1. Ohio Department of Health Update DiAnn McMillen BSN, MS, RN, LSN Head Start Impact SIIS School Nurse Consultant School Nursing Program

2. Overview Legislative Update House Bill 296- “the epi bill” House Bill 264- “the diabetes bill” House Bill 39- “the inhaler bill” Step Up & Be Counted! Hearing and Vision Immunizations Essential Oils in the School Setting Summary

3. Legislative Update

4. House Bill 296 “the epi bill”

5. House Bill 296 “ The epi bill ” ORC 3313.7110, 3313.7111, 3314.143, 3326.28, 3328.29-Effective spring 2014 Allows schools to procure, maintain and administer stock epinephrine autoinjectors Requires school policy and protocol developed with a licensed prescriber Requires training for staff who may administer

6. House Bill 296 ODH Resource: Epinephrine Autoinjectors in Ohio Schools: A Train- the-Trainer for School Nurses Online independent study through OhioTRAIN (https://oh.train.org )https://oh.train.org Course #1051726 Will provide 1.8 CNE Provides PowerPoint, handouts, skills checklists, etc., for training UAPs

7. House Bill 296 ODH Resources: Under Guidelines and Publications: Sample Anaphylaxis Emergency Action Plan Sample Epinephrine Autoinjector School Policy http://www.odh.ohio.gov/odhprograms/chss/schn urs/guidepub.aspx http://www.odh.ohio.gov/odhprograms/chss/schn urs/guidepub.aspx

8. House Bill 296 National Association of School Nurses Resources: Developed as a collaboration between NASN, NASSNC and AAP Includes: Sample Epinephrine Autoinjector School Policy Sample Epinephrine Autoinjector School Protocol Sample Epinephrine Autoinjector Reporting Form http://www.nasn.org/ToolsResources/FoodAllergyandAnap hylaxis/EpinephrinePoliciesProtocolsandReporting

9. House Bill 264 “the diabetes bill”

10. House Bill 264 “ The diabetes bill ” ORC 3313.7112 --Effective fall 2014 Addresses public and chartered nonpublic schools To ensure a student with diabetes receives appropriate care, the school: Provides care in accordance with prescriber’s orders Shall inform parents regarding 504 eligibility May administer diabetes medication May provide training to school staff Reports selected data to Ohio Department of Education

11. House Bill 264 “ The board…shall ensure that each student…who has diabetes receives appropriate and needed diabetes care in accordance with an order signed by the student's treating physician. ” Checking and recoding blood glucose and ketones Responding to blood glucose levels out of target range Administering Glucagon, insulin, oral diabetes medications Understanding recommended schedules for food to calculate medication dosages Following meal and activity instructions

12. House Bill 264 “…14 days after receipt of an order…of a student with diabetes, the board…shall inform the student's parent… that the student may be entitled to a 504 plan regarding the student's diabetes.” Responsibility of the administration ODE developed a letter to be used by district Nurse should be involved in 504 plan development http://education.ohio.gov/Topics/Other- Resources/Diabetes-Management

13. House Bill 264 http://education.ohio. gov/Topics/Other- Resources/Diabetes- Management

14. House Bill 264 “ …diabetes medication may be administered…by a school nurse or a school employee who is trained in diabetes…medication …may be kept in an easily accessible location ” ODE identified guidelines for training that include: Recognition of hypo/hyperglycemia, emergency situations treatment Performance of blood glucose and ketone tests Medication administration based on orders (must be recorded) Understanding dietary recommendations http://education.ohio.gov/Topics/Other- Resources/Diabetes-Management

15. House Bill 264 “ …a board …may provide training that complies with the guidelines …to a school employee at each school attended by a student with diabetes. ” Coordinated by school nurse or licensed health care professional with expertise in diabetes Before the beginning of school year or 14 days after diagnosis Includes determination of competence Include follow-up training as needed

16. House Bill 264 “ The principal of a school attended by a student with diabetes …may distribute a written notice to each employee containing… “ Description of tasks to be performed and statements that: The school must provide diabetes care to a student Participation is voluntary Training will be provided Who to contact if they are interested The trained employee is immune from liability No one can discourage staff or penalize those not volunteering

17. House Bill 264 “ A student with diabetes shall be permitted to attend the school the student would otherwise attend… ” “ …shall be permitted to attend to the care and management …during regular school hours and school-sponsored activities… ”

