1. Frequent Flyers Nancy Nadel Sharon-rose Gargula Nadel and Gargula 2012

2.  The student will decrease unscheduled non-acute care visits to the nurse. Nadel and Gargula 2012

3.  Unscheduled  Non emergency  Unnecessary  No significant complaint Nadel and Gargula 2012

4.  Chapped lips  Invisible injuries  Stomach aches just before lunch  Paper cut  Frequent visits out of the same class for vague complaints  Picking scab off healing cuts  Personal female care  Symptoms that just started 1 minute ago Nadel and Gargula 2012

5.  Scheduled medication  Scheduled treatment  Asthma attack  Chronic Illness care (diabetes, seizures)  Fever  Vomiting  Chest Pain  Injury requiring first aid  Significant mental health crisis Nadel and Gargula 2012

6. Choose a group of students (between 10-150) that are at risk for frequent visits  Hint- the larger the group the better the outcome will be  Use eschool or DSC to determine who will be at risk  Past frequent flyer  New student to the building who has found their way to you Nadel and Gargula 2012

7.  50% of the selected cohort will show improvement over a defined period of time with a minimum of 4 weeks.  If your cohort is 20, then a minimum of 10 students will have a decrease in their unscheduled office visits by at least one visit during the second time frame you have chosen to measure. Nadel and Gargula 2012

8.  Any visit to the nurse  Include time of visit and length of visit  Chief complaints  Is it vague or specific?  Is it medically necessary?  Discuss with the student what the ultimate goal is for this visit (rest, pain free, go home)  Where is the student coming from or where is the student supposed to be going? Nadel and Gargula 2012

9.  History, including onset of complaint  Care provided at home  If an injury, where did it happen?  Are parents aware of the illness/injury?  How is this interfering with outside activities?  Physical assessment  Staff conference: what is the teacher seeing in the classroom?  How often is the student leaving the classroom?  Is the teacher aware that the student has come to the health suite? Nadel and Gargula 2012

10.  Choose 2 equal points in time  Min 4 weeks max is school year  Example Nov 1st-30 th and April 1 st -30 th or 1 st MP and 3MP  Compare the number of visits for the cohort (identified students)  Improvement can be by a single visit! Nadel and Gargula 2012

11.  Identify the real reason for the visit.  Look for patterns such as a common time  Is there a substitute teacher?  Is it the same teacher who is making excessive referrals?  Ensure medication availability and compliance Nadel and Gargula 2012

12.  Educate the student about acceptable reasons for visiting the nurse  Identify a motivator for staying in class which might include a reward system  Develop an IHP  Teach student self care and facilitate a means for this to happen  Consider scheduling a time for an office visit, just to check in Nadel and Gargula 2012

13.  Is there a plan for the substitute teacher and what to do with students who are frequent flyers?  Educate teachers on proper referrals - decision tree  Make teacher aware of excessive referrals  Attend PLC’s  Utilize support staff, IST, guidance counselor  Speak with administration about support for teachers Nadel and Gargula 2012

14.  Communicating concerns, genuine caring for student’s well being  Obtain a health history.  Set common goals with parent.  Conference with parents/teacher & nurse  Encourage parents to follow-up with PCP to rule out any physical cause for the student complaint.  Mental health issues if untreated can cause physical symptoms Nadel and Gargula 2012

15.  Students showing improvement  ___________________  Total number of students  Acceptable growth rate is 50% - unless you chose something else in agreement with your administrator Nadel and Gargula 2012

16.  School nursing started with the premise that healthy children should be in the classroom and sick students should be at home.  By decreasing the frequency of non emergent visits we are supporting our teachers and helping students become successful.  The documentation for this indicator can lead to data for other indicators  We can combine this indicator with other indicators. Nadel and Gargula 2012