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Transcript of Beth Anne Bahn Acting Director Division of School Health Bureau of Community Health Systems April...
Beth Anne Bahn Acting Director
Division of School HealthBureau of Community Health
Systems
April 14, 2011
SCHOOL HEALTH UPDATE 2011
DIVISION OF SCHOOL HEALTH
• Beth Anne Bahn, Acting Director
• Vacant, State School Health Consultant
• Mary Taylor, Administrative Officer
• 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 - Linda Katherman 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 CertificationSchool StaffMandated Student Examinations
ACT 104 of 2010
• Epinephrine Auto-injectorsSchool policy on possession and use of asthma inhalers need to include Epi-pens
Demonstrate competency Specify conditions could lose privilegeRequire updated prescription and parental approval annually
ACT 104 of 2010
• Food Allergy Reaction ManagementPart of Wellness PolicyDevelopment of Guidelines
Co-chair of committee with PDE, Division of Food and Nutrition ServicesPattern after Diabetes GuidelinesStakeholder meeting April 21
• Published in PA Bulletin May 29, 2010http://www.pabulletin.com/secure/data/vol40/40-22/984.html
• Effective August 1, 2011 for the 2011-2012 school term
IMMUNIZATION REGULATIONS
For For NewNew School Enterers in Kindergarten or First Grade School Enterers in Kindergarten or First Grade
• 4 doses tetanus (DTaP, DT, Td) (1 dose on or after 4 years old)• 4 doses diphtheria (DTaP, DT, Td) (1 dose on or after 4 years old)• 3 doses polio• 2 doses measles (MMR)• 1 dose mumps (MMR)• 1 dose rubella (MMR)• 3 doses hepatitis B• varicella immunity (vaccine or history of disease)
NOW:NOW: NEW:NEW:• 4 doses tetanus (DTaP, DT, Td)(1 dose on or after 4th birthday)• 4 doses diphtheria (DTaP, DT,
Td) (1 dose on or after 4th birthday)
• 3 doses polio• 2 doses measles (MMR)• 2 dose mumps (MMR)• 1 dose rubella (MMR)• 3 doses hepatitis B• 2 doses varicella or immunity
(vaccine or history of disease)
IMMUNIZATION REGULATIONS
For Attendance In All Grades For Attendance In All Grades
• 3 doses tetanus (DTaP, DT, Td)• 3 doses diphtheria (DTaP, DT, Td)• 3 doses polio• 2 doses measles (MMR)• 1 dose mumps (MMR)• 1 dose rubella (MMR)
NOW:NOW: NEW:NEW:
•4 doses tetanus (DTaP, DT, Td) (1 dose on or after 4th birthday)
•4 doses diphtheria (DTaP, DT, Td) (1 dose on or after 4th birthday)
•3 doses polio•2 doses measles (MMR)•2 doses mumps (MMR)•1 dose rubella (MMR)•3 doses hepatitis B•2 doses varicella or immunity (vaccine or history of disease)
IMMUNIZATION REGULATIONS
For Entering 7For Entering 7thth Grade Grade
NOW:NOW: NEW:NEW:
• 4 doses tetanus (DTaP, DT, Td) (1 dose on or after 4th birthday)• 4 doses diphtheria (DTaP, DT, Td) (1 dose on or after 4th birthday)• 1 dose tetanus/ diphtheria/ acellular pertussis (Tdap)• 3 doses polio• 2 doses measles (MMR)• 2 doses mumps (MMR)• 1 dose rubella (MMR)• 3 doses hepatitis B• 2 doses varicella or immunity (vaccine or history of disease)• 1 dose meningococcal conjugate
• 3 doses tetanus (DTaP, DT, Td) • 3 doses diphtheria (DTaP, DT, Td)• 3 doses polio• 2 doses measles (MMR)• 1 dose mumps (MMR)• 1 dose rubella (MMR)• 3 doses hepatitis B• varicella immunity (vaccine or history of disease)
IMMUNIZATION REGULATIONS
•1 dose MCV•1 dose of Tdap (if 5 years have elapsed since last tetanus immunization)
NOTE: If the student is
attending 7th grade, do they
also have?
Place on provisional status and review every 60 days for 8 months.•May exclude from school if non-compliance continues past provisional period.
NO
In Compliance
YES
Place on provisional status and review every 60 days for 8 months.•May exclude from school if non-compliance continues past provisional period.
•4 doses of tetanus•4 doses of diphtheria•3 doses of polio•2 doses of measles•2 dose of mumps•1 dose of rubella•3 doses of hepatitis B•2 doses of varicella (chickenpox) or history of disease
Does the student have the following immunization requirements
for attendance in all grades?
Does the student have at least one dose of DT, OPV/IPV, MMR, HepB and Varicella?
Deny admission until one dose of each antigen listed to the left is received.
NONO
YES
In Compliance
YES
School Immunization Requirements for school attendance for all grades according to PA school law.
