Health Services Annual Training

August 19, 2013 @ Educational Service Center8:30 am - 12:00 pm

Today's Agenda• Why are you here?

• Then and Now...

• Today’s plano 10 minute breaks

After section 4 After Section 8

o Noon Lunch

• Training Content

• Resources

Health Service Staff Model & Student Health Concerns

Only employees that have been delegated by the School RN are allowed to work in the Health Center. These designated employees must also be:

- Certified in First Aid/CPR - Trained by the School RN - Receive documented annual reviews of health room policies and procedures by the School RN

10 Schools + Homelink & ELC8,200 students (1,171 average per Nurse)

281 Life Threatening Conditions138 Anaphylaxis/Severe Allergies & 23 Diabetes Insulin D.

808 Asthma & 72 Seizure ConditionsOverall .... 4,925 students with Health Concerns

7 District Nurses

Health Room & School Nurse Delegation

School Nurse

Health Room Assistant Office Professional

Paraeducator - General Clerical Support

Appropriate Delegation

& AdequateTraining

Delegated Staffing: Job DescriptionHealth Room Role

Office Professional • Register new students and maintain student records including attendance,

discipline and health information. • Oversee health room and provide basic services in the absence of a nurse.• Know and follow health, safety and emergency procedures of the district

Paraeducator - General Clerical Support• Assist students seeking care in the health room• Provide general RN support, set appointments for parents to meet with RN,

make arrangements for School Bell• Know and follow health, safety and emergency procedures of the district

Health Room Assistant • Provide health room management and assists in the implementation of the

District health services programs. • Assists students, staff and teachers with health-related issues.

Safe Schools1. Participants will:

• 1. Understand their training assignments with safe schools online and expectation for completion.

Safe Schools Online1). Health Room Assistant Training by RN

Goal: To be completed by first day in position and then annually.

Safe Schools Online Cources: Blood borne Pathogen Exposure Prevention, Health Emergencies Overview, HealthEmergencies: Asthma Awareness, Diabetes Education, Hemophilia, Life Threatening Allergies, Seizures, Coking & the Heimlich Maneuver, Medication Administration Basics, HIV Aids, AED Training, Heat Illness Prevention, Concussion.

*First Aid Certified (every 2 years)

2). Health Room Para Educator and Secretary Annual August Training Goal: To be completed annually at the beginning of each new school year.

Safe Schools Online Cources: Blood borne Pathogen Exposure Prevention, Health Emergencies Overview, Health Emergencies: Asthma Awareness, Diabetes Education, Hemophilia, Life Threatening Allergies, Seizures, Coking & the Heimlich Maneuver, Medication Administration Basics, HIV Aids, AED Training, Heat Illness Prevention, Concussion.

*First Aid Certified (every 2 years)

Safe Schools Online3). General health related Training for All School Building Staff, New

Certificated Hires, New Classified Hires, New Subs Certificated/Classified. Goal: To be completed by early September, Annually

Safe Schools Online Courses: Blood borne Pathogen Exposure Prevention, Health Emergencies Overview 25 mins (Asthma Awareness, Diabetes Education, Life Threatening Allergies, Seizures)

Individualized staff specific training for individual student with

HCP/ECP Goal: As needed/promptly, ongoing

RN provides one-on-one or small group setting training.

Provides condition information and/or ECP

Delegation1. Participants will:

• 1. Understand their role and limitations with school nurse delegation.

• 2. Understand when to seek clarification and guidance.

Delegation Defined

• Delegation is defined by the American Nurses’ Association as “the transfer of responsibility for the performance of an activity from one individual to another, while maintaining the accountability for the outcome.”

• The Nursing Care Quality Assurance Commission (NCQAC) has the legal authority (RCW 18.79 and RCW 18.130) to regulate nursing practice in order to safeguard the health and safety of citizens in Washington.

Nurse Delegation A registered nurse may delegate tasks of nursing

to another individual where the registered nurse determines that it is in the best interest of the patient.

1) The delegating nurse shall:

a) Determine the competency of the individual to perform the task;

b) Evaluate the competency of the individual to perform the tasks;

c) Supervise the actions of the person performing the tasks; and

d) Delegate only those tasks that are within the registered nurse’s scope of practice.

Nurse Delegation No person may coerce a nurse into

compromising patient safety by requiring the nurse to delegate if the nurse determines that it is inappropriate to do so.

Nurses shall not be subject to any employer reprisal or disciplinary action by the nursing care quality assurance commission for refusing to delegate tasks or refusing to provide required training for delegation if the nurse determines delegation may compromise patient safety.

Nurse Delegation

Nurse delegation models the nursing process:

Assess – the student and the school employee’s competency

Plan – documentation of the training and nursing care

Implement – supervision requirements

Evaluate – changes in student needs, changes in school personnel, activities, change the plan or continue

Nurse Delegation

For school nurses, NCQAC (WAC 246-840-700) Standards of Nursing Conduct or Practice discusses delegation of nursing tasks to non-licensed personnel (WAC 246-840-010), and provides direction on how tasks may be delegated to a non-licensed individual by a licensed registered nurse. The delegating school nurse will be responsible for ongoing training and competency evaluations of the non-licensed personnel to safeguard the health and welfare of the students in their care.

