Presentation on theme: "Filling the Nurse’s Tool Box in Constructing a Well Built IEP"— Presentation transcript:
1 Filling the Nurse’s Tool Box in Constructing a Well Built IEP Care PlanningCommunicationSystem /ProtocolGoals and ObjectivesCare EvaluationNursing EvaluationsIHP and ECPPresent Levels of PerformanceFilling the Nurse’s Tool Box in Constructing a Well Built IEPReimbursementPED Licensed School Nurses
2 Presentation BY….. Susan Acosta, B.S. RN State of New Mexico, Human Services DepartmentMedical Assistance Division, Quality Bureau
3 Disclosures Disclosures All planning committee members and presenter(s) author(s), and content reviewer(s) participating in this educational activity do not have any financial relationships they or an immediate family member may have with any commercial interest in any amount occurring within the past 12 months that create a conflict of interest.
4 Presentation FocusThis presentation is to assist the participant in delivering services that meet New Mexico Medicaid School Based Service ProgramThe specific focus is for Nursing ServiceBest practices to integrate or link nursing services into special education service to enhance communication and notification of student need for Related Health and Nursing ServiceNursing Evaluation as a best practice to determine need for Related Health and Nursing ServiceBest practice on how to place Related Health and Nursing services on the written IEP to meet New Mexico Medicaid School Based Service ProgramCare planning, care coordination, and care evaluation as a claimable service under New Mexico Medicaid School Based Service Program
5 Learning ObjectivesThe steps in creating an Individualized Educational Plan from student referral to placement on written IEPWhat are Related Services and Support ServicesHow Related Services are used in the IEP processDistinction between Related Health and Nursing Service and why distinction is important
6 Learning ObjectivesBest practice on how to document nursing service justification in a written IEP for MSBS program purposeHow to use the Independent Care Plan in the IEP process and how to make it claimable under the MSBS programMaking Care Evaluation claimable for Medicaid School Based Program requirements
7 Where to beginThink of the Individual Educational Program (IEP) as if you were constructing a house. The project manager (special education case manager) will get the request to begin the construction of the IEP for a special education student through information given by the Early Intervention Program, SAT team, diagnostician, school registrar office of a transfer student with existing special education services. At this point the process is deployed and the special education team goes into action. At this point is when the related services are to be deployed to if the student’s needs may a related service or support service to help the student to achieve success in special education or to receive a free and appropriate public education (FAPE).
8 Special Education and Health Issues IDEA describe students with health issuesand the health service they require within twocategories:• Other Health Impaired – 504 services and plans• Special Education – IEP special education services and related services
9 Working Together IDEA-97 emphasizes a collaborative approach. The IEP requirements under IDEA emphasize the importance of working cooperatively as a team.Under IDEA-97, the IEP process is a focal point for reaching improved outcomes for students with disabilities. The process, critically important to children with disabilities, must be carefully managed to ensure that the unique needs of the student are addressed and to ensure full compliance with statutory and regulatory requirements.
10 Construction of the IEP Think of the Individual Educational Program (IEP) as if you were constructing a house for the special education studentThe request to begin the construction of the IEP may come by way of a request or referral from a Child Find Program, Early Intervention Program, SAT team evaluation, diagnostician, school registrar office of a transfer student with existing special education services, teacher or parent referral.The IEP process starts at this point and an evaluation is done by an eligibility team or case manager to determine if the student meets special education requirements for eligibility and related service need(s).
11 Case Management model Multidisciplinary Team Model IEP ModelsCase Management model Multidisciplinary Team Model
12 Multidisciplinary Team Model The team has integrated activities to manage. Each activity is of equal importance and interdependent on the quality of the other.Multidisciplinary Team ModelEligibility determinationEvaluation of disabilities needs and impactDetermine the need for related and support services and refer for evaluationsGuide to the Individualized Education ProgramOffice of Special Education and Rehabilitative Services U.S. Department of Education July 2000Each public school child who receives special education and related services must have an Individualized Education Program (IEP). Each IEP must be designed for one student and must be a truly individualized document. The IEP creates an opportunity for teachers, parents, school administrators, related services personnel, and students (when appropriate) to work together to improve educational results for children with disabilities. The IEP is the cornerstone of a quality education for each child with a disability.