Foreign exchange students or foreign students visiting PA schools need at least one-dose of each antigen to attend or visit PA schools, then they will be placed on provisional status.
IMMUNIZATION REGULATIONS
OLD
•Grace Period•Vaccine dose administered within the 4-day period prior to the minimum age for the vaccination or prior to the end of the minimum interval between doses
•Considered a valid dose
Example: MMR Example: hepatitis B
IMMUNIZATION REGULATIONS
• Children <5 years old, 28 Pa. Code § 27.77 (ACIP recommendations)
• Children 5 years and older, follow School Health regulations, 28 PA Code, Chapter 23, Subchapter C
IMMUNIZATION REGULATIONS
IMMUNIZATION FAQs
• Can a parent ask for moral exemption after student has had several doses of vaccine?
Case by case basisDetermined by school administrationNeeds to be in writing
Can sign back of immunization card
Not required to be renewed annually
IMMUNIZATION FAQs
• Doctor office not providing immunizations, citing HIPAA
Share joint guidance HIPAA/FERPAInclude parent release on school formsEncourage use of PA-SIIS
• Can school policy require students to have immunizations on the 1st day of school, no provisional?
Have to follow DOH regulations
• Provide Hepatitis B, MCV4, Tdap, and Varicella
Students unable to obtain through their medical homes
• School districts plan, develop, and implement programs
Consultation from local Health Department. Protocols available from the Division of Immunizations
• Vaccine is provided at no cost to school districts for VFC eligible students
SCHOOL IMMUNIZATION CATCH-UP PROGRAM (SICU)
IMMUNIZATION RESOURCES
• Resources available on What’s New with School Health, www.health.state.pa.us/schoolhealth
Slide presentation from March 15, 2011 webinar, “Update to School Immunization Regulations”Division of Immunizations website
Law and regulations regarding immunizations Updated Immunization Manual (when available) Information on ordering immunization cards and new rack cards
IMMUNIZATION RESOURCES
• PDE, Basic Education Circular (BEC), Education for Homeless Students
• Joint Guidance on HIPAA and FERPA• PA State Immunization Information System (PA-
SIIS)• CDC Childhood and Adolescent Immunization
Scheduler Assist in determining immunization compliance Provides an "instant picture of immunity.“
REFUGEE HEALTH
• DOH and DPW• Provider Network• Timely comprehensive health assessment
for each arriving refugeeIdentify communicable diseasesIdentify and treat health conditions or health-related issues
• http://www.portal.state.pa.us/portal/server.pt/community/refugee_health/19001
TB TESTING OF STUDENTS
• PA Public School CodeSection 14-1402 (a) & (f)
• 28 PA CodeSection 23.9
• ModificationEncouraged since 1997
TB TESTING OF STAFF
• PA Public School CodeSection 14 – 1416 & 14 – 1418
• 28 PA CodeSection 23.44
• Law doesn’t allow for modification of TB testing for staff
• Does allow for alternative testing methods
TB TESTING OF STAFF
• VolunteersMust comply with TB testing requirement if:
In direct contact with students for 10 or more hours per week
MEDICALLY IMPAIRED DRIVER LAW
• Effective October 9, 2010• CRNP and PA
When conducting physical exams for driver’s permits or in determining whether person has a disorder affecting ability to drive safely Report to PennDOT within 10 daysAny patient 15 years of age or older diagnosed with condition that could impair ability to safely operate motor vehicle.Don’t need to report conditions expected to last less than 90 days
MEDICALLY IMPAIRED DRIVER LAW
• DiabetesSevere hypoglycemic reactions or symptomatic hyperglycemia
Not qualified to driveUnless continuous period of at least 6 months free from disqualifying episode
• Request on-line accesshttps://www.dot3.state.pa.us/contact_us/medicalEmail.jsp
MEDICALLY IMPAIRED DRIVER LAW
• Report to Primary Care ProviderDiabetics
Severe hypoglycemic reactions (requires outside intervention or assistance of others) or produces confusion, loss of attention or loss of consciousness Symptomatic hyperglycemic (caused loss of consciousness or an altered state of perception, including, but not limited to, decreased reaction time, impaired vision or hearing, or both) and confusion reactions
Seizure activityCardiovascular
Syncopal attack, loss of consciousness, vertigo, paralysis or loss of qualifying visual fields
MEDICALLY IMPAIRED DRIVER LAW
http://www.dot3.state.pa.us/centers/medicalReportingCenter.shtml
AED
• Check Battery & pads for expiration dats
Potentially greater liability than not having an AED
• Grants/funding- Kiwanis, Lions, Rotary, PTA, booster clubs
MEDICATION ISSUES
• Field Trips (pp. 18-19 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)Advance notice to nurse for planningLimit # of field trips from building per day
MEDICATION ISSUES
• Field TripsInvite parent or parent designeeUtilize licensed nurse from sub list Licensed parent volunteer
Need clearancesApproval as district volunteer
