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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