13 Case Management ModelIn order to ensure the integrated delivery of services, some school systems use a case management approacha team leader coordinates and oversees services on behalf of the student. In some schools, this person might be the child's special education teacher. In other schools, supervisory school district personnel may assume this responsibility.
14 What is IEP?It is an Individualized Educational Program for the a special education studentThe IEP is a collaborative process and productThe product of the IEP is the written document which reflects that the student is receiving a Free Appropriate Public Education (FAPE) consistent with all federal and state requirements.The written IEP specifies the services to be provided, how often the services will be provided, the student’s present level of performance, specific accommodations and modifications that will be provided and how the student’s disabilities may affect their academic performanceThe IEP is the foundation for a student achieving an individualized educational experience.It captures the special education student’s and the family’s vision for how to educate to the extent appropriate with individuals who do not require special education (Least restrictive environment).The IDEA requires that public schools create an Individualized Education Program (IEP) for each student who is eligible under both the federal and state eligibility standards.
15 Considerations and Suggestions IDEA 2004 requires all related services to be considered (evaluated) and specifically defines health related servicesSince related health services can be provided by qualified individuals other than a nurse, it is recommended for MSBS billing purposes that the NM PED licensed school nurse be the professional who evaluates, delegates, trains, monitors and provides the ongoing assessment for all health related services provided to a student in special education.School health services and school nurse services means health services that are designed to enable a child with a disability to receive FAPE as described in the child's IEP. School nurse services are services provided by either a qualified school nurse or other qualified person.
16 Recommend Nurse Evaluation A key component of this multidisciplinary evaluation for a child with ahealth related condition is a health assessment that may be conducted bythe school nurse. Based on this assessment, the school nurse identifiesthose health issues that are relevant to the child's educational progress.If a child with health related disabilities is determined eligible forspecial education and related services an individualizedhealth care plan (IHCP) with specific health and medical related objectives, interventions and evaluation criteria should be initiated by the school nurse as part ofthe child's individual education program (IEP) or the individual familyservices plan (IFSP) team process, and incorporated into the IEP or IFSP.
17 What Are Related Services Related services are the supports needed for a child to benefit from special education.Transportation and such developmental, corrective and other supportive services are required to assist a child with a disability to benefit from special educationIncludes speech-language pathologyAudiology servicesInterpreting servicesPsychological servicesPhysical and occupational therapyCounseling ServicesRehabilitation CounselingOrientation and Mobility ServicesRecreation - including therapeutic recreationEarly identification and assessment of disabilities in childrenMedical services for diagnostic or evaluation purposesSocial work services in schools and parent counseling and trainingHealth and Nursing services
18 Construction Process STEP ONE Identification STEP TWO Special Education EvaluationSTEP THREEIndividual Education Plan Meeting
19 Related Service Evaluation IEP PROCESSStep FourRelated Service EvaluationStep FiveIEP MeetingStep SixIEP Written
20 Related Health vs. Related Nursing Service A related health service can be provided by either a qualified licensed provider or non licensed provider, such as a resource aid. Examples would be providing assistance with ADLs, providing delegated care indicated in the Independent Care Plan.A Nursing service requires a qualified licensed skilled nurse to provide the service. Examples of this service would be medication administration, skilled nursing procedures, assessment, care planning and care evaluating.School health services have long been a part of IDEA’s related services definition. The definition of related school health services changed under IDEA in 2004, which delineates the difference between related school health services and school nurse services and explicitly added nursing services to the list of related services in special education What was previously called “school health services” has been expanded to distinguish between services that are provided by a qualified nurse and those that may be provided by other qualified individuals (paraprofessional or teacher). Why is it important to understand how related health service is defined in IDEA 2004? The implications for related health services are primarily two fold.
21 Notification and Awareness….. Who needs nursing services that receive special education ???Which special education students are MedicaidParticipants or eligible?