Provider permission to change dosage time or skip a dose
MEDICATION ISSUES
• Out of state field tripsCheck with Board of NursingGet in writing
• Delegation to student by parentStudent under school jurisdictionZero tolerance drug policies
• Self-administration by studentEmergency medications only
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)
MEDICATION ISSUES
• Emergency MedicationsPA Public School Code- self carry and administer asthma inhalers/epinephrine auto-injectorsMay train unlicensed staff to assist with their administrationDiastat, glucagon etc. require licensed medical professional to administer
SPECIAL NEEDS STUDENTS
• 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 component504 Service Agreement
SPECIAL NEEDS STUDENTS
• Nurse should be part of team for IEP and 504
Nurse who has student as part of their caseloadShould not sign legal document if not involved in development of planReasonable accommodations for student
SPECIAL NEEDS STUDENTS
• Students with newly diagnosed or unstable Type 1 Diabetes and an IEP
Medical provider can write as part of Medical Management Plan
Nurse required in school building at all timesFederal funds to cover cost
SPECIAL NEEDS STUDENTS
• Factors to Consider Individualized Transition Plan (ITP)Transition Healthcare ChecklistWho can legally provide Care?Dietary Accommodations
SPECIAL NEEDS STUDENTS
• ITPEffort to standardize assessment of student transportation needsResources and training availableWorking with Bureau of Family Health and PDE Bureau of Special Education
SPECIAL NEEDS STUDENTS
• Transition Healthcare ChecklistRequired to start transition planning by age 14School responsible for successful transitionShould include a health component
Most likely area for failure according to PATTAN statisticsChecklist updated in 2010Also available in Spanishhttp://www.portal.state.pa.us/portal/server.pt?open=514&objID=558090&mode=2
SPECIAL NEEDS STUDENTS
• Provision of CareCare of Medically Fragile Child
http://www.aft.org/pdfs/healthcare/medicallyfragilechild0409.pdf
Scope and Standards (ANA)Code of Ethics (ANA)
PA laws and regulations
•Dietary Accommodations•Special dietary needs medical form has been updated •http://www.portal.state.pa.us/portal/server.pt/community/national_scho ol_lunch/7487/special_dietary_needs_in_school_nutrition_programs-_resources/509222.•Must be signed by physician•Share medical form with Food Services
Director•Collaboration with Food Services is critical for appropriate provision of health and food services
SPECIAL NEEDS STUDENTS
CONTINUING EDUCATION
• Act 48DSH will submit hrs reported for courses from ANCC, ANA, AMA, AGD and PADHS Fax certificates to 717-783-4790 or e-mail to [email protected] along with PDE ID
• Act 58If CSN, Act 48 hours count for RN CE
LEARNING MANAGEMENT SYSTEM (LMS)
• All School Personnel & Supplemental Licensed Health Staff
• Offers on-line courses for school staff Act 48 hours through the Division of School HealthAct 58 hours through the Dept. of Health
• To become a registered user:www.paprepared.net
PA ASTHMA PARTNERSHIP
• www.PAasthma.org
• Resources• Partners Sharing Newsletter• Funding Opportunities• Research Articles
THE CENTER (CNAP)
• Formerly PA Advocates for Nutrition and Physical Activity
• Now Center for Nutrition and Activity Promotion at Penn State Hershey Children’s Hospital
www.nrgbalance.org
nrgZone Enrollment
• March 14 – April 22, 2011• www.nrgbalance.org/schools
Click on Healthy Schools Campaign25- question assessment
• Online resources• Monthly eNewsletter• Annual events (ex. Apple Crunch)
PROPOSED CH. 12 REGULATIONS
• Establish baseline nutritional & physical activity standards
• Adopted by State Board of Education May 6, 2010
• Approved by Governor’s Office November 6, 2010
• Currently in Attorney General’s Office
PROPOSED CH. 12 REGULATIONS
• Physical Activity30 minutes daily Moderate – to – vigorous
• Physical Education150 minutes at elementary level225 minutes at secondary levelTo be removed in final version
PROPOSED CH. 12 REGULATIONS
• Encourages active commuting (bike or walk) safely to & from school
• Establish & maintain coordinate school health advisory committee
• Coordinated School Health planStudent nutrition, health & physical activity Includes the wellness policy
PROPOSED CH. 12 REGULATIONS
• Nutrition StandardsEncourages school gardens or farmsGuidelines for classroom celebrations
Offer sample party menusComply with nutrition standardsNon-food rewards & celebrations
FundraisingComply with nutrition standards
Set standards for competitive foods & beverages
SCHOOL HEALTH WEB PAGE
• Data/reports from Annual Report Database• Laws and Regulations• Policies and Procedures• Manuals, Guidelines and Forms• Training opportunities, Grants and Funding• Information on Current and Future Health
Issues• What’s New
www.health.state.pa.us/schoolhealth
HAPPY SCHOOL NURSE’S DAY May 11, 2011