1. Division of School Health Bureau of Community Health Systems SCHOOL HEALTH UPDATE 2012

2. 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

3. REGIONAL SCHOOL HEALTH CONSULTANTS NW – Donna Leffler 724-662-6068 dleffler@pa.govdleffler@pa.gov NC – Deb Frey 570-327-3400 defrey@pa.govdefrey@pa.gov NE – Kristen Cheslick 570-826-2062 kcheslick@pa.govkcheslick@pa.gov SC – Sue Templin 717-787-8092 stemplin@pa.govstemplin@pa.gov SE – Sheri Mountz 610-378-4352 smountz@pa.govsmountz@pa.gov SW – Joseph Donahue 724-830-2701jodonahue@pa.govjodonahue@pa.gov

4. ACT 104 of 2010 (HB101) Allows CRNP/PA to complete physicals for: Teacher Certification School Staff Mandated Student Examinations

5. 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

6. ACT 104 of 2010 (HB101) PA Guidelines for Management of Food Allergies in School Part of Wellness Policy Development of Guidelines www.health.state.pa.us/schoolhealth “What’s New with School Health” http://www.portal.state.pa.us/portal/server.pt/comm unity/national_school_lunch/7487/special_dietary_ne eds_in_school_nutrition_programs- _resources/509222

7. FOOD ALLERGY GUIDELINES REQUIRED 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

8. 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 GUIDELINES REQUIRED CONTENT

9. Understanding the Disease Addressing Student Needs Tools for Effective Food Allergy Management in Schools School Responsibilities Under Law Appendices 9 FOOD ALLERGY GUIDELINES SECTIONS

10. 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

11. 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

12. 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

13. 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

14. FOOD ALLERGY MANAGEMENT RESOURCES 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

15. 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

16. 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)

17. 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

18. Questions Authority to exclude students Exclude now or end of school year May provision period be renewed Classification for absence Provision of homebound instruction

19. 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

20. IMMUNIZATION REGULATIONS Questions (cont) Requirements for school year 2012-13 Department of Health assistance

21. 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)

22. 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/schoolchildreni mmunizations Updated forms will be available on website approximately May 1 for school year 2012-13 SCHOOL IMMUNIZATION CATCH-UP PROGRAM (SICU)

23. 2012-13 SCHOOL FLU INITIATIVE Injectable and nasal influenza vaccine available Department of Health provides Vaccine with supplies Informational packet for parents For more information, visit http://www.portal.state.pa.us/portal/server.pt/co mmunity/immunizations/14141/school_children_i mmunizations/557995 http://www.portal.state.pa.us/portal/server.pt/co mmunity/immunizations/14141/school_children_i mmunizations/557995

24. IMMUNIZATION RESOURCES Available at “What’s New with School Health” www.health.state.pa.us/schoolhealth www.health.state.pa.us/schoolhealth Updated Immunization Manual Information on ordering immunization cards and new rack cards CDC Pink Book http://www.cdc.gov/vaccines/pubs/pinkboo k/index.html

25. IMMUNIZATION RESOURCES PA- Statewide Immunization Information System (PA-SIIS) View-only access for school nurses http://www.portal.health.state.pa.us/portal/se rver.pt/community/pa_statewide_immunizatio n_information_system_%28pa- siis%29/14281/school_nurses/556459 Send application to Attention: Frank Caniglia

26. 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

27. DIVERSITY Diversity Commitment to recognize similarities and celebrate people’s differences in order to highlight their uniqueness and create inclusiveness in a gradually diverse world community Diversity Awareness Creates respect and appreciation of the mixture of characteristics that make individuals unique and groups distinctive from one another

28. 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

29. Partnership Federal Office of Refugee Resettlement Department of Public Welfare Department of Health, Office of Health Equity Department of Health, Bureau of Epidemiology Goal Ensure all newly arriving refugees receive a comprehensive health screening as soon as possible after entering the United States REFUGEE HEALTH

30. Refugee Defined 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 Program Refugees Asylees Cuban/Haitian Entrants Amer-Asians Victims of Human Trafficking Unaccompanied Alien Children Survivors of Torture REFUGEE HEALTH