22 Best Practices to link nursing services to special education School nurses are not always aware that a special education student has a health related or medical condition which could impact the student’s ability to meet the goals and objectives in his or her special education.The best practice is for each district or campus to have a formal process or system to ensure that all student’s related service needs are being met and communicated in a timely and effective method.Special educations case managers, do not know the student has a health related or medical condition which could influence the outcome of the student’s ability to achieve goals established in special education.Therefore, it is vital
23 Create formal communication systems which consistently link the school nurse to the special education studentBest practices for linkage:Each month obtain a roster of special education students and review for health related needs or medical conditions that may impact the student education –Ensure that the school nurse is on the notification list distributed by the school’s registrar for incoming students –Be a standing member of the SAT team: The school nurse will not attend every meeting but will be linked in to be notified of students who have been determined to qualify for special education-Develop a campus protocol- only the school nurse is to complete page 13 of IEP to be completed by nurse.Establish a procedure that all special education students with a medical or health related condition must have a evaluation to determine the need for health related and nursing servicesThe last process can be automated if the district’s electronic system is programmed to only allow the nurse to complete and sign off on page 13 before the case manager could proceed in developing the draft IEP. We currently have a large school district using this concept sucessfully.
24 How to Determine if the student has a need for Related Health or Nursing Service? Providing a health assessment is part to the Standards of Professional School Nursing Practice (National Association of School Nurses, 2000).New Mexico Licensed School Nurses, NM Public Education licensed NM Registered Nurses (PED-RN) can only perform the Assessment/Evaluation and not NM Licensed Professional Nurses (LPN). LPNs can only participate in the assessment per NM Nurse Practice ActThis evaluation may reimbursed through the MSBS program if the student’s evaluation determines the need for Related Health and Nursing Services
25 Conduct a Related Health and Nursing Evaluation
26 Identifying Related Service Role of School NurseAs evaluation proceeds, the team or case manager will be responsible demonstrating an understanding of the impact of the health condition and the needs for care during the school day.Schools nurse acts as health professional consultantSchool nurse can determine Related Health and Nursing Service neededSchool nurse develops the individualized healthcare plan that becomes the blue print to care for health related needsSchool nurse provides direct care and indirect careSchool nurse makes the decision to delegate careSchool nurse determines competency of unlicensed personnel to provide delegated care.
27 Skilled Nursing Evaluation Assesses the student’s health or medical conditions which may impact the student’s ability to learn or achieve special education goals and objectivesAssesses of need for direct nursing service and health related service necessary to enable a student with a disability to receive FAPEAssesses the educationally relevant medical or health related conditions that are likely to adversely impact the student’s educational performanceIf related health and or nursing services are neededTo assess the type of care, amount of care, and which environment to deliver health and nursing care in a safe and effective manor to promote optimal student outcomes.
28 Nursing Evaluation Continued The assessment or evaluation information is to be used in the development of the student’s individualized health care plan (IHCP).The care planning for the IHCP and ECP is a collaborative process that includes the student’s parent or guardian, the student (when appropriate), the student’s physician, other school staff, community health providers, and medical specialists, if applicable.
29 Components of Nursing Evaluation Students health historyPhysical AssessmentSchool and medical record reviewConsultation with health care providers, teachers, parentsStudent observationDetermine if health condition impacts student’s ability to learnAssessment of needed accommodations & other related services.New Mexico Licensed School Nurses, NM Public Education licensed NM Registered Nurses (PED-RN) can only perform the Assessment/Evaluation and not NM Licensed Professional Nurses (LPN). LPNs can only participate in the assessment per NM Board of Nurses.
