Transcript School Nurses Train Staff to Respond to Anaphylactic Emergencies

SCHOOL HEALTH UPDATE 2013
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]
CONCUSSION MANAGEMENT TEAMS
• Initial 4 weeks: Assist with academic
management
• Symptoms continue: BrainSTEPS
referral
• May refer to BrainSTEPS earlier if:
Multiple concussions
Not progressively recovering
CONCUSSION MANAGEMENT TEAMS
• School teams consist of:
Academic Monitor
Symptom Monitor
Tools for monitoring are provided
Training also provided
Working on posting training to Learning
Management System (LMS)
CONCUSSION MANAGEMENT TEAMS
http://www.brainsteps.net/_orbs/about/index.aspx
CONCUSSION MANAGEMENT
• Standardized testing
Limited Medical Emergency provision
Only for students NOT receiving education
(i.e. homebound instruction)
Can always make accommodations
based on need
District can elect to excuse student from
testing if it would cause harm
CONCUSSION/SUDDEN CARDIAC ARREST
• Recent laws only address
management for athletes
• Recommend following same
protocols for management of all
injuries (athletes and non-athletes)
SPECIAL NEEDS STUDENTS
• PennDOT Yellow Dot Program
Quick access to medical information at
scene of accident
Alerts first responders to check glove
compartment
Complete one for each person who
routinely uses a vehicle
To order materials, visit
http://www.yellowdot.pa.gov/
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
• PA Public School Code
•
§ 14-1401. Definitions
CHILDREN OF SCHOOL AGE" or "CHILD OF SCHOOL AGE" means every child
attending or who should attend an elementary grade or high school, either public
or private, within the Commonwealth and children who are attending a
kindergarten which is an integral part of a local school district.
• § 14-1402. Health services
• Each child of school age shall be given by methods established by
the Advisory Health Board
Screens (growth, hearing, scoliosis, vision)
Examinations (dental, physical)
• Every child of school age shall be provided with school nurse
services
SCHOOL HEALTH SERVICES
SCHOOL HEALTH SERVICES
Who’s responsible for provision of services?
• Public School Entities (school district,
charter and cyber charter schools,
comprehensive CTC, Intermediate Unit)
Follow provisions of:
Article XIV of PA Public School Code
28 PA Code, Chapter 23
SCHOOL HEALTH SERVICES
• Who’s responsible for provision of
services?
Part-time CTC
May have their own CSN
Services from School District where located
Supplemental staff working with home SD
CSN
Homeschool students
School district approved home education
plan
Not officially enrolled as SD student
SCHOOL HEALTH SERVICES
• Who’s responsible for provision of
services?
Licensed, Private Academic
Non-public, Unlicensed
Alternative Education
Approved Private
Behavioral Health/Day Treatment
Other Private, Non-Licensed
SCHOOL HEALTH SERVICES
• Who’s responsible for provision of
services?
Private Residential Rehabilitation
Institute
Private Tutor
Residential Treatment Facility
Special Education
State Juvenile Correctional
Early Intervention
SCHOOL HEALTH SERVICES
• BMI Information
Mail letter or via Parent Portal
Need to have way to notify parents
without on-line access
• Physical Exams
Work permits no longer require physical
Driver’s permit ok as long as not
completed by chiropractor
SCHOOL HEALTH SERVICES
• Dental Examinations
Public Health Dental Hygiene
Practitioner
Must have PDE certification to function in
school
Mandated and Dental Hygiene program
SCHOOL HEALTH SERVICES
• Teachers Refusing to Send Students
Develop protocol
Nurse is the medical professional
Qualified to assess student
Work with teacher to develop plan of care
• Services to staff
Certificate: K – 12
License: Birth - Death
SCHOOL HEALTH SERVICES
• Bus Accidents
EMS in charge at scene
CSN usually not a first responder
Recommend CSN remain at school
Bring students from scene of accident to
CSN
• Fire Drills
First priority- Get out of the building
SCHOOL HEALTH SERVICES
• Communication with providers
Add CSN to HIPAA form
Example language from Wellspan:
I give Wellspan Health entities permission to
release protected health information, in
accordance with PA State Education System
Guidelines to the following:
School Name & School Nurse Name
SCHOOL HEALTH SERVICES
• 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
• CSN Caseload
CSN must go to all assigned buildings
on regular basis
Based on # of students and health needs
Can’t cover caseload you never see
Responsibilities:
Coordinate care
Develop plans of care
Participate in teams (ex. Student
Assistance, IEP)
Communicate with parents
SCHOOL HEALTH SERVICES
• Supplemental Staff
Can’t carry a caseload
Function under their own license
Under the direction of the CSN
Responsibilities:
Daily care of students
Assist with completion of mandated screens
and exams
SCHOOL HEALTH SERVICES
• LPN
Must function as part of a team
