ACADEMIC STANDARDS Council Rock

Health Services Department December 5, 2013

Definition of School Nursing “School nursing is a specialized practice of professional

nursing that advances the well-being, academic success and life-long achievement and health of students. To that end, school nurses facilitate positive student responses to normal development; promote health and safety including a healthy environment; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self-management, self advocacy, and learning .”(NASN, 2010)

School Nursing

Academic Requirements for School Nurse Certification

Pennsylvania: School nurses must obtain registered Nurse licensing to practice as a registered nurse. School Nurse Certification requirements are: Bachelor Of Science degree in Nursing Completion of a PDE approved school nurse certification program. Level I certificate issuedLevel I Pennsylvania Instructional and Educational Specialist certifications are valid for six (6) years of service, not calendar years.  If you have been employed as a certified school nurse in Pennsylvania on a Level l certificate for 3-6 years of satisfactory service and have earned 24 post-baccalaureate credits, you can apply for a Level ll certificate.

Mandated School Health ProgramThe School Health Program facilitates the healthy growth and development of children of school age in Pennsylvania. The School Health Program serves all children of school age attending public, private and non-public schools in Pennsylvania. This program prevents and detects health problems, and maintains and improves the health status of students.  Council Rock School Nurses service 20 school public, private and alternative school settings in the district

3 High Schools: CR North, CR South and Villa Joseph Marie3 Middle Schools: Holland Middle, Newtown Middle, Richboro

Middle St. Andrew’s (STA) and St. Katherine Drexel (SKD)10 Elementary Schools, CES, GES, HCE, HES, MMW, NES, RES,

RHE, SFE, WED. 2 Private Kindergartens: Ohev Shalom and Shir Ami2 Alternative school Settings: Theodore A. Sloan/ Achieve and

Sail House

Certified School Nurses and Non-Certified Staff Nurses 14 Certified Nurses

# of Students Assigned Nurses Name School Assignment(404 + 731) Sarah Barfoot RHE + STA * Access (774/50 SPED ) Carol Baron GES + Sail House(1054/17 SPED) Carrie Blumenthal CRHS-South +MDS+ Sloan/Achieve(663/4 SPED) Nancy Cook- NES + MDS Class (999) Dana Daniels SFE + WES(864/25 SPED) Jeanene Hecht NMS(960/17 SPED) Sheri Jokic RMS + RES(959/15 SPED) Judy Kaufmann MMW + HES(917/23 SPED) Teri Lavin CRHS North + Sloan/Achieve(1053/18 SPED) Tina Latham CRHS South + MDS+ Sloan/Achieve(916/24 SPED) Julie Moore CRHS North + Sloan/Achieve(637+ 380) Janet Ostoyich CES + VJM(521 + 392-32-18) Julie Roccograndi HCE + SKD + Shir Ami+OHEV(516) 25 SPED Lynn Smith HMS + Coordinator

SPED) 11 Staff Nurses- Michele Adames, Suzanne Alden, Debbie Cattolico, Nancy Crivaro, Dianne Ernest, Mary Jordan, Dianne Mullin, Helen Rodriquez, Suzanne Tentilucci, Janine White, Pam Wolfe.

PUBLIC ENROLLMENT Elementary- 5,407 Middle- 1,890 High School 3,340 TOTAL 11,278

PRIVATE ENROLLMENT STA 731, SKD 392, SHIR AMI 32 , OHEV18, Total 1,173

GRAND TOTAL 12,451

Mandated School Health ProgramSegment 1 -   Introduction Segment 2 -   Nurse Practice Act and Regulations  Segment 3 -   School Health Law and Regulations Segment 4-   Department of Education (This link is currently nonfunctional)Segment 5 -   Documentation Segment 6 -   Medication Administration Segment 7 -   Immunization Requirements Segment 8 -   Child Protection LawSegment 9 -   Special Education/Special Health Care Issues                   (Information on Specific Chronic Diseases are now located here.)Segment 10 - School Health Program – Screens/Physical Examinations/TB TestingSegment 11 - Dental Health ProgramSegment 12 - Annual Request for Reimbursement and Report of School Health ServicesSegment 13 - Communicable Diseases/Bloodborne Pathogens Segment 14 - All-Hazard Planning Segment 15 - Environmental Segment 16 - Resources (This link is currently nonfunctional).