30 Assessment of Health/Physical Status is recommended when: Medications or health care procedures are necessary at school for the student to be able to receive FAPEA student has a physical or mental Health Condition (past or present) that may be impacting learningA student has a sensory deficit (i.e. fluctuating hearing loss) which requires ongoing monitoring and/or case management by the School NurseA student has a complex health/medical history requiring Individual and/or Emergency Health Care PlanThe Licensed School Nurse is involved in care coordination and/or case management for a student who has physical and/or mental health conditions
31 Assessment and Evaluation Tools Log into the internetClick on nmschoolhealthmanual.orgEnter Special EducationYou will find most of your information needed under this section, including DNR, 3 assessment forms: Student Health AssessmentInitial Student Health HistorySpecial Education Nurse Screening Summary Form
32 What Happens After the Nursing Evaluation? Case Manager Construct the written IEPSchool Nurse Develops the Independent Health Care Plans
33 The written IEP is developed by the case manager and Independent Care Plan is developed and written by the School NurseAll related services must provide evaluation results and recommendationsNursing service is unique –traditionally special education staff write in information regarding servicesIt is imperative the school nurse collaborates and provides results of the nursing evaluation and provides service justification, scope, and service time
34 IEP FormThe Federal special education law tells us what information must be included in the IEPThe Federal special education law does not specify we use particular formEach state may decide what form to use – The Public Education Department has a recommended IEP form for useEach school district in New Mexico may use own form or written IEP design – Most likely when districts use Electronic Student Records or documentation systemsMost important is that each written IEP form used must be clear and useful to parents, educators, related service providers, and administrators.
35 Next Step in Constructing Building the Written IEP Next Steps in Constructing IEPNext Step in ConstructingBuilding the Written IEPThe IEP is written by the Case Manager/team leader with evaluation information entered by each related service provider, except nursing.The school nurse is to participate in the development of the IEP by providing the case manager (written) information as to why related health and nursing services are needed for the student. This reason or justification is to be incorporated in to the Present Level of Performance area of the written IEP.The type of related health and nursing service are needed, the amount of service, and frequency of service to include on the service page of the written IEP.The related health services can be placed in multiple area of the written IEP. Such as, medical supplemental page, or accommodation section
36 Medicaid Reimbursement Program for the Schools For a school to bill Medicaid for covered IEP services the followingrequirements must be met:The student receiving the service must be enrolled in the Medicaid program.2. The student must qualify for services under the IDEA.3. The student must have an IEP or FSP.4. The services must be specified in the IEP or FSP.5. The services must be furnished by a practitioner who meets Medicaid qualifiedprovider criteria and who is qualified to provide the service underapplicable NM State licensure requirements.6. The school must obtain a signed parental consent to bill Medicaid for covered IEP services provided to the student.*The school corporation must first bill other liable insurers (if any) beforebilling Medicaid for the services. Note: if billing a student’s third party carrierwould constitute a FAPE violation (cost the parent/student a copayment,exhaust a benefit cap, etc.), the school may not bill either public or privateinsurer for the IEP service
37 Components of the Written IEP for Related Health and Nursing Service for MSBS Program Present Level of PerformanceMedical ConsiderationsService PageService JustificationService need for Related Health and Nursing ServiceService Time and Place
38 Schedule of Service Requirements for Medicaid School Based Service Program Nursing services rendered must be listed in the written IEP in the following areas:Justification listed in the Present Level of Performance sectionMedical Considerations pageSchedule of Service page either in the direct service grid or supplemental area of the service pageSN Services must be considered medically necessary under MSBS regulationsSN services are provided by practitioners who meet MSBS qualifications and who are acting within the scope of their license.
39 What is a Present Level of Performance? For the MSBS program serves as the written justification for services to be claimed and billed under the MSBS programThe PLP according to Special Education in Plain Language, “The IEP must provide information on the child's present level of performance, addressing each area of need. The present level of performance is a clear, descriptive statement of how the child is performing. Any health issues, limitations, or needs can be incorporated into PLP if it describes how the student’s disability affects the student’s involvement and progress in the general curriculum and also how the disability affects the child’s participation in school and recreational activities. (20 U.S.C. Section 1414 (d) (1) (A) of IDEA).Other needs for supports, adaptations, accommodations, equipment and other issues related to the student’s health concerns also can be recorded in the present level of performance.Any health issue or limitation can be incorporated into the present level if it describes how the child’s disability affects the child’s participation in school and recreational activities. (20 U.S.C. Section 1414 (d) (1) (A) of IDEA
40 Examples of Present Level of Performance Statements for Nursing Service Jane missed 10 days of school last year due to pressure sores. So that Jane does not miss school, Health related and nursing services are needed to for assessment of care needs and plans, health related classroom interventions to prevent skin breakdown, needed direct nursing services for skin breakdown if needed. Student unable to move self due to physical and cognitive inabilityDanny requires nursing services for medication management and administration since her medications are taken mid day and Sarah is not developmentally able to self administer. Danny also has “as needed” medication for her asthma. She is beginning to recognize her symptoms that indicate the need for her to use her inhaler, but needs more instruction and practice therefore related nursing services are needed.Example statements for justification provided in a handout.