Even when unlicensed school personnel perform the task, the nurse who delegates the task, will retain responsibility for the outcome. Supervision of the unlicensed school personnel does not require the delegating nurse to be present in the same building, however the delegating school nurse should be available by phone for consultation.

Medication DelegationHouse Bill 2247 allows registered school nurses to delegate the administration of the following medications:

Oral medications

Eye drops

Ear drops

Topical ointments

Additionally, administration of an epinephrine autoinjector (Epi Pen) may be delegated by a licensed school nurse

Recent changes in legislation may expand medications which may be delegated, however, the school board will need to review these legislative rulings and respond with policies

Nurse Delegation

• When accepting the delegation to perform medication administration in a school setting, the unlicensed school personnel performs this function under the supervision of the delegating licensed professional nurse.

• Unlicensed school personnel should only accept delegation that he/she knows is within his/her skill set or knowledge and should always contact the school nurse if unclear about administration of medication.

• Unlicensed staff have a responsibility to follow school district policy and procedures and report to the nurse immediately if they have any reason to believe they have made a medication error.

Nurse Delegation

School district, school district employee, agent, or parent-designated adult who, acting in good faith and in substantial compliance with the student’s individual health plan and the instructions of the student’s licensed health care professional, provides assistance or services under RCW 28A.210.330 shall not be liable in any criminal action or for civil damages in his or her individual or marital or governmental or corporate or other capacities as a result of the services provided under RCW 28A.210.330 to students with diabetes.

Nurse Delegation

The American Nurses Association (ANA) Code of Ethics states, “The Nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care.” The National Council of State Boards of Nursing (NCSBN) states the delegate must be, “accountable for accepting the delegation and for his/her own actions in carrying out the task.”

Medication Administration1. Participants will:2. 1. Gain a basic knowledge of the Washington State WAC

and of the LSSD policy on medication administration. 3. 2. Gain a basic knowledge of medication administration,

medication errors, classification, safety, and documentation.

Always refer to individual student care plan

Medication AdministrationSchools will administer health services per

WAC392-172-A01155, including medication administration, to students who require this service during the school day. Therefore, school districts should have in place, policies and procedures that address how medications and other health services should be delivered. Lake Stevens School District policies for medication administration are included in the consent forms for Administration for Oral Medication and on our HCP forms.

Medication Administration

• Prescribed medication must be sent to school in the original labeled container and the label should include:o Name of studento Expiration date of medicationo Name of medication, dosage and strength of

medicationo Route of medicationo Name and address of pharmacyo Name of the prescribing health care providero Date the prescription was dispensed.

Medication Administration

• Student self medication is allowed under in certain situations, with a written health care providers authorization. Prescribing HCP shall include:o The student demonstrated proper technique and is

capable of administering the prescribed med.o The name and purpose of the medicationo The prescribed dosage of medicationo The times at which or circumstances under which

the medication may be giveno The time period for which the medication is

prescribedo The side effects and further instructions if order is for

more than 15 days.

Medication Safety

• Medication safety:o The first dose of a medication should be given at home

and not at school.o Prescribed medication should be brought to school by

parent or guardian and picked up by the same.o Prescribed medication should be counted and the

number of pills documented on the Medication Administration form and signed by 2 adults.

o Medication shall only be administered according to the health care provider’s instructions on the Medication Authorization form and should match the information on the prescription label

o No change in prescription can be made without authorization from prescribing HCP.

Storage and Disposal of Medication

• Storage and Disposal of medication:o Except for emergency medications (EpiPens and

inhalers and antihistamines) all medications should be kept in a secure, locked container or cabinet accessible only to responsible authorized school personnel.

o Medications requiring refrigeration shall be kept in separate refrigerator in a supervised area. Temperature of that refrigerator will be checked on a regular basis

o Disposal of medications may be made at the Lake Stevens Police department office. Document disposal date.

Medication Errors

• Medication Errors:o A medication error occurs when on the “6 rights of

medication administration” has been violated, ie:o Administering the wrong medicationo Administering the wrong dosage of medicationo Administering the medication at the wrong timeo Administering medication in the wrong wayo Administering medication to the wrong studento Failing to document that medication was given or

inaccurate documentation of medication given.

• Medication errors may result in adverse reactions to the student. These reactions could range from a rash to life threatening.

Medication Errors (con’t)

• When a medication error occurs, follow these guidelines:o Keep the student in the health room or officeo If the student has returned to class, have them escorted

by an adult back to health roomo Observe the student’s status and document what you seeo Identify the incorrect dose or type of medication takeno Notify the supervising school nurse or principal if

medication was given by non-licensed personnel.o Complete a Medication Administration Incident Report

form.o Call Parent/Guardian to inform of the incident.

