Division of School Health

Bureau of Community Health Systems

SCHOOL HEALTH UPDATE 2012

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 dleffler@pa.gov

NC – Deb Frey 570-327-3400 defrey@pa.gov

NE – Kristen Cheslick 570-826-2062 kcheslick@pa.gov

SC – Sue Templin 717-787-8092 stemplin@pa.gov

SE – Sheri Mountz 610-378-4352 smountz@pa.gov

SW – Joseph Donahue 724-830-2701 jodonahue@pa.gov

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 Guidelineswww.health.state.pa.us/schoolhealth

“What’s New with School Health”

http://www.portal.state.pa.us/portal/server.pt/community/national_school_lunch/7487/special_dietary_needs_in_school_nutrition_programs-_resources/509222

FOOD ALLERGY GUIDELINESREQUIRED 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

• Responsibilities of parent/guardian, school staff, and primary care provider

• Emergency Response Protocols

• Roles of staff members in care of students with life-threatening allergies

8

FOOD ALLERGY GUIDELINESREQUIRED CONTENT

• Understanding the Disease

• Addressing Student Needs

• Tools for Effective Food Allergy Management in Schools

• School Responsibilities Under Law

• Appendices

9

FOOD ALLERGY GUIDELINESSECTIONS

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

• 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: ANAPHYLAXIS

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 MANAGEMENTRESOURCES

• 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

• 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

ACT 101 of 2011 (SB200)

• 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

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 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/schoolchildrenimmunizationsUpdated forms will be available on website approximately May 1 for school year 2012-13

SCHOOL IMMUNIZATION CATCH-UP PROGRAM (SICU)

2012-13 SCHOOL FLU INITIATIVE

• Injectable and nasal influenza vaccine available

• Department of Health providesVaccine with suppliesInformational packet for parents

• For more information, visit http://www.portal.state.pa.us/portal/server.pt/community/immunizations/14141/school_children_immunizations/557995

IMMUNIZATION RESOURCES

• Available at “What’s New with School Health” www.health.state.pa.us/schoolhealth

Updated Immunization ManualInformation on ordering immunization cards and new rack cards

• CDC Pink Bookhttp://www.cdc.gov/vaccines/pubs/pinkbook/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/server.pt/community/pa_statewide_immunization_information_system_%28pa-siis%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

• DiversityCommitment to recognize similarities and celebrate people’s differences in order to highlight their uniqueness and create inclusiveness in a gradually diverse world community

• Diversity AwarenessCreates 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

• PartnershipFederal Office of Refugee ResettlementDepartment of Public WelfareDepartment of Health, Office of Health EquityDepartment of Health, Bureau of Epidemiology

• GoalEnsure all newly arriving refugees receive a comprehensive health screening as soon as possible after entering the United States

REFUGEE HEALTH

• RefugeeDefined 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 ProgramRefugees Asylees Cuban/Haitian Entrants Amer-Asians Victims of Human Trafficking Unaccompanied Alien Children Survivors of Torture

REFUGEE HEALTH

• OHEhttp://www.health.state.pa.us/healthequity

• Refugee Healthhttp://www.portal.state.pa.us/portal/server.pt/community/refugee_health/19001

OFFICE OF HEALTH EQUITY

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:

mchalifoux@zoll.com800-242-9150 ext. 9565Cell phone: 804-240-4388

SCHOOL HEALTH SERVICES

SCHOOL HEALTH SERVICESPART 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

• Supplemental Staff

Can’t carry a caseloadFunction under their own licenseUnder the direction of the CSN

CSN must go to all assigned buildings on regular basis Can’t cover caseload you never see

SCHOOL HEALTH SERVICESSUPPLEMENTAL STAFF

SCHOOL HEALTH SERVICESCHIROPRACTORS

• 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 physicalsWrite prescriptions for medicationsSign medical exemptions for immunizationsWrite dietary restrictions

• Provision of services by:EMTs

28 PA Code, § 1003.23Scope of practice performed under medical command or Statewide BLS medical treatment protocols

Scope of practices does not include Routine administration of medicationsSupervising students self-administering medications

SCHOOL HEALTH SERVICESEMTs

• 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 SERVICESATHLETIC TRAINERS

• 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 SERVICESAGENCY STAFF

SCHOOL HEALTH SERVICES

• Licensed Private Academic• Non-public/Non-licensed• Career and Technology Centers

Full-timePart-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“in loco parentis” pertains only to conduct and behavior

• Waiver of LiabilityPossible violation of federal laws

Office of Civil Rights (OCR) - Berlin Brothersvalley SD (1988)

DELEGATION

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

DOCUMENTATIONSUSPECTED CHILD ABUSE

• Child Abuse

Document in health recordStatement made by studentAssessment and treatment of injuriesNotification of ChildLineCopy of CY-47 form in file with note of outcome of investigation

Photos of injuriesPart of school district policy

• Sharing Health InformationExpectation of privacy

FERPA - educational need to knowHealth 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

DOCUMENTATIONFERPA

DOCUMENTATION

• 49 Pa. Code § 21.18Standards 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 privacyDuty to maintain confidentiality

• Electronic vs. paper recordsMay 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

DOCUMENTATIONELECTRONIC

DOCUMENTATION

• Health logsSign-in logs okay (name, time of arrival, time of departure)

Individual record for each student for assessment and treatment

• Medical plans of careStandard 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 secureBe careful about sending identifiable health information

• Division of School HealthRemove identifiable information on students before sending e-mailDon’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

• Field Trips (cont)