41 Identified Area of Need: Health Maintained PRESENT LEVELS OF FUNCTIONAL PERFORMANCEPlease document the student’s present levels of functional performance for identified areas of need (eg. social/emotional, behavior, life skills, energy level, sustained attention, memory function, impulse, processing speed, and motor skills).Identified Area of Need: Health MaintainedStudent/Parent Input:Student has difficulty remembering to take oral medication each morning for ADHD. Student has missed 4 out of 5 doses of ADHD medication in the past 3 weeks, which has affected his cognitive ability and ability to maintain attention to participate in instructional interventions and the meeting of educational goals. The missing of oral medication for his ADHD also affects his ability to control impulses, which create behavioral issues. The student has had 7 behavior/disciplinary referrals in 3 weeks in which affects instructional time. Parent is not able to provide daily supervision for medication or able to administer daily oral medication.Intermittent skilled nursing for development of IHP related to ADHD, and daily skilled nursing for medication administration for ADHD. Student’s cognitive ability and participation in special education interventions dependent on daily compliance of prescribed ADHD medication, Student and family not able to be consistent in prescribe daily administration regime.Student reports he does not remember, and does not remember to set alarm to use as an aid.Mother reports she is a single mother and due to her work schedule is unable to be present to supervise or to administer medication administration.Symbol indicates information that goes into the Student Teacher Accountability Recording System (STARS).IEP Page 7 of 31 IEP for ___________________________________________________ Date: _________________________
42 Medical Consideration Page School Nurse to collaborate with the case manager or provide written information to the case manager for scribing purposesMedical Consideration Page is where the student’s medical needs are communicated and where specific related health and nursing service can be documentedImportant to check whether student has IHCP and or ECPThis is an area we find areas of opportunity for improvement from our site reviews (audits)
43 MEDICAL/SIGNIFICANT HEALTH INFORMATION MEDICATION: Twice a day oral medication for ADHD. Intermittent Skilled nurse to assessments for medication effectiveness and medical management needsSIGNIFICANT HEALTH INFORMATION: Student has diagnosis of severe ADHD, and struggles with medication compliance.Student can self monitor blood glucose, but does not have hand dexterity to conduct finger prick, and use glucose monitoring device. Intermittent SN assessment to evaluate the delegation of interventions in IHCP/ECP, training of Interventions in IHCP and ECP, and provided re-assessment of effectiveness of IHCP and ECP. .Direct Skilled nursing care to respond and deliver nursing interventions for diabetic emergency care per ECPDoes the student require an individualized health plan or school health services as a related service? YES NO:If YES, attach the health plan to the IEP and/or indicate on the Schedule of Services.Does the student require an emergency evacuation plan? X YESIf YES, attach the emergency evacuation plan, including the person(s) responsible to the IEP.Physical Education: Regular with accommodations AdaptedMOBILITYDoes the student require assistance to move in and around the school?YES NO:If YES, describe the assistance to be provided:TRANSPORTATIONDoes the student require transportation as a related service?If YES, what accommodations and supports are required in order for the student to be transported with typically developing peers in the Least Restrictive Environment (LRE)?- Symbol indicates information that goes into the Student Teacher Accountability Recording System (STARS).IEP Page 20 of 31 IEP for ___________________________________________________ Date: ____________________
44 Schedule of ServiceWhile it is likely that most covered services appear in the related services grid, the federal regulations simply require that the covered services be ordered in the child’s IEP.Ultimately the service must be included in the IEP, but the required location of the service is not designated in the federal regulation.