The 6 Rights of Medication Administration

1. Right student

2. Right medication

3. Right dose

4. Right time

5. Right documentation

6. Right route (eye drops, oral med, ear drops)

Classification of Medications

• Classification of Medications:o Prescription medications: have been ordered for

treatment by a health care providero Controlled/scheduled meds: are medications that are

potentially addictive and are regulated under the Controlled/scheduled Substance Act of 1970

o Non-controlled/scheduled medication:require an order from a HCP.

o Over-the-counter (OTC) medications: OTC medications are administered to students according to district policy. OTC meds require a completed authorization form by parent/guardian and the student’s HCP.

Field Trip Procedures-Medication

Notification and preparation for administering medications during a field trip should begin well in advance of the day of the field trip(at least 2 weeks). The medication should not be repackaged for field trips by school personnel and student medication bottle should have a pharmacy prescription label attached.

Medication Handouts

• Administration of Medication Policy Letter

• Medication Dosage Log

• Medication Error Report Form

• Common Medication Abbreviations

• Glossary of Medical Terms

• Brand & Generic Names for Common Medications

• Common Medications

• Medication Administration Checlist(i.e. Oral, Liquid, Eye Drops, Oinment, Ear Drops, Topical Ointment, Inhalers, EpiPen)

Diabetes Participants will:

• 1. Gain a basic understanding of diabetes.

• 2. Identify signs and symptoms of low and high blood sugar.

• 3. Understand their role in treatment and emergency response.

Always refer to individual student care plan

Diabetes Management Training For School Personnel Is Essential

• For the immediate safety of students with diabetes

• For the long-term health of students with diabetes

• To ensure that students with diabetes are ready to learn and participate fully in school activities

• To minimize the possibility that diabetes-related emergencies will disrupt classroom activities

Diabetes

Diabetes results from the failure of the pancreas to make insulin. Insulin is a hormone that is necessary for the body to convert sugar or glucose into energy. Without insulin, sugar accumulates in the blood causing symptoms.

Type 1 Diabetes

• Most children with diabetes have Type 1 Diabetes.

• Pancreas makes too little or no insulin.

• Treatment consists of administering multiple doses of insulin, monitoring blood sugar levels throughout the day, eating nutritious meals and snacks, and following a regular exercise program.

Symptoms of Type 1 Diabetes

Symptoms:• Increased thirst and urination• Weight loss • Blurred vision• Feeling tired all the time

Risk Factors:• Genetics• Environment

The symptoms of type 1 diabetes are due to an increase in the level of glucose in the blood. These symptoms may be mistaken for the flu. If left undiagnosed, the child with type 1 diabetes can lapse into a life-threatening condition known as diabetic ketoacidosis (DKA). Signs of DKA include vomiting, sleepiness, fruity breath, difficulty breathing, and if untreated, coma and death.

Type 2 Diabetes

• Cells are insulin resistant and do not use insulin well.

• Children with Type 2 Diabetes often do not take insulin but may take a diabetes pill such as Metformin.

• Blood sugar monitoring, careful attention to a healthy diet, and daily exercise are important to controlling Type 2 Diabetes.

Type 2 diabetes is the most common form of the disease. It can develop at any age, even during childhood. Type 2 diabetes is a progressive disease and usually begins with insulin resistance where muscle, liver, and fat cells do not use insulin effectively. The pancreas produces more insulin but eventually loses its ability to produce enough insulin to control the glucose levels. More children and adolescents in the United States have become overweight and sedentary in their activity level resulting in an increase of Type 2 diabetes occurring in this younger population.

Risk Factors:

• Being overweight

• Having a family member who has type 2 diabetes

• Being African American, Hispanic/Latino, American Indian, Alaska Native, Asian American, or Pacific Islander including Native Hawaiian

Symptoms:• Feeling tired all the time

• Increased thirst and urination

• Weight loss

• Blurred vision

• Frequent infections

• Slow-healing wounds

Prevalence of Diabetes in Children is Increasing

200,000 or 1 in every 400 children and adolescents in the United States has Diabetes. According to recent estimates, about 19,000 youths are diagnosed with type 1 and type 2 diabetes each year.

Goals of Diabetic Management in Children

To promote normal childhood and adolescent growth and development.

To promote healthy, emotional well-being.

To maintain a balance between insulin, food and exercise.

Diabetes ResearchResearch has shown that maintaining good control of

blood sugar levels can prevent long-term complications of diabetes.

The goal of effective diabetic management is to keep the blood glucose levels in the “target range” which is determined by the student’s health care provider.

Good Blood Glucose Control is a Balancing Act 24/7

INSULIN

EXERCISE

FOOD

Hyperglycemia

Hypoglycemia

Diabetes management involves checking blood glucose levels throughout the day, following an individualized meal plan, getting regular physical activity, and administering insulin to try to maintain blood glucose levels in the target range and to prevent hypoglycemia or hyperglycemia.

Checking Blood Glucose Levels

Regular glucose monitoring is essential in good diabetic management. Blood glucose levels are most often done by poking the end of the finger with a lancet via a poking device and placing a drop of blood on a test strip which is inserted into a glucose meter where the meter displays the blood glucose level.