Council Rock Health Services Web Site Welcome to Council Rock Health Services

  

 

State Mandated ProgramIMMUNIZATIONS

Council Rock School Board Policy 201 Communicable Diseases and Immunizations

Pennsylvania State Law and RegulationsPennsylvania Code Subchapter C. IMMUNIZATION

23.83. Immunization requirements. (a)  Duties of a school director, superintendent, principal or other person in charge of a public, private, parochial or nonpublic school. Each school director, superintendent, principal, or other person in charge of a public, private, parochial or nonpublic school in this Commonwealth, including vocational schools, intermediate units, and special education and home education programs, cyber and charter schools, shall ascertain that a child has been immunized in accordance with the requirements in subsections

(b), (c) and (e) prior to admission to school for the first time, under section 1303 of the Public School Code of 1949 (24 P. S. §  13-1303a) regarding immunization required; penalty.  (b)  Required for attendance. The following immunizations are required as a condition of attendance at school in this Commonwealth:

State Mandated Program Continued

School Immunization Requirements For ALL Students

Children in ALL grades (K-12) need the following vaccines:4 doses of tetanus*(1 dose on or after 4th birthday)4 doses of diphtheria* (1 dose on or after 4th birthday)3 doses of polio2 doses of measles**2 doses of mumps**1 dose of rubella (German measles) **3 doses of hepatitis B2 doses of varicella (chickenpox) or evidence of immunity

*Usually given as DTP or DT or Td**Usually given as MMR

 

State Immunization Requirements – PA. CODE Subchapter C-Immunization

State Mandated Program Continued

State Immunization Requirements – PA. CODE Subchapter C-Immunization

7th Grade ADDITIONAL immunization requirements for entry:

1 dose meningococcal conjugate vaccine (MCV)

1 dose of tetanus, diphtheria, acellular pertussis(Tdap) [if five years have elapsed since last tetanus immunization]

State Mandated Program Continued

The only exemptions to the school laws for immunizations are:

medical reasons;religious beliefs;

orNEW: philosophical/strong moral or ethical conviction. 

If your child is exempt from immunizations, he or she may be

removed from school during an outbreak.

State Mandated Program ContinuedREGISTRATION

CRSD Health Forms Required for ALL Registrations

At the time of registration, you must submit written proof of your child's immunizations signed by a physician.PA law requires that proof of immunization must be provided before a child can be admitted to any public, private or parochial school. Please read the Health Letter to ParentsGrades K-1 / (Grades 2-12). The following forms can be downloaded from the website, obtained from Central Registration or the school:

Physician Immunization Form (#37)-

Private Physician Form (#511)-

Private Dental Exam (Grades K-8)

Health History (Grades K-6)

Health History (Grades 7-12)

State Mandated Program Continued

Registration process Immunization review and Family Health History Review

New registrations for 2013 - 593

Physical Exams(Grades k-11): private(PP) and school (SP) PP 2012-2013 3,753 SP- 2012-2013 -8 Referred 2012-

2013 6Dental Exams (Grades K-8) private(PD) and school (SD)

PD 2012-2013- 2,628 SD 2012-2013- 89 Referred 32Scoliosis screening (Grades 6-7)

2012-2013-1,969 Referred-35

State Mandated Program ContinuedCommunicable Diseases Requiring Exclusion

28 PA Code, Chapter 27 Communicable and Non-communicable Disease

"Disease Prevention and Control Law of 1955". Council Rock School Board Policy 203

It is important that the health office be notified if your child contracts a communicable disease. If a communicable disease is suspected in school, the parent will be notified and the child will be excluded from school. The student will not be readmitted before the minimum number of days designated by the State and Local Departments of Health which are: Diphtheria – 2 weeks from the onset or until appropriate negative culture tests. Chicken Pox** – 5 days from onset of the last crop of vesicles (blisters). All vesicles must be dried and crusted before returning to school. Rubella (German Measles) – 4 days from onset of rash. Rubeola (Regular Measles) – 4 days from onset of rash. Mumps – 9 days from onset or until subsidence of swelling. Pertussis (whopping cough) – 3 weeks from the onset or five days from institution of appropriate therapy. Respiratory streptococcal infections (including Scarlet Fever) – Not less than 10 days from the onset if no medication is prescribed or 24 hours from the institution of appropriate therapy.