45 Schedule of ServiceThe amount of a special education or related service to be provided to a child may be stated in the IEP as a range (e.g., speech therapy to be provided three times a week for minutes per session) only if the IEP team determines that stating the amount of the services as a range is necessary to meet the unique needs of the child.For example, it would be appropriate for the IEP to specify, based upon the IEP team's determination of the student's unique needs, that particular services are needed only under specific circumstances, such as the occurrence of a seizure or of a particular behavior. A range may not be used because of personnel shortages or uncertainty regarding the availability of staff. [Appendix A, Response to Question 35, 64 Federal Register, page (March 12, 1999).]
46 How to document SN and Health Related Services Schedule of ServiceHow to document SN and Health Related ServicesDocument Skilled Nursing Services directly in the service grid area if services are usual and predictableUsual and predicable are those services that you provide routinely and can estimate timeexamples: Medication administration, procedures, assessessment if routineDocument Skilled Nursing Service in Supplemental or Support Area if not routine and predictableNon routine would be PRN services, or intermittent that cannot be predicted routinelyexamples: Intermittent assessment for evaluation of care in IHCP or ECP. Intermittent SN service to implement Emergency Care Plan for seizure, or low blood glucoseAlways use language to document related SN services, “as per medical order/ medical plan or IHCP/ECP” to prevent the need for frequent IEP amendment. If changes in the medical order or plan required extensive changes in the IHCP or ECP it is recommended the SN discuss with the case manager, for an IEP amendment may be required.Related health services are to be placed on the supplemental area of the Service Page of the IEP. Examples of supplemental services and accommodations would be: examples:Skilled nurse to assess ability of resource aide to provide care RN delegated interventions outlined within the IHP/ECP.SN to teach delegated interventions to resource aide outlined in IHP for health related services provided in the classroom. Resource aide to provide daily interventions outlined in the IHP in classroom- not a reimbursable direct service but should be on the IEP.
47 How to document SN and Health Related Services Schedule of ServiceHow to document SN and Health Related ServicesThe amount of a special education or related service to be provided to a child may be stated in the IEP as a range (e.g., speech therapy to be provided three times a week for minutes per session) only if the IEP team determines that stating the amount of the services as a range is necessary to meet the unique needs of the child.For example, it would be appropriate for the IEP to specify, based upon the IEP team's determination of the student's unique needs, that particular services are needed only under specific circumstances, such as the occurrence of a seizure or of a particular behavior. A range may not be used because of personnel shortages or uncertainty regarding the availability of staff. [Appendix A, Response to Question 35, 64 Federal Register, page (March 12, 1999).]