BLOOD GLUCOSE TESTING

Helpful information:

Students should be allowed access to their diabetic testing equipment and supplies at all times

Students experiencing hypoglycemia (low blood sugar) may need assistance in testing their blood glucose levels

If low blood sugar is suspected, testing should be done in the tip of the finger

Hands should be thoroughly washed and dried before testing

Sharps and contaminated supplies must be disposed of according to district policy and students IHP

Students usually check their blood glucose:

• As outlined in their Individual Health Plan (IHP)

• Before and after eating

snacks and meals

• Before and after physical

activity

• When they have symptoms of low or high blood glucose levels

HYPOGLYCEMIA

Hypoglycemia means

LOW blood sugar and is defined as a blood sugar less than 60 mg/d

• Hypoglycemia, which is not always preventable, is the greatest immediate danger to students with diabetes

• Low blood sugar can develop within minutes and requires immediate attention

• Hypoglycemia usually can be treated easily and effectively. If it is not treated promptly, however, hypoglycemia can lead to loss of consciousness and seizures and can be life threatening

Causes of Hypoglycemia

•Too much insulin

•Missing or delaying meals or snacks

•Not eating enough food (carbohydrates)

•Getting extra, intense, or unplanned physical activity

•Being ill, particularly with gastrointestinal illness

•Hypoglycemia is most likely to occur before lunch, end of the school day or after PE/recess

Hypoglycemia Symptoms

Hypoglycemia can impair a student’s cognitive abilities and adversely affect academic performance. Sometimes, its symptoms are mistaken for misbehavior.

“I’m the Blood Sugar Fairy. If you can see me, yours is too low.”

Mild to Moderate Hypoglycemia

• Shaky or jittery

• Sweaty

• Hungry

• Pale

• Headache

• Blurry vision

• Sleepy

• Dizzy

• Confused

• Disoriented

• Uncoordinated

• Irritable or nervous

• Argumentative

• Combative

• Changed personality

• Changed behavior

• Inability to concentrate

• Weak

• Lethargic

• When hypoglycemia is suspected, always treat immediately as outlined in student’s Emergency Care Plan (ECP)

• Never leave a student unattended who is suspected of having hypoglycemia

• Never allow another student to escort a student suspected of having hypoglycemia

• Do not delay treatment, when in doubt always treat for hypoglycemia as symptoms may progress rapidly

Treatment for Mild to Moderate Hypoglycemia: Requires immediate action

• Give the student a quick-acting glucose (sugar) equivalent to 15 gm of carbohydrate:3-4 glucose tabs

4 oz fruit juice

6 oz regular soda (1/2 can)

1 tube glucose gel

• Wait 10-15 minutes and recheck blood glucose (BG)

• Repeat treatment if BG is below target range as indicated on student’s ECP

• Follow with snack of complex carbohydrate and protein if longer than 30 minutes until next meal.

• Treatment should follow guidelines outlined in student’s Emergency Care Plan (ECP)

• Notify school nurse at first sign of hypoglycemia

• Check blood sugar to determine low blood sugar

• Student safety is priority, when in doubt treat for hypoglycemia then continue procedures outlined in student’s ECP

Severe Hypoglycemia: Urgent Response necessary to treat life-threatening symptoms

• Contact school nurse or initiate 911 if nurse if not immediately available

• Position student on side

• School RN to administer Glucagon per HCP orders

• Do not attempt to put anything in student’s mouth

• Notify parent

Symptoms:

• Inability to eat or drink

• Unconsciousness

• Unresponsiveness

• Seizure activity or convulsions

Glucagon

• Glucagon is hormone that raises blood sugar levels and is administered as an injection for the treatment of severe hypoglycemia

• Glucagon can only be administered by the school nurse or qualified Parent Designated Adult (PDA), glucagon cannot be delegated to non-licensed personnel

• Glucagon may cause nausea or vomiting once the student regains consciousness, student should be placed in a side-lying position to prevent choking

•Call 911 when Glucagon is administered •Call 911 immediately if Glucagon is not prescribed or included in student’s ECP or if school nurse is not immediately available

Hyperglycemia

Hyperglycemia means HIGH blood sugar and is defined as a blood sugar greater than 250 mg/dl

• Elevation in blood sugars in children are usually minimally above the target range and are short in duration, whereas older children may experience frequent spikes throughout the day in blood sugars that are high (above 250 mg/dl) and last longer in duration

• Short-term effects of hyperglycemia impact student’s cognition and academic performance

• Long-term effects of hyperglycemia result in serious health complications such as heart disease, kidney failure, stroke, blindness, and amputation

Causes of Hyperglycemia

• Too little insulin or other glucose-lowering medications

• Too little food intake that has not been covered by insulin

• Decreased physical activity • Illness, infection, injury, or severe physical or

emotional stress

The onset of hyperglycemia may occur over several hours or days

Hyperglycemia Symptoms

• Increased thirst and/or dry mouth• Frequent or increased urination• Change in appetite• Nausea• Blurry vision • Fatigue

Treatment for Hyperglycemia

• Contact school nurse at first sign of hyperglycemia

• Check blood glucose levels to determine if blood sugar is above target range

• Encourage student to drink water or non-sugar beverage

• Allow for free and unrestricted access to water and restroom

• Modify physical activity in presence of ketones and according to student’s ECP

• Authorized staff to verify pump is connected and working properly if student wearing insulin pump

