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 [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]
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:
[email protected] 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 [email protected] 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
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