18. House Bill 264 “ The student shall be permitted to perform diabetes care tasks in a classroom, in any area of the school or school grounds, and at any school-related activity, and to possess on the student's self at all times all necessary supplies and equipment to perform these tasks.…[or]…shall have access to a private area for performing diabetes care tasks.” “ If the student performs any diabetes care tasks or uses medical equipment for purposes other than the student's own care, the board…may revoke the student's permission to attend to the care and management of the student's diabetes. “

19. House Bill 264 “… a board or governing authority shall report to the department of education…number of students with diabetes enrolled…the number of errors associated with the administration of diabetes medication to students with diabetes …” “… March of each year, the department shall issue a report summarizing the information received by the department …[and]… shall make the report available on its internet web site.”

20. House Bill 39 “the inhaler bill”

21. House Bill 39 “ The inhaler bill ” ORC 3313.7113, 3313.7114, 3314.144, 3326.30, 3328.30-Effective spring 2016 Allows schools to procure inhalers for use in emergency situations Requires school policy and protocol developed with a licensed prescriber Requires training for staff who may administer

22. House Bill 39 “ The inhaler bill ” Encouraged to maintain, at all times, at least two inhalers at each school May accept donations of inhalers from a wholesale distributor…and may accept donations of money from any person to purchase inhalers Shall report to the department of education each procurement and occurrence in which an inhaler is used from a school's supply

23. House Bill 39 “ The inhaler bill ” Policy developed with a licensed health professional Specify definitive orders including the dosages to be administered through them and number of uses before disposal Identify the one or more locations in each school…in which an inhaler must be stored Specify the conditions under which an inhaler must be stored, replaced, and disposed

24. House Bill 39 “ The inhaler bill ” Policy developed with a licensed health professional Specify the individuals who may access and use an inhaler to provide the inhaler to an individual in an emergency situation Identify the emergency situations Specify that assistance from an emergency medical service provider must be requested immediately after an inhaler is used Specify the individuals to whom an inhaler may be administered in an emergency situation

25. Step Up & Be Counted!

26. A joint national data collection project of the National Association of School Nurses (NASN) and the National Association of State School Nurse Consultants (NASSNC)

27. Step Up & Be Counted! Goal: development of a national uniform, standardized data set for all school nurses around the country to collect specific data points the same way

28. Step Up & Be Counted! Role of the Designated State Data Champion: The person identified in the state to be the point person for the state’s data collection To promote the program to all school nurses in the state To develop process to collect data in aggregate form from schools (districts, public, private, charter, parochial, or other) and providing to national database

29. Step Up & Be Counted! Initial year data points (2014-15): the number of nurses in schools the number of children with diagnosed chronic health conditions the disposition of children seen in the school nurse office

30. Step Up & Be Counted! Second year data points (2015-16): Data will be collected twice this school year Different data will be collected each time Report district level data when possible All data must be aggregated to protect confidentiality of individual students

31. Step Up & Be Counted! http://www.odh.ohio.gov/odhprograms/chss/ schnurs/nurseforms.aspx

32. Step Up & Be Counted! http://www.odh.ohio.gov/odhprograms/chss/ schnurs/nurseforms.aspx

33. Step Up & Be Counted! http://www.odh.ohio.gov/odhprograms/chss/ schnurs/nurseforms.aspx **Due by June 1, 2016** While these data are not due until June, nurses need to start tracking them as soon as possible. You will need to provide the date when data collection starts and ends. PLEASE report confirmed data so that you can be accurate in your counts. Do NOT guesstimate. 20. Number of student encounters/health office visits to RN resulting in the student returning to class or staying in school during the 2015-2016 school year 21. Number of student encounters/health office visits to the RN resulting in 911 being called or regionally appropriate equivalent during the 2015-2016 school year 22. Number of student encounters/health office visits to the RN resulting in the student being sent home during the 2015- 2016 school year 23. Number of student encounters/health office visits to LPN/LVN resulting in the student returning to class or staying in school during the 2015-2016 school year 24. Number of student encounters/health office visits to the LPN/LVN resulting in 911 being called or regionally appropriate equivalent during the 2015-2016 school year 25. Number of student encounters/health office visits to the LPN/LVN resulting in the student being sent home during the 2015-2016 school year 26. Number of student encounters/health office visits to health aide/UAP (non-RN, non- LPN/LVN) resulting in the student returning to class or staying in school during the 2015-2016 school year 27. Number of student encounters/health office visits to the health aide/UAP (non-RN, non- LPN/LVN) resulting in 911 being called or regionally appropriate equivalent during the 2015- 2016 school year 28. Number of student encounters/health office visits to the health aide/UAP (non-RN, non- LPN/LVN) resulting in the student being sent home during the 2015-2016 school year)