• Treatment should follow student’s Emergency Care Plan and may include:

• Insulin administration as prescribed

• Urine ketone testing

• Additional blood sugar monitoring

• Pump troubleshooting

Non-licensed Personnel are limited to tasks delegated by the licensed school nurse in accordance to state nursing laws

Diabetic Ketoacidosis (DKA)

• Diabetic ketoacidosis develops over hours to days and is associated with hyperglycemia, a buildup of ketones (ketosis) in the blood, and dehydration

• Caused by prolonged inefficient delivery of insulin, pump malfunction in delivery of insulin, illness, or prolonged physical or emotional stress

• Signs include severe abdominal pain with vomiting, dry mouth and extreme thirst, fruity breath, heavy breathing and shortness of breath, chest pain, increasing sleepiness or lethargy, and decreased level of consciousness

Contact school nurse or 911 if

nurse is not immediately

available

Insulin

Insulin is classified in four types by how it works:

• Rapid-acting

• Short-acting

• Intermediate-acting

• Long-acting

Insulin has three characteristics

• Onset of effect – the length of time insulin reaches the bloodstream and starts lower blood glucose levels• Peak time of effect – time insulin is at its maximum effect in lower blood glucose levels• Duration of effect - number of hours insulin actively lowers blood glucose levels

Improvements in the types of insulin and delivery systems help keep blood glucose levels within the target range, however, this means more frequent blood glucose monitoring and greater need for student assistance in diabetic management

Insulin Administration

Schedule for blood sugar testing, insulin administration, and level of student independence is detailed in the student’s Individual Health Plan (IHP) according to physician orders. This may include a plan to take insulin to cover meals and/or snacks, the need for additional or corrective dosages of insulin to treat hyperglycemia, and a plan to cover a rise in blood glucose levels

VIDEO LINK: http://www.youtube.com/watch?v=SmSWCGJEUG8&feature=share&list=PL3DE9DDE8EB2A2E56

Insulin Delivery

Three most common ways to administer insulin:

• Insulin syringe – syringe is used to draw up prescribed amount of insulin out of vial

• Insulin pen – pen holds a cartridge of insulin, needle tip is screwed onto tip of pen, desired insulin dosage is dialed up

• Insulin pump – small computerized device which delivers a set amount of insulin 24 hours a day directly into the student’s skin

Insulin-to-carb ratio for meals

• Carbohydrate (carb) counting is the most popular meal planning approach for children and youth - the number of grams of carbohydrate, or choices of carbohydrate, the student eats is calculated (one carb choice equals 15 grams of carbohydrate) • Insulin-to-carb ratio - determines the number of units of insulin needed to cover the number of grams of carbs to be eaten•The blood glucose correction factor (insulin sensitivity factor)—determines the amount of insulin needed to lower blood glucose to target level. This additional insulin may be needed if blood sugar is elevated above target level prior to meal or snack

Example of HCP order

Insulin-to-carb ratio -

1:10

Correction ratio -

1:50

Sensitivity – 50 mg/dl

Target BS -

120 mg/dl

Parent Designated Adult (PDA)

• Written documentation of intent to be a PDA along with ongoing training documentation required to be submitted to district

• Must attend district training for direct care (IHP)

• Additional training requirements if PDA is a school employee

• School nurse is not responsible for the training, supervision, or actions of a PDA

A Parent Designated Adult (PDA) is a volunteer, who may be a school district employee who receives additional training from a healthcare professional or expert in diabetic care selected by the parent and who provides care for the child consistent with the individual health plan.

Personnel Guidelines for Care of Students with Diabetes in School

• Verify number on insulin pen for student independent in management of self-injecting

• Verify number on glucose meter for student independent in the management of his/her self-monitoring

• Ketone urine testing per physician order

• Treatment of mild and moderate hypoglycemia, initiation of 911 for severe hypoglycemia

• Administration of snacks as needed

Delegation of responsibilities to unlicensed staff by the licensed staff R.N. is in accordance with statute, regulation, Nursing Care Quality Assurance Commission guidelines, nurse practice act , and best practice.

All other responsibilities and tasks require nursing judgment and cannot be delegated.

Diabetes affects the entire family

Night VisitsThe minutes tick byI watch the clock, can't sleepIt strikes midnightand into your room I creep.Not for a tuck in or even a drink,but to test your blood sugar while you sleep.Your sweet little face,your "Barrie" held tight,these awful visits in the night.I hate this diabetes it won't go away!Please God let her numbersbe good today.One test down,thousands to go,I need to be strong for herI love her so.Written by Pam Bushway in 2005 for her 6 year-old child

THE LAW AND DIABETES

Diabetes is considered a disability under federal law. Under Section 504 of the Rehabilitation Act of 1973, it is illegal to discriminate against a person with a disability. Children with diabetes must have full access to all activities, services, or benefits provided by public schools. Any school receiving federal funds must accommodate the special healthcare needs of students with disabilities in order to provide them with “free appropriate public education.” These accommodations are developed with parent consent and may be reflected in the student’s Individual Health Plan (IHP)/504 Plan or as part of the student’s individualized education program (IEP) if student qualifies for special education services.