31. OHE http://www.health.state.pa.us/healthequity Refugee Health http://www.portal.state.pa.us/portal/server.pt /community/refugee_health/19001 OFFICE OF HEALTH EQUITY

32. 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/ http://aedgrant.com/

33. 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.com 800-242-9150 ext. 9565 Cell phone: 804-240-4388

34. SCHOOL HEALTH SERVICES

35. SCHOOL HEALTH SERVICES PART 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

36. Supplemental Staff Can’t carry a caseload Function under their own license Under the direction of the CSN CSN must go to all assigned buildings on regular basis Can’t cover caseload you never see SCHOOL HEALTH SERVICES SUPPLEMENTAL STAFF

37. SCHOOL HEALTH SERVICES CHIROPRACTORS 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 physicals Write prescriptions for medications Sign medical exemptions for immunizations Write dietary restrictions

38. Provision of services by: EMTs 28 PA Code, § 1003.23 Scope of practice performed under medical command or Statewide BLS medical treatment protocols Scope of practices does not include Routine administration of medications Supervising students self-administering medications SCHOOL HEALTH SERVICES EMTs

39. 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 SERVICES ATHLETIC TRAINERS

40. 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 SERVICES AGENCY STAFF

41. SCHOOL HEALTH SERVICES Licensed Private Academic Non-public/Non-licensed Career and Technology Centers Full-time Part-time Intermediate Units Alternative Education

42. 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

43. Delegation “in loco parentis” pertains only to conduct and behavior Waiver of Liability Possible violation of federal laws Office of Civil Rights (OCR) - Berlin Brothersvalley SD (1988) DELEGATION

44. 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

45. DOCUMENTATION SUSPECTED CHILD ABUSE Child Abuse Document in health record Statement made by student Assessment and treatment of injuries Notification of ChildLine Copy of CY-47 form in file with note of outcome of investigation Photos of injuries Part of school district policy

46. Sharing Health Information Expectation of privacy FERPA - educational need to know Health 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 DOCUMENTATION FERPA

47. DOCUMENTATION 49 Pa. Code § 21.18 Standards 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 privacy Duty to maintain confidentiality

48. Electronic vs. paper records May 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 DOCUMENTATION ELECTRONIC

49. DOCUMENTATION Health logs Sign-in logs okay (name, time of arrival, time of departure) Individual record for each student for assessment and treatment Medical plans of care Standard of nursing practice

50. 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

51. CORRESPONDENCE E-mails are not secure Be careful about sending identifiable health information Division of School Health Remove identifiable information on students before sending e-mail Don’t have “educational need to know” Right to Know policies

52. 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

53. Field Trips (cont) Invite parent or parent designee Utilize licensed nurse from sub list Licensed volunteer Need clearances Approval as district volunteer Provider permission required to change dosage time or skip a dose of medication MEDICATION ISSUES: FIELD TRIPS

54. Out of state field trips Check with Board of Nursing Obtain in writing Delegation to student by parent not allowed Student under school jurisdiction Zero tolerance drug policies Self-administration by student Emergency medications only MEDICATION ISSUES: FIELD TRIPS

55. MEDICATION ISSUES Extracurricular activities Same rules as field trips Early Intervention Programs School District responsibility Integral part of school program Located in school district building Medications, immunizations & emergency care Screenings for baseline (optional)

56. Emergency Medications PA 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

57. MEDICATION ISSUES Require licensed medical professional to administer Intranasal Versed Diastat Glucagon

58. 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 http://smartmovessmartchoices.org

59. SPECIAL NEEDS STUDENTS MEDICAL PLANS OF CARE Medical Plans of Care Standard 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

60. SPECIAL NEEDS STUDENTS PA ELKS HOME SERVICE PA Elks Home Service Program No charge In-home medical care coordination services Assess needs & help to access equipment Advocate for appropriate education services http://www.paelkshomeservice.org/who WeServe.php

61. 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 STUDENTS PLANS OF CARE

62. 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 STUDENTS DIABETES

63. Factors to Consider Individualized Transportation Plan (ITP) Transition Healthcare Checklist Who can legally provide care? Dietary accommodations SPECIAL NEEDS STUDENTS TRANSPORTATION PLAN

