Transcript document

Communication Partnership
Student Health Collaboration
Overview – Delaware School Nurses
May 10, 2012
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The Challenge
 Currently School Nurses are not able to access
protected patient information due to the fact they
are not routinely recognized as part of the care
team.
 Exchange of information about the care of
students/patients would improve health outcomes
for children.
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STORY (Head Injury Example)
During PE class a student received a head injury. He was taken to
Nemours ED by the family.
The school nurse followed up with the family who reported, “A
deep wound requiring 11 stitches, a slight skull fracture, and a
concussion”. The nurse requested the discharge instructions be
sent to school.
Two days later the student returned to school, without the
discharge instructions.
Nurse’s action: Student restricted from PE class and recess. After
several weeks of phone calls to the family requesting
documentation, the mother completed a release form for the school
nurse.
The records did not indicate a skull fracture or concussion.
Weeks of activity restriction, nurse/parent conflict, and staff
frustration could have been avoided if the nurse was able to view
the discharge instructions in a timely manner.
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Authorization
FORM
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The Response
 Nemours and the Delaware Department of Education
formed a multi-disciplinary team that created a
process to facilitate the exchange of medical/
educational information between DE School Nurses
and Nemours Clinical Providers.
 A HIPAA / FERPA compliant authorization form was
designed to obtain consent from parent/caregivers to
allow school nurses to view the medical records of the
students under their care
 The authorization form reinforces that school nurses
are part of the care team.
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Workgroups
Technology
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Dave Nichols, Chair
Linda Wolfe
Dave West
Vicki Sanders
Sam Strally
Mary Zier
Ann Hurst
Aguida Atkinson
Shari Thomassen
Jamie Crooms
Claudia Kane
Beth Light
Marina Kaplan
Implementation Design
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Claudia Kane, Chair
Aguida Atkinson
Linda Wolfe
Vilma Davis
Shari Thomassen
Ann Hurst
Jamie Crooms
Vicki Sanders
Mary Zier
Mary Newman
Andrea Littleton
Beth Light
Pat Guilday
Sharon Gandolfo
Stefanie VanStan
Barbara Wilson
Evaluation
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Luanne Stratton, Chair
Steve Lawless
Linda Wolfe
Stefanie VanStan
Marina Kaplan
Katherine King
Jamie Crooms
Claudia Kane
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Information Sharing
 Treatment
– Asthma
management/action
plan
– Diabetes care plan
– Medications
– Allergy
management/action
plan
– Discharge
instructions
– PE / Classroom
restrictions
 Non-Treatment
– Physical
examinations
– Immunizations
– Letter indicating
the types of
activities in which
students should
be engaged
– Lead levels and
TB screening
– Contact
information for
other care
providers
 Educational
– Academic
performance
– Attendance
– Behavioral issues
– Frequency of
school nurse visits
and for what
reason
– Medication/
Treatment
compliance
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Communication PATHWAY
DELAWARE SCHOOL
NURSING PRACTICE
PATIENT
Fax to
Nemours
Informatics
(V.Sanders)
Send to Health
Info
Management –
EPIC (M. Zier)
SCHOOL
NURSES
Authorization
NEMOURS
CLINICIANS
Abstractor Fax to
Nemours
Informatics
(V.Sanders)
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 A web-based portal that provides access to
Nemours electronic medical records (EPIC) by
community health care providers
 A legal contract between Nemours and School
District will allow school nurses a user-account
in NemoursLink.
 School nurses will be able to access current
medical information but will not have access to
behavioral health records.
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The Partnership
Parent
Student
Nemours
Provider
School
Nurse
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Benefits
 Greater efficiency in accessing current student
medical information
 Commonality of information seen by school
nurse and medical providers
 Reinforces information that families are given
regarding their child’s care
 Minimizes the miscommunication between care
providers
 Reinforces the school nurse role in the care
team during the school year.
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Pilot Sites
Schools
Red Clay School District (4 schools)
Milford School District (6 schools)
Primary Care Practices
St. Francis
Milford
Specialty Sites
Endocrinology
Hematology Oncology Clinic
Orthopedics
Pulmonology
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Role of Pilot Participants
 To identify what works and what doesn’t
 To identify situations in which this process
improved communication and student health
 To identify success stories
 To develop workflow ideas, which can be used
universally throughout the partner schools in
Delaware
 To participate in evaluation interviews
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Next Steps
– School pilot sites will participate in a
NemoursLink training
– Pilot sites will be invited to a meeting and greet
event (if possible)
– Nemours Evaluation & Research team will reach
out to school pilot sites to schedule initial (preimplementation) interviews
– School nurses and Nemours clinicians will
engage in sharing of information across sites
– Address questions coming from pilot sites
– Develop plan for expansion into other school
districts and within the school district
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Measuring Success: Pilot
 Short term (Process indicators)
– Utilization of NemoursLink among school nurses
– Reported ease of use and satisfaction
 Intermediate
– Increased awareness of individual patients’ care plans
among school nurses
– Perceptions of improved care coordination
– Change in quantity, quality and nature of communication
between school nurses and providers, parents and
students
– Less time spent by school nurses on fact checking and
searching for information
 Timeline ≈ 3 months
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Measuring Success: Full Scale
 Same short-term and intermediate
outcomes as pilot
 Addition: Long-term outcomes
– Decreased absenteeism among students
– Decreased behavioral problems & discipline
referrals among students
– Improved health-related QOL among students
– Improved compliance with medications
– Changes in health care utilization (ER, PCP visits,
hospitalizations)
 Timeline: 1−3 years
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Comments from the Field
 Pat Guilday – Workgroup Member
 Rossana Palermo, Warner Elementary,
Pilot Site
 Sue Smith – Milford Central Academy,
Pilot Site
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