Common accommodations for students with Diabetes

Eligibility and accommodations are determined through district process, either by the Guidance Team or team of members coordinating 504 plans or by coordinated efforts of the school nurse through the Professional Education Group for students qualifying for specialized education. The parent is involved in the team process in developing appropriate accommodations.

• Free access to testing equipment and supplies with ability to test and treat as needed without restriction according to DMMP and IHP

• Free and liberal access to food

• Free and liberal access to water or non-sugar drinks, as well as access to restroom

• Meals must never be withheld for nonpayment of fees or disciplinary action

• Access to fully participate in physical education and team sports in accordance to DMMP and ECP

• Participation in school-sponsored field trips and extracurricular activities without restriction, including supervision by school personnel at outlined in DMMP and IHP

• Extra time to complete tests or work without penalty when related to high or low blood glucose levels

• Extra time to complete missed work without penalty when due to absences related to diabetic care

Washington State Law, SHB 2834, now requires that the necessary order, medications, equipment, and nursing plan must be in place before a student with a life-threatening condition may attend school.

Registrars, Head Secretaries and Office Staff play a key role in identifying students with life-threatening health conditions before they begin their first day of school. Any student indicating a life-threatening health condition on the enrollment health history form must meet with the school nurse to coordinate a treatment plan before the student may attend school.

• Diabetic Medical Management Plan (DMMP) includes the health care provider orders for all aspects of student’s routine and care

• The school nurse uses the DMMP for developing the student’s Individual Health Plan (IHP) which details the specific care for the student as outlined by the physician. In many cases, the IHP and 504 are the same document

• The Emergency Care Plan (ECP) is created by the school nurse from the IHP and describes emergency treatment for the treatment of hypoglycemia and hyperglycemia for the student

School district, school district employee, agent, or parent-designated adult who, acting in good faith and in substantial compliance with the student’s individual health plan and the instructions of the student’s licensed health care professional, provides assistance or services under RCW 28A.210.330 shall not be liable in any criminal action or for civil damages in his or her individual or marital or governmental or corporate or other capacities as a result of the services provided under RCW 28A.210.330 to students with diabetes.

The statue adds the requirement that every student with diabetes has an Individualized

Health Plan

Example of required medical documentation required for school attendance (Seattle Children’s DMMP with HCP orders)

Seattle Children’s DMMP – Parent form

• Information from the DMMP, along with parent and student input is essential for the school nurse in developing student’s IHP and ECP

• Students who fail to provide the required physician orders and emergency medication are subject to exclusion from school (SHB 2834)

IHP in Skyward IHP in Skyward

Emergency Care Plan (ECP)

Useful Tips• Become familiar with students in your building who have life-

threatening conditions – look up their pictures on Skyward

• Never leave a student with diabetes unattended in the health room

• Become familiar with the IHP and ECP of students in your building who have life-threatening health conditions, know where emergency medication is stored according to

• Perform only those duties which you have been delegated

• Consult the school nurse in your building for concerns or questions, contact a district nurse if the nurse assigned to your building is unavailable

Diabetes Q/A

Seizure1. Participants will:

• 1. Identify signs and symptoms of types of seizures.

• 2. Understand how to respond to a student having a seizure and the appropriate emergency procedures.

Always refer to individual student care plan

Seizure Medication

Seizure: Scenario 1

• Called to classroom for a student who appears to be having a grand mal (tonic- clonic) seizure.

• Student does not have a known seizure disorder.

How do you respond?

Seizure: Scenario 1Response:

1. Call 911 - this is a first time seizure for a student without a seizure disorder diagnosis.

2. Ensure student's safety.

3. Protect student's head. Assist student to side lying position.

4. Time the seizure.

Questions?

Seizure: Scenario 2

• Called to a classroom for student with a known seizure disorder who is having grand mal (tonic- clonic) seizure.

How do you respond?

Seizure: Scenario 2Response:1. Ensure student's safety.

2. Protect student's head. Assist student to side lying position.

3. Time the seizure. If the seizure lasts longer then 5 minutes call 911.

4. Stay with the student until they regain consciousness. Provide emotional support.

5. Allow student to rest. Notify parents.

6. Document seizure.

Questions?

CardiacParticipants will understand that:1. 1. Cardiac arrest can happen to anyone (e.g., student,

parent, co-worker, visitor, etc.). 2. 2. Cardiac arrest is not always associated with sports.

3. Sometimes the person doesn't know they have symptoms or won’t admit them if they do.4. Cardiac arrest can happen at anytime without warning.

Always refer to individual student care plan

Project ADAM... The mission of Project ADAM is to serve children and adolescents through education and deployment of life-

saving programs that help prevent sudden cardiac arrest. Project ADAM helps schools across the nation

implement public access defibrillation programs through support and education.

Understanding Sudden Cardiac

Arrest

Project ADAM... Understanding

Sudden Cardiac Arrest

CPR/AED1. Participants will:2. 1. Recognize the symptoms of cardiac arrest.3. 2. Know how to check the person’s airway, breathing, and

circulation.3. Know when to start CPR and call 911.

