SPECIAL NEEDS STUDENTS
MEDICAL PLANS OF CARE
• Medical Plans of Care
Standard of Care: “If you didn’t write it,
you didn’t do it.”
Emergency Care Plan (ECP)
Individualized Health Care Plan (IHP)
Individualized Education Plan (IEP) with
medical component
504 Service Agreement
SPECIAL NEEDS STUDENTS
PA ELKS HOME SERVICE
• PA Elks Home Service Program
No charge
In-home medical care coordination
services
Assess needs & help to access
equipment
Advocate for appropriate education
services
http://www.paelkshomeservice.org/who
WeServe.php
SPECIAL NEEDS STUDENTS
PLANS OF CARE
• IEP and 504
Plans should provide reasonable
accommodations for student
Nurse should be part of team for
students in caseload
Nurse should not sign legal document if
not involved in development of plan
SPECIAL NEEDS STUDENTS
DIABETES
• Students with newly diagnosed or
unstable Type 1 Diabetes and an IEP
If medical provider writes in Medical
Management Plan that nurse is required
in school building at all times then
federal funds may be used to cover cost
SPECIAL NEEDS STUDENTS
TRANSPORTATION PLAN
• Factors to Consider
Individualized Transportation Plan (ITP)
Transition Healthcare Checklist
Who can legally provide care?
Dietary accommodations
SPECIAL NEEDS STUDENTS
TRANSPORTATION PLAN
• ITP
Standardize assessment of
transportation needs for every student
Resources and training available
https://www.gotoskn.state.pa.us/About
/StatewideInitiatives/Transportation/tab
id/66/Default.aspx
SPECIAL NEEDS STUDENTS
TRANSITION HEALTHCARE CHECKLIST
• Transition Healthcare Checklist: Transition
to Adult Living in PA
School responsible for successful transition
Start transition planning by age 14
Include health component
Omission most likely reason for failure according to
statistics from the Pennsylvania Training and
Technical Assistance Network (PATTAN)
Checklist updated in 2010
Also available in Spanish
http://www.portal.state.pa.us/portal/server.pt?open=514&
objID=558090&mode=2
COMMUNICABLE DISEASE
• Report suspected case(s) of communicable
disease
Call the District Office or State Health Center
Talk to staff – DO NOT leave messages
List of reportable diseases in Chapter 27 PA
regulations
http://www.pacode.com/secure/data/028/chapter27/
subchapBtoc.html
COMMUNICABLE DISEASE
• TB Testing
Students
Staff/Volunteers
• Critters
Bedbugs
http://www.spcpweb.org/factsheets/BBinSchoolsand
CC.pdf
Head Lice
Recommend following AAP guidelines
No nit policy outdated
BUREAU OF LABS
• Schools are NOT required to obtain a
license to do blood glucose testing
• Licenses are only required if testing
occurs in a place where the primary
purpose is to perform lab testing
SCHOOL HEALTH FORMS
• Online orders
http://www.portal.state.pa.us/portal/server.pt/communi
ty/schools/14130/school_health_forms__welcome/613260
• Fax with updated order form
http://www.portal.state.pa.us/portal/server.pt/communi
ty/schools/14130/publications___documents/556694
• School Health Record forms only
Last order printed packs of 50 instead of 100
If ordered this form since November
Verify forms received match number ordered
Place additional order if needed
HEALTH ALERT NETWORK
• Pennsylvania Health Alert Network (PAHAN)
Rapidly distributes information on emerging
public health issues
Licenses now available for ALL Certified School
Nurses
Only Certified School Nurses should register
Most appropriate to interpret alerts
May need to re-register in new system
PROFESSIONAL EVALUATION
• Evaluation will be specific to educational
specialist
Based on Charlotte Danielson
Enhancing Professional Practice: A
Framework for Teaching
Domains:
Planning and Preparation
Environment
Delivery of Service
Professional Responsibilities
SCHOOL NURSE FEEDBACK
• Request your suggestions for improving:
Annual Report
SHARRS - Reimbursement Reporting System
Manual/Procedure
Screens - Growth, Hearing, Scoliosis, Vision
Dental
Documentation
Other
School Health Website
• Send your suggestions to the school health
consultant in your district
NETWORKING
• Share the methods you utilize to
reach the required number of dental
and physical exams in your school.
• Send your comments to the school
health consultant in your district
CONTINUING EDUCATION
• Act 48
Division of School Health submits courses from
ANCC, ANA, AMA, AGD, PADHS, and Learning
Management System (LMS)
E-mail certificates to [email protected] with
PDE ID number
Fax certificates to 717-783-4790 and include
PDE ID number, e-mail address, and phone
number
• Act 58
If CSN, Act 48 hours count for RN CE
ACT 48 MORATORIUM
• Act 24 of 2011
Suspended Act 48 continuing professional
education requirements for 2 years
Until June 30, 2013
Does not prohibit taking courses
Hours accrued will be credited during moratorium
FAQS from Department of Education
http://www.education.state.pa.us/portal/server.pt/commu
nity/act_48_-_continuing_professional_education/8622
CONTINUING EDUCATION AUDIT
• Audits by PA Board of Nursing (BON)
Print screen shot from PDE Act 48
profile on day license renewed
If audited, mail screen shot and
Educational Specialist certificate to BON
BON sends letter approving CE
CONTINUING EDUCATION
CONTINUING EDUCATION
CONTINUING EDUCATION
CONTINUING EDUCATION
LEARNING MANAGEMENT SYSTEM (LMS)
• On-line courses for school staff
School Personnel & Supplemental Licensed
Health Staff
Act 48 hours through the Division of School
Health
Act 58 hours through the Department of
Health
• Become a registered user:
www.paprepared.net
RESOURCES
• American Heart Association
Be the Beat School Challenge
Hands-Only CPR
http://bethebeat.heart.org/
• Assistance with prescription medications
www.pfizerHelpfulAnswers.com
www.TogetherRxAccess.com
www.pparx.org
• Bullying prevention toolkit
http://www.stopbullying.gov/
RESOURCES
• CDC Tips from Former Smokers
http://www.naquitline.org/resource/resmgr/m
edia_campaign/tips_digital_media_toolkit_l.pdf
• CDC, STD Awareness - Reaching Young
People
http://www.cdc.gov/std/sam/default.htm
• CDC, COCA Clinical Reminder
DO NOT use insulin pens for more than one
person
RESOURCES
• ER Guidelines for PA Schools
www.paemsc.org
• Eagle Books Toolkit
http://www.cdc.gov/diabetes/pubs/eagle/pdf/E
agle%20Books%20Toolkit%20for%20Families
%20Classrooms%20and%20Communities.pdf
• Indoor Air Quality Toolkit
http://www.epa.gov/iaq/schools/
RESOURCES
• Mid-Atlantic Center for Children’s Health
and the Environment (MACCHE)
http://www.childrensnational.org/MACCHE/Res
ourcesAndTutorials/
Fact sheets on environmental issues in schools
Mold, Mildew
Pesticides in the Environment
Autism and the Environment
Asthma and school environment
RESOURCES
• Medical Assistance Information
http://www.dpw.state.pa.us/helpfultelephonen
umbers/contactinformationhelpformaproviders/
index.htm
• Pediatric Asthma Toolkit
http://www.paasthma.org/asthma-resources/asthmatoolkit
RESOURCES
• Orthodontic Emergencies
http://www.aaomembers.org/Press/HealthCare
Professionals/SchoolNurses.cfm
• PA Emergency Preparedness Guide
www.ReadyPA.org
HAPPY SCHOOL NURSE’S DAY
May 9, 2012