34. Step Up & Be Counted! https://www.n asn.org/porta ls/0/2015_20 16_NASN_N ASSNC_Unif orm_Dataset _Data_Points.pdf

35. Step Up & Be Counted! https://www.n asn.org/porta ls/0/2015_20 16_NASN_N ASSNC_Unif orm_Dataset _Data_Points.pdf

36. Step Up & Be Counted! http://www.odh. ohio.gov/odhpr ograms/chss/s chnurs/nursefo rms.aspx

37. Step Up & Be Counted! http://www.odh.ohio. gov/odhprograms/ch ss/schnurs/nursefor ms.aspx

38. Step Up & Be Counted! To report data Send Email to Adolescent.Health@odh.ohio.govAdolescent.Health@odh.ohio.gov Attach spreadsheet to the email In Subject line write “SU&BC” In the Body of the email include: Name of District or Public, Private, or Charter or parochial school Contact person: (name, phone number, email) Date report was submitted

39. Hearing & Vision

40. Hearing http://www.odh.ohio.gov/odhprograms /cfhs/hvscr/requir.aspx 2015 Ohio Hearing Screening Guidelines

41. Vision

42. Immunizations

43. Director’s Journal Updated in December, 2014 http://www.odh.ohio.gov/~/me dia/ODH/ASSETS/Files/bid/imm unizations/directorsjournal- schoolrequirements%2012-5- 2014.pdf http://www.odh.ohio.gov/~/me dia/ODH/ASSETS/Files/bid/imm unizations/directorsjournal- schoolrequirements%2012-5- 2014.pdf Includes definitions of outbreaks Basis of the Immunization Summary

44. 2015-16 Immunization Summary http://www. odh.ohio.gov /odhprogram s/bid/immuni zation/imunc hsc.aspx

45. Immunizations: Early Childhood Child Care Immunization Requirement 5104.014 Medical statement of immunization

46. Child Care Vaccine Requirement House Bill 536—Effective March 19, 2015 Covers: Child day-care centers, parent cooperative centers, part-time centers, drop-in centers, school-age child care centers (ORC 5104.015) Type A family day-care homes, parent cooperative type A homes, part-time type A homes, drop-in type A homes, school-age child type A homes (ORC 5104.017) Type B family day-care homes (ORC 5104.018)

47. Child Care Vaccine Requirement ORC 5104.014 30 days after enrollment & every 13 months thereafter Parent provides a medical statement that child has been immunized Statement must include: Dates child received required immunizations Any exceptions (medical, reasons of conscience, age appropriateness, availability of influenza vaccine) A component where parent indicates that they decline to have child immunized

48. Immunizations http://www.cdc.gov/vaccines/who/teens/downloads/parent -version-schedule-7-18yrs.pdf

49. Essential Oils in the School Setting

50. Essential Oils Over the Counter (OTC) The law is silent School should develop their own policy Environmental Toxin Concern with increasing Asthma & Allergy statistics Considered an irritant Not in the best interest of ALL children and staff

51. ODH Resources

52. http://www.odh.ohio.g ov/odhprograms/chss/ schnurs/conf.aspx ODH Trainings Epinephrine Autoinjector Live Webcasts Online Independent Study

53. Ohio Department of Health (ODH) School Nursing Program http://www.odh.ohio.gov/odhprograms/chss/schnurs/schnurs1.aspx

54. Summary As the laws change updates are highlighted and communicated on the School Nursing Bulletin Board (SNBB) Contribute to Step Up & Be Counted! Hearing screening requirements have changed for the school year 2016-17 Immunization requirements are also changing for the school year 2016-17

55. Thank you for your attention! DiAnn McMillen BSN, MS, RN, LSN 614-644-8248 diann.mcmillen@odh.ohio.gov Questions?