CPR/AED• It is your responsibility to keep your

CPR/AED & First Aid certification up to date - renew every 2 years.

• Know where your AEDs are in your building.

WHEN IN DOUBT CALL 911

Asthma1. Participants will:

• 1. Identify signs and symptoms of asthma.

• 2. Understand how to administer inhaler and/or with spacer. 3. Identify an asthma emergency and how to respond.

Always refer to individual student care plan

Source: National Asthma Education and Prevention Program (NAEPP)

Source: National Asthma Education and Prevention Program (NAEPP)

Source: National Asthma Education and Prevention Program (NAEPP)

Source: National Asthma Education and Prevention Program (NAEPP)

Source: National Asthma Education and Prevention Program (NAEPP)

Source: National Asthma Education and Prevention Program (NAEPP)

Source: National Asthma Education and Prevention Program (NAEPP)

Source: National Asthma Education and Prevention Program (NAEPP)

Source: National Asthma Education and Prevention Program (NAEPP)

Source: National Asthma Education and Prevention Program (NAEPP)

Source: National Asthma Education and Prevention Program (NAEPP)

Source: National Asthma Education and Prevention Program (NAEPP)

Source: National Asthma Education and Prevention Program (NAEPP)

Source: National Asthma Education and Prevention Program (NAEPP)

Source: National Asthma Education and Prevention Program (NAEPP)

Source: National Asthma Education and Prevention Program (NAEPP)

Source: National Asthma Education and Prevention Program (NAEPP)

Source: National Asthma Education and Prevention Program (NAEPP)

Asthma Emergency Plan

Call 911 if you see ANY ONE of the following

emergency signs:

*Trouble walking or talking without stopping to breathe

* Child is hunched over

*Child is struggling to breathe

*Lips or fingernails are gray or blue

*Cough

Asthma Emergency Plan continued

*Tightness in chest, or tickle in throat

* Shortness of breath

* Wheeze

*Unable to catch their breath-Gasping,

*Rapid breaths

*Nostrils flaring

*Feelings of fear or confusion

After calling 911, call the office and tell them to contact a parent or guardian.*

Source: National Asthma Education and Prevention Program (NAEPP)

Asthma: Scenario 1

• Student walks into Health Room. Student says they feel "tight" and would like to use their inhaler.

• They do not appear to be in distress and are able to speak to you.

• Student says they last used their inhaler before school. It is now 1pm.

How do you respond?

Asthma: Scenario 1Response:1. Student has a medication order and an inhaler in the

Health Room. Verify time of last inhaler administration - Call parents if needed.

2. Following appropriate medication administration protocol - administer inhaler.

3. Document medication administration and health office visit.

4. If you did not need to call parents to verify when inhaler was last used - notify parents of inhaler use, as appropriate.

Questions?

Asthma: Scenario 2

• Called to cafeteria for a student who is having an asthma attack, they are unable to walk to the Health Office.

• Student unable to talk/ speak because of poor air movement.

• Lips blue.

How do you respond?

Asthma: Scenario 2Response:1. Call 911 - It is better to have too much help then not enough.

2. Student has an inhaler in the Health Room.

3. Stay with the student. Have another staff member obtain the inhaler.

4. Administer the inhaler, using appropriate medication administration protocol.

5. If the student improves - GREAT! Call parents. Medics will evaluate the student on their arrival and make appropriate determination.

6. If student does not improve - Medics will assume responsibility for student's care.

Questions?

Anaphylaxis & Life Threatening

Food Allergies1. Participants will:

• 1. Identify signs and symptoms of an allergic reaction and anaphylaxis

• 2. Be able to initiate treatment for an allergic reaction Always refer to individual student care plan

AnaphylaxisPrevent a Severe Food Allergy

Reaction:Follow the FAST FormulaFACTS about Food Allergies

*Food allergy reactions can be triggered by a tiny trace of allergen

*A food allergy reaction can cause death within minutes

*Children with asthma are at the highest risk of dying

*know every child's emergency treatment plan

AVOID the Allergen

*Read food ingredient labels

*Clean tables, desks and other surfaces

*Wash hands often

*check ingredients of art supplies and personal care products

AnaphylaxisSIGNS and Symptoms

*Itching of the mouth, swelling of lips and/or tongue

*Tightness of the throat and hoarseness

*Shortness of breath, coughing, wheezing

*Vomiting, diarrhea, cramps

*Weak pulse, dizziness, fainting

*Symptoms vary and can change quickly

TREAT immediately

* Give epinephrine-do not delay!

*Call 9 1 1 and request that a paramedic respond

*Call emergency contacts

Anaphylaxis

Anaphylaxis

Anaphylaxis

Anaphylaxis

Anaphylaxis

Anaphylaxis

Anaphylaxis

Anaphylaxis

Anaphylaxis

Anaphylaxis

Anaphylaxis

Anaphylaxis

Anaphylaxis

Anaphylaxis

Anaphylaxis

Anaphylaxis

Anaphylaxis

Anaphylaxis

Anaphylaxis

Anaphylaxis

Anaphylaxis

Anaphylaxis

Anaphylaxis: Administering Epi-Pen

Epi-Pen

Anaphylaxis: Administering Epi-Pen

Auvi-Q

Anaphylaxis: Scenario

• Student comes to Health Room complaining of tingling, scratchy throat, hacking cough, upset stomach/ nausea, saying they don't feel right after eating lunch at school. They say they traded their chips for their friend's cookies

How do you respond?