Cannot carry a caseload
Cannot substitute for a CSN
May not use the title school nurse
• Non-certified RN
Cannot carry a caseload
May not use the title school nurse
SCHOOL HEALTH SERVICES
• 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
• 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
• Provision of services by:
Athletic Trainers (now licensed)
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
• 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
• 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
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
• 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
• National Task Force on Confidential
Student Health Information
Access should be strictly limited to
licensed health professionals
Best to interpret their meaning
Policy should grant school health
records same protections as medical
records
DOCUMENTATION
• National Task Force (cont)
Only share information that will directly
benefit the student’s academic success
• No difference between electronic and
paper records
Expectation of confidentiality the same
DOCUMENTATION
• Access to student health records
Substitutes
Must have access to student information in
order to provide appropriate care
Must be able to authenticate author of
records
Provider of care is to document the care
Documentation is to be completed in a
timely manner
DOCUMENTATION
• Electronic vs. paper records
May keep health record electronically
Not necessary to maintain paper record
May scan paper record into electronic format
Shredding of original paper record- up to school
policy
Electronic must keep track of changes
to record
DOCUMENTATION
• Electronic Signature
Acceptable
Must be able to verify order came from
the provider
• Provider order without signature
Not acceptable
DOCUMENTATION
• Health logs
Sign-in logs okay (name, time of arrival,
time of departure)
Individual record for each student for
assessment and treatment
• 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
DOCUMENTATION
• Transferring health records
Pa Public School Code, 14-1402.
Maintain comprehensive health record
28 PA Code, 23.55
Records shall be kept in building where child
attends
Records shall be transferred with child
DOCUMENTATION
• Transferring health records
No differentiation between:
In-state and out-of-state transfers
Cyber or charter school and school district
School may keep a copy but original
comprehensive record is to be
transferred
DOCUMENTATION
• Transferring health records
Student no longer enrolled in SD
No educational need to have access to their
record
If student transfers, print copy of record
to send to receiving school
Should be separated from academic records
Marked as confidential
MEDICATION ISSUES
• 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 Brothersvalley SD-1988)
Advance notice to nurse for planning
Limit # of field trips from building per day
MEDICATION ISSUES
• Field Trips
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
• Out of state field trips
Check with Board of Nursing in visiting state
Obtain their answer in writing, if possible
• 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
• Pre-pouring medications
28 PA Code, Part IV Health Facilities
§ 109.62. Administration of drugs
(a) The individual preparing a dose of
medication for administration shall also
administer it, except as provided by subsections
(b) and (c).
MEDICATION ISSUES
• Medication orders
§ 21.14. Administration of drugs.
(a) A licensed registered nurse may
administer a drug ordered for a patient in the
dosage and manner prescribed.
Parents are not recognized as licensed
prescribers
Prescriber must be licensed to practice
within Pennsylvania
MEDICATION ISSUES
• Medication orders (cont.)
Dosages must be specific
Administer “per packaging instructions” not
acceptable
• Standing orders
New school year begins July 1st
Need orders for activities prior to start of
school (ex. Band camp)
Written to cover volunteer nurses or
students in private/non-pubs
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
SAVING LIVES AT SCHOOL
• NASN program
Pa- 4 Epinephrine Resource CSNs
Lisa Albert
Beth Anne Bahn
Lynn Heard
Kathleen Maguire
To contact them for a training:
http://www.nasn.org/ToolsResources/FoodA
llergyandAnaphylaxis/EpinephrineResourceS
choolNurseProgram
SAVING LIVES AT SCHOOL
• School Nurses Train Staff to Respond to Anaphylactic
Emergencies
Students experiencing anaphylaxis need life-saving
medication without delay – it can mean the difference
between life and death
School nurses can take the leadership position in the
school to train school staff members to administer
epinephrine using an auto-injector
This presentation will highlight the need for this training
and provide the school nurse with an overview of
anaphylaxis and every resource needed to provide this
vital training at their school.