64. ITP Standardize assessment of transportation needs for every student Resources and training available https://www.gotoskn.state.pa.us/About /StatewideInitiatives/Transportation/tab id/66/Default.aspx SPECIAL NEEDS STUDENTS TRANSPORTATION PLAN

65. SPECIAL NEEDS STUDENTS TRANSITION HEALTHCARE CHECKLIST Transition Healthcare Checklist: Transition to Adult Living in PA School responsible for successful transition Start transition planning by age 14 Include health component Omission most likely reason for failure according to statistics from the Pennsylvania Training and Technical Assistance Network (PATTAN) Checklist updated in 2010 Also available in Spanish http://www.portal.state.pa.us/portal/server.pt?open=514& objID=558090&mode=2

66. 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

67. COMMUNICABLE DISEASE TB Testing Students Staff/Volunteers Critters Bedbugs http://www.spcpweb.org/factsheets/BBinSchoolsand CC.pdf Head Lice Recommend following AAP guidelines No nit policy outdated

68. 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

69. SCHOOL HEALTH FORMS Online orders http://www.portal.state.pa.us/portal/server.pt/communi ty/schools/14130/school_health_forms_- _welcome/613260 Fax with updated order form http://www.portal.state.pa.us/portal/server.pt/communi ty/schools/14130/publications___documents/556694 School Health Record forms only Last order printed packs of 50 instead of 100 If ordered this form since November Verify forms received match number ordered Place additional order if needed

70. 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

71. PROFESSIONAL EVALUATION Evaluation will be specific to educational specialist Based on Charlotte Danielson Enhancing Professional Practice: A Framework for Teaching Domains: Planning and Preparation Environment Delivery of Service Professional Responsibilities

72. Request your suggestions for improving: Annual Report SHARRS - Reimbursement Reporting System Manual/Procedure Screens - Growth, Hearing, Scoliosis, Vision Dental Documentation Other School Health Website Send your suggestions to the school health consultant in your district SCHOOL NURSE FEEDBACK

73. 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

74. CONTINUING EDUCATION Act 48 Division 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 numberc-paschool@pa.gov Fax certificates to 717-783-4790 and include PDE ID number, e-mail address, and phone number Act 58 If CSN, Act 48 hours count for RN CE

75. 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 courses Hours accrued will be credited during moratorium FAQS from Department of Education http://www.education.state.pa.us/portal/server.pt/commu nity/act_48_-_continuing_professional_education/8622

76. 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

77. CONTINUING EDUCATION

81. 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

82. RESOURCES American Heart Association Be the Beat School Challenge Hands-Only CPR http://bethebeat.heart.org/ Assistance with prescription medications www.pfizerHelpfulAnswers.com www.TogetherRxAccess.com www.pparx.org Bullying prevention toolkit http://www.stopbullying.gov/

83. RESOURCES CDC Tips from Former Smokers http://www.naquitline.org/resource/resmgr/m edia_campaign/tips_digital_media_toolkit_l.pdf CDC, STD Awareness - Reaching Young People http://www.cdc.gov/std/sam/default.htm CDC, COCA Clinical Reminder DO NOT use insulin pens for more than one person

84. RESOURCES ER Guidelines for PA Schools www.paemsc.org Eagle Books Toolkit http://www.cdc.gov/diabetes/pubs/eagle/pdf/E agle%20Books%20Toolkit%20for%20Families %20Classrooms%20and%20Communities.pdf Indoor Air Quality Toolkit http://www.epa.gov/iaq/schools/

85. RESOURCES Mid-Atlantic Center for Children’s Health and the Environment (MACCHE) http://www.childrensnational.org/MACCHE/Res ourcesAndTutorials/ Fact sheets on environmental issues in schools Mold, Mildew Pesticides in the Environment Autism and the Environment Asthma and school environment

86. RESOURCES Medical Assistance Information http://www.dpw.state.pa.us/helpfultelephonen umbers/contactinformationhelpformaproviders/ index.htm Pediatric Asthma Toolkit http://www.paasthma.org/asthma-resources/asthma- toolkit

87. RESOURCES Orthodontic Emergencies http://www.aaomembers.org/Press/HealthCare Professionals/SchoolNurses.cfm PA Emergency Preparedness Guide www.ReadyPA.org

88. HAPPY SCHOOL NURSE’S DAY May 9, 2012