Anaphylaxis: ScenarioResponse:1. Student has a known allergy to peanuts. They have an

epi-pen at school and school care plan on file.

2. Administer epi-pen per medication administration policy.

3. Call 911. Call parents.

4. Remain with student until medics arrive. When medics arrive they will assume care for the student.

Questions?

911 Emergency Procedures

1. Participants will:

• 1. Understand procedures and roles when calling 911.

Calling 911 / Procedures

• When to call?

• Who calls?

• Who is immediately notified?

• Who else in the district is called?

• What paperwork to fill out?

When to call 911Call 911 for medical emergencies:

• Severe allergic reaction (anaphylaxis)

• Choking or severe difficulty breathing

• Shock

• Deep wound or part of the body that was crushed

• Bleeding that is difficult to control

• Back and neck injuries or broken bones

• Severe head injury

• Unconsciousness

• Seizure - if longer than three to five minutes, if there is a second seizure, or if

the student has never had a seizure before

• Serious burns

• Spill or release of hazardous chemicals

• Several students injured or ill at the same time

Calling 911 / ProceduresCALL AID CAR WHEN:

1. A student’s health could be compromised. When in doubt, call anyway. It is better to have too much help than not enough.

2. A student is experiencing breathing difficulties, severe bleeding, seizures, severe bee sting reactions, possible broken bones, and/or is unconscious.

PROCEDURE WHEN CALLING AN AID CAR:

3. Someone should stay with student at all times while at school.4. Do not move student. Provide safe environment. Cover with blanket if needed.5. Clear area of all other students.6. A designated person in office calls:

a. 911b. School RN (if not in building)c. Parentsd. Teachere. Principal

7. Information needed for 911 team:a. Copy of locator card.b. Check Health Concerns list for additional health problems that the student may have.

8. Once the AID care arrives, the 911 team is responsible for the student. DO NOT sign any forms or waivers provided by the 911 team.

Calling 911 / ProceduresIMPORTANT REMINDERS:

• DO NOT accompany student in AID car. Do not make any treatment decisions at the hospital or doctor’s office.

• DOCUMENT: o Fill out the Incident Report

Formo Fill out 911 Emergency

Medical Notification Checklist

• FOLLOW UPa. Call ESC switchboard 425-335-

1500 to report 911 call

b. Complete accident report and send original to Teresa Main at ESC

c. Keep copy at building

Incident & EmergencyProcedures

1. Participants will:

• 1. Become familiar with district procedures and forms.

How to Respond

Know where this

resource is in

your health room.

Source: WA DOH

Head BumpsEVERY head bump....

1. Needs a head bump

form filled out,

no matter how minor

it seems.

2. Call Parent/Guardian

ConcussionL

Concussion

Incident: Student/ Non-Employee Injury

Revised7/2013

In google drive for all LSSD Staff

Skyward &Confidentiality1. Participants will:

• 1. Will understand their role using the health module in

• Skyward. 2. Will understand the obligation to maintain student health information confidential.

Skyward: Health Room/Documentation• Multiple windows - have one for health and one for office

work.

• Automatically dates, times and signs who entered what information. You are responsible for what you write - so don't let others write under your log in.

• Write enough so that you know what happened.

• TOAD - what they told you, what you saw (observed), what action you took, disposition (where'd they go)

• Reminder for communication best practice:

- RN needs to know about incident reports, head bumps

and any critical student/staff concerns.

- Call parent/guardian with important information about

their student

Confidentiality• All unlicensed health care providers, such as health room aides or

pupil transportation staff who assist the health care provider in the delivery of health care to students, must be informed of the confidentiality requirements of the Federal Family Education Rights and Privacy Act (FERPA) and state requirements under chapter 70.02 RCW, Medical Records - Health Care Information Access and Disclosure.

• Health care information about a student cannot be disclosed without signed consent of parent, guardian, or student except in selected situations identified by the licensed health care provider (such as the nurse).

• Everything that happens in the health room, stays in the health room!!!!

Lice1. Participants will:

• 1. Recognize head lice.

• 2. Understand head lice district procedures.

• 3. Identify information available to assist parents with treatment.

Head Lice Procedures

• Each fall, there will be an elementary school-wide lice screening by designated employees.

• New students will be screened prior to starting school.

• Students are screened throughout the year on teacher/parent referrals.

Head Lice Procedures

• Students with nits/head lice are sent home for treatment.

• Students are checked by school personnel prior to readmission to school.

• Students are only readmitted to school if free of live lice.

Head Lice Procedures

• Students are re-examined one week after re-admission.

• At the school nurse’s discretion, classrooms will be re-screened by designated personnel as needed throughout the school year.

• Classrooms will receive a general letter regarding head lice as deemed necessary by the school nurse.

Head Lice Recognition

Thank you for joining us today

and your commitment to keep kids safe.