Invite parent or parent designee

Utilize licensed nurse from sub list

Licensed volunteerNeed clearancesApproval as district volunteer

Provider permission required to change dosage time or skip a dose of medication

MEDICATION ISSUES: FIELD TRIPS

• Out of state field tripsCheck with Board of NursingObtain in writing

• Delegation to student by parent not allowed

Student under school jurisdictionZero tolerance drug policies

• Self-administration by studentEmergency medications only

MEDICATION ISSUES: FIELD TRIPS

MEDICATION ISSUES

• Extracurricular activitiesSame rules as field trips

• Early Intervention ProgramsSchool District responsibility

Integral part of school programLocated in school district buildingMedications, immunizations & emergency careScreenings for baseline (optional)

• Emergency MedicationsPA Public School Code

Students may self carry and administer asthma inhalers / epinephrine auto-injectors (Epi-pens)

Nurses may train unlicensed staff to assist with the administration of rescue inhalers and Epi-pens

EMERGENCY MEDICATION ISSUES

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 STUDENTSMEDICAL PLANS OF CARE

• Medical Plans of CareStandard 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 STUDENTSPA ELKS HOME SERVICE

• PA Elks Home Service ProgramNo chargeIn-home medical care coordination servicesAssess needs & help to access equipmentAdvocate for appropriate education serviceshttp://www.paelkshomeservice.org/whoWeServe.php

• 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 STUDENTSPLANS OF CARE

• 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 STUDENTSDIABETES

• Factors to Consider

Individualized Transportation Plan (ITP)

Transition Healthcare Checklist

Who can legally provide care?

Dietary accommodations

SPECIAL NEEDS STUDENTSTRANSPORTATION PLAN

• ITP

Standardize assessment of transportation needs for every student

Resources and training available

https://www.gotoskn.state.pa.us/About/StatewideInitiatives/Transportation/tabid/66/Default.aspx

SPECIAL NEEDS STUDENTSTRANSPORTATION PLAN

SPECIAL NEEDS STUDENTSTRANSITION HEALTHCARE CHECKLIST

• Transition Healthcare Checklist: Transition to Adult Living in PA

School responsible for successful transition

Start transition planning by age 14

Include health componentOmission most likely reason for failure according to statistics from the Pennsylvania Training and Technical Assistance Network (PATTAN)

Checklist updated in 2010Also available in Spanishhttp://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 TestingStudentsStaff/Volunteers

• CrittersBedbugs

http://www.spcpweb.org/factsheets/BBinSchoolsandCC.pdf

Head LiceRecommend following AAP guidelinesNo 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 ordershttp://www.portal.state.pa.us/portal/server.pt/community/schools/14130/school_health_forms_-_welcome/613260

• Fax with updated order formhttp://www.portal.state.pa.us/portal/server.pt/community/schools/14130/publications___documents/556694

• School Health Record forms onlyLast order printed packs of 50 instead of 100

If ordered this form since NovemberVerify forms received match number ordered

Place additional order if needed

HEALTH ALERT NETWORK

• Pennsylvania Health Alert Network (PA-HAN)

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 DanielsonEnhancing Professional Practice: A Framework for TeachingDomains:

Planning and PreparationEnvironmentDelivery of ServiceProfessional Responsibilities

• Request your suggestions for improving:Annual Report

SHARRS - Reimbursement Reporting System

Manual/ProcedureScreens - Growth, Hearing, Scoliosis, VisionDentalDocumentationOther

School Health Website

• Send your suggestions to the school health consultant in your district

SCHOOL NURSE FEEDBACK

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 48Division of School Health submits courses from ANCC, ANA, AMA, AGD, PADHS, and Learning Management System (LMS)

E-mail certificates to c-paschool@pa.gov with PDE ID number

Fax certificates to 717-783-4790 and include PDE ID number, e-mail address, and phone number

• Act 58If 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 coursesHours accrued will be credited during moratorium

FAQS from Department of Educationhttp://www.education.state.pa.us/portal/server.pt/community/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 AssociationBe the Beat School ChallengeHands-Only CPRhttp://bethebeat.heart.org/

• Assistance with prescription medicationswww.pfizerHelpfulAnswers.comwww.TogetherRxAccess.comwww.pparx.org

• Bullying prevention toolkithttp://www.stopbullying.gov/

RESOURCES

• CDC Tips from Former Smokershttp://www.naquitline.org/resource/resmgr/media_campaign/tips_digital_media_toolkit_l.pdf

• CDC, STD Awareness - Reaching Young People

http://www.cdc.gov/std/sam/default.htm

• CDC, COCA Clinical ReminderDO NOT use insulin pens for more than one person

RESOURCES

• ER Guidelines for PA Schools www.paemsc.org

• Eagle Books Toolkithttp://www.cdc.gov/diabetes/pubs/eagle/pdf/Eagle%20Books%20Toolkit%20for%20Families%20Classrooms%20and%20Communities.pdf

• Indoor Air Quality Toolkithttp://www.epa.gov/iaq/schools/

RESOURCES

• Mid-Atlantic Center for Children’s Health and the Environment (MACCHE)

http://www.childrensnational.org/MACCHE/ResourcesAndTutorials/

Fact sheets on environmental issues in schoolsMold, Mildew

Pesticides in the Environment

Autism and the Environment

Asthma and school environment

RESOURCES

• Medical Assistance Informationhttp://www.dpw.state.pa.us/helpfultelephonenumbers/contactinformationhelpformaproviders/index.htm

• Pediatric Asthma Toolkit http://www.paasthma.org/asthma-resources/asthma-toolkit

RESOURCES

• Orthodontic Emergencieshttp://www.aaomembers.org/Press/HealthCareProfessionals/SchoolNurses.cfm

• PA Emergency Preparedness Guidewww.ReadyPA.org

HAPPY SCHOOL NURSE’S DAY May 9, 2012