EMERGENCY MEDICATION ISSUES
Auvi-Q
Provides step-by-step instructions
Similar in cost to Epi-pen
Not yet covered by all insurances
Fits in a pocket
MEDICATION ISSUES
• Require licensed medical professional
to administer
Intranasal Versed
Diastat
Glucagon
]
SPECIAL NEEDS STUDENTS
• 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)
SPECIAL NEEDS STUDENTS
• Plans of Care (cont.)
Individualized Education Plan (IEP) with
medical component
504 Service Agreement
Individualized Transportation Plan
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
Checklist updated in 2010
Also available in Spanish
http://www.portal.state.pa.us/portal/server.pt/community/
special_kids_network/14205/transition_health_care_checkl
ist/558090
SPECIAL NEEDS STUDENTS
• 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
• When developing plans of care, don’t
forget to plan for emergencies
Lock-Down
Equipment/snacks needed in the classroom
Must follow state/federal laws/regulations
Shelter-in-Place
Equipment/medications used at home
3-days worth of supplies
SPECIAL NEEDS STUDENTS
• 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
SPECIAL NEEDS STUDENTS
• Identify student with need
• Contact parent/guardian for
permission to refer
• Call Special Kids Network
1-800-986-4550
Complete referral form
SPECIAL NEEDS STUDENTS
• Do Not Resuscitate
Out of Hospital Nonresuscitation Act
January 28, 2007
Provides direction to EMS personnel in
complying with DNR orders
Does not mention schools
Up to school policy
SPECIAL NEEDS STUDENTS
• PennDOT Yellow Dot Program
Quick access to medical information at
scene of accident
Alerts first responders to check glove
compartment
Complete one for each person who
routinely uses a vehicle
To order materials, visit
http://www.yellowdot.pa.gov/
EPILEPSY FOUNDATION
• Parent-led teams
Meetings in 6 Health Districts
Understand needs and service gaps for
children/youth with epilepsy
Looking for parents to serve as
facilitators
Commitment- approximate 4 hrs/month
through Sept. 2013
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
• Change to PA Publisher
• New order form only
• NUMBER of forms, no longer in packets
ORDERING SCHOOL HEALTH FORMS
• Taking about 2 weeks to send
orders. School Health Record takes
longer
• Send 1 order/school district if
possible
• Incomplete or incorrect order
received
Contact School Health
SHARRS
• School Health Annual Request
Reimbursement System (SHARRS)
First upgrade since School Year 2005-06
Changes effective June 2013
Public
Private/Non-Public
Registered Nurse
Licensed Practical Nurse
CRNP
Other
Unlicensed
Physician
Physician Assistant
CRNP
Dentist
Dental Hygienist
Dental Clerk/Assistant
Other
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
PROFESSIONAL EVALUATION
• Minipilot now through end of school
year
• Meet to re-evaluate in June
• Implement school year 2014-15
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
LEARNING MANAGEMENT SYSTEM (LMS)
• Courses in Development
Emergency Medication for Seizures
Sickle Cell Training for Schools
2013 School Health Update
Concussion Management Team Training
LEARNING MANAGEMENT SYSTEM (LMS)
• For Act 48 hours to be submitted to
PDE
Send e-mail to [email protected]
Include PPID number
Certificate
SCHOOL HEALTH WEBSITE
• All-Hazards Planning
• Chronic Diseases
• Communicable Diseases
• Coordinated School Health
• Dental Health Program
• Educational Opportunities
• Environmental
SCHOOL HEALTH WEBSITE
• Laws and Regulations
• Nurse Practice Issues
• Order School Health Forms
• Reimbursement
• School Health Program
• Special Concerns
• Special Health Care Concerns
• What’s New with School Health
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
2013-14 SCHOOL FLU INITIATIVE
• Injectable and nasal influenza vaccine
available
• Department of Health provides
Vaccine with supplies
Informational packet for parents
• Letter of participation available at
www.health.state.pa.us/schoolhealth on
the “What’s New with School Health” page
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
HEALTHY HOME RESOURCES
http://keystoahealthyhome.com
RESOURCES
• Lend a Hand, Save a Life CPR
• If you see a teen or adult collapse,
call 9-1-1 and push hard and fast in
the center of the chest to the
• Beat of the classic disco song
“Stayin’ Alive.”
HAPPY SCHOOL NURSE’S DAY
May 8, 2013