48 SCHEDULE OF SERVICESIf this IEP spans between two school years, please complete this page twice, separating the services to be delivered in each school year.Special Education & Related ServicesMinutes per Day/Week/Month/Semester/YearStartDateEnding DateService Provider (s)LocationTime in RegularSettingTime in Special Education SettingSpeech-Language Therapy1 hr/wk8/1/20138/1/2014SLP30 min/wkOccupational TherapyOTDirect Skilled Nursing Service15 min/day or per medical orders8/14/2014SNSchool Health Office1 hr/day08/01/201308/01/2014Time TotalsSupplementary Aids andServicesStart DateEnding DateRelated Skilled NursingIntermittent SN for Evaluation and AssessmentsEducational ClassroomsRelated Health Services1.5 hrs/week for assistance with blood glucose monitoring in classroom.Resource AideClassroomsCafeteriaPlaygroundIntermittent to implement Diabetic ECP08/13/2014
50 Care Planning for Related Health and Nursing services The school nurse (RN) is responsible for planning, coordinating and developing the IHP. As the Case Manager develops the written IEP the School Nurse develops the Care Plans.The IHP is a document or the blueprint of care that is needed for the student to be safe in a school setting and care that is needed to keep the student in school to receive FAPE or to achieve special education goals and objectives.The IHCP provides direction to staff that implement all or a portion of the plan.The care plans are to correlate with information found in the Present Level of Performance section of the written IEP.Every student with an IEP who requires direct nursing care, or health related intervention in the classroom, or care supervision must have a written Health Care Plan and if applicable an Emergency Care Plan (ECP)
51 Care Planning for Related Health and Nursing services Continued The IHP is a document or the blueprint of care that is needed for the student to be safe in a school setting and care that is needed to keep the student in school to receive FAPE or to achieve special education goals and objectives. The IHCP provides direction to staff that implement all or a portion of the plan.The Individual Health Plan should detail the nursing services that will be required in the school environment. There are a variety of options for nursing care, ranging from using an on-site school nurse for intermittent needs to assigning a dedicated one-to-one nurse for the entire school day.Student’s goals for health and nursing related services are to be documented in the IHCP and ECP and do not need to be written in the actual written IEPIHP is to be signed by the school nurse (RN) who wrote the plan, the student’s parents or guardian, and the student’s primary health care providerThe IHP and ECP is to be retained in the student health record, and a statement placed in the written IEP as to where to access or locate the IHP and ECP.
52 Development of the IHCP/ECP The Health AssessmentDevelopment of the IHCP/ECPHealth Assessment:The collection, documentation and analysis of information or data about a student's health situation leading to the development and initiation of an individualized health care plan to determine the student's state of health, patterns of functioning and need for health services, counselingand education.The health assessment is on going and as-needed basis evaluating the student's current health status, reviewing medical diagnoses, treatments, or orders and requesting a change in a physician’s order if necessary, reviewing nursing diagnoses and collaborative health problems, assessing routine and emergency health care needs, confirming health procedures, equipment and supplies.
53 Independent Health Care Plan Components Independent Health Care PlansIndependent Health Care Plan ComponentsIHPs are individualized to each student’s medical, nursing, and educational needs.The IHP is to identify health services the child will need during the school day and contain interventions to meet those needs.The IHP is to contain interventions which support the student’s participation in school activities both inside and outside of the classroom and is to be written with consideration of minimal disruption of the student’s school day.The IHP should also contain an Emergency Care Plan (ECP) for each student to include care instructions on how to address the child's specific medical or care needs during an fire drills, power failures, and school lockdowns. Access to building exits, the need for additional staff support and emergency response time by school nursing and /or local ambulance service should be considered
54 Individualized Health Care Plan considerations Written for a broad audience: the multidisciplinary team and must correlate with what is written inthe IEP and is to detail the health related and nursing services that will be required in the school environmentWhen planning for nursing in the school environment it is important to consider:Type of skilled medical needsLevel and frequency of skilled medical needsProximity of the nurse to the child Type of nursing skill and / or licensure required to provide the careHow providing the required care impacts student participation in a typical school schedule Hours of care required during the school dayQualified/ designated personnelLocation of the IHP and ECPIs updated whenever necessaryUses language appropriate for the broad audienceCan be ”sectioned” as needed- e.g. emergency info to take onfield tripsThere are a variety of options for nursing care, ranging from using an on-site school nurse for intermittent needs to assigning a dedicated one-to-one nurse for the entire school day. Some school districts may use Licensed Practical Nurses or aides who are supervised by a Registered Nurse.
55 EvaluationIHCP/ECPThe school nurse is to evaluate care provided by licensed or unlicensed staff contained in the care plan on a routine basis or as dictated by the student’s needs or staff needs.The school nurse is to revised the care plan if the student’s health related, nursing, or medical needs change, but at least yearly.The maintenance of an ongoing, collaborative plan of care can be facilitated by the school nurse attending and being an active participant in all student evaluation and planning meetings.The evaluation of the effectiveness of the IHCP and ECP is reimbursable service within the MSBS program (Medicaid School Based Services program).
56 References http://idea.ed.gov ED. Gov, U.S. Department of Education New Mexico Public Education DepartmentOffice of School Health