State Mandated Program ContinuedCommunicable Diseases Requiring Exclusion

Acute Contagious Conjunctivitis (Pink Eye) – Until judges non-infective; that is, without a discharge (usually after 24 hours after institution of appropriate therapy). Ringworm – Immediately after therapy is instituted, if body lesions are covered. Neither scalp nor body lesions that are dried need to be covered. Impetigo Contagiosa – 24 hours from institution of appropriate therapy. Pediculosis Capitis (Head Lice) – After the first treatment and until judged non-infective by the school nurse or child’s physician. Council Rock has a no-nit policy – therefore all nits must be removed from a student’s hair before returning to school after treatment for pediculosis. Pediculosis Corpora (Body Lice) – After completion of appropriate treatment and judged non-infective by the school nurse or child’s physician. Scabies – After completion of appropriate therapy and until judged non-infective by the school nurse or child’s physician. Trachoma – 24 hours from institution of appropriate therapy. Tuberculosis– Following a minimum of 2 weeks of adequate chemotherapy and 3 consecutive sputum smears. In addition, a note from the physician that the child is non-communicable shall be submitted prior to readmission. Neisseria menigitidis – Until judged non-infective after a course of rifampin or other drug which is effective against this disease, or otherwise shown to non-infective.

State Mandated Program ContinuedMandated Screenings

Students in the District are scheduled to receive mandated screening examinations in accordance with the following schedule:

Vision, growth and development Annually……… Kindergarten through 12th grade Hearing Annually…………………………….. Kindergarten through 3rd grade, 7th grade and 11th grade. Annually for all special education student’s with hearing concerns Medical examination…………………….. Kindergarten or First, 6th and 10th grade Dental examination………………………..Kindergarten or First, 3rd and 7th grade Scoliosis screening……………………….. 6th and 7th grades

The District recommends that all medical and dental examinations be administered by the family physician and dentist since they can best evaluate the child’s health and assist in obtaining necessary treatment and corrections. In the case of financial need, any child not seen by a private physician or dentist for the mandated medical and dental examinations will be scheduled to be seen by the school physician and dentist. All students who are entering Council Rock School District as transfers from other school districts are required to have current medical and dental examinations.

State Mandated Program Continued

Total screenings completed 2012-2013

VISION: 12,884 961 referrals

HEARING: 6,293 175 referrals

HEIGHT & WEIGHT: K-6 6,304 7-12 7,424

BLOOD PRESSURE: 5,890

SCOLIOSIS: 1,969 35Referrals

State Mandated Program ContinuedHealth Office Visits

All student and staff health office visits are entered into the daily log. For all serious injuries a CRSD accident report is completed as well.

Injury/First Aid: 54,170

Illness: 117,429

Students sent home with health reasons: 8499

Students requiring skilled nursing care: 904

Students with a IHP/504/IEP with medical: 941

Students emergency requiring 911: 17

Health Services for staff and other adults Illness- 2,022 Injury 648 EMS 8

State Mandated Program ContinuedAbsentee Tracking

Council Rock School Board Policy # 204

Pennsylvania Truancy Elimination Plan

In accordance with school Board policy and Pennsylvania Compulsory Attendance and Truancy Elimination Plan (24 P.S. 13-1327), School Nurses assist tracking student absence by contacting parents/guardians on the third day of absence to inquire about the health of the student.

School Nurses receive medically excused absence notes and collaborate with the attendance office and the educational staff if accommodations are needed when a student returns to school after an injury or extended illness.

School Nurses in middle school and high school are also part of the attendance team and meet on a regular basis to support students, families and encourage regular attendance.

Medication AdministrationNumber of Doses Administered

BY Individual MD Order By Standing OrderAnalgesic 368 14,179Antibiotic 301 7,045Anticonvulsant 1,098Antihistamine/Decongestant 185 5Anti-inflamatory 607 532Asthmatic 3,670Diabetic 9,080Gastrointestinal 868 9,507Psychotropic ADD/ADHD 4,994

all other 1,437Other 1,235 4,806TOTAL 23,843 36,074

Medication Management in Diabetes Insulin Syringe

Medication Management in DiabetesInsulin Pen

Medication Management in Diabetes Administering Insulin via an Insulin Pump

Medical Emergency in Diabetes Glucagon

AUVI-Q

State Mandated Program: Medication Administration

Auvi-Q -epinephrine auto‑injector that is easy to use. I talk you through the injection process step by step. Watch and see how easy I am to use.

Auvi-Q demo

Seek immediate medical treatment after use. Each Auvi-Q contains a single dose of epinephrine. Auvi‑Q should only be injected into your outer thigh.

Anaphylactic Reaction- Anaphylaxis is a life-threatening allergic reaction that can occur quickly (as fast as within a couple of minutes). Symptoms of anaphylaxis vary, but can include hives, itching, flushing, and swelling of the lips, tongue, and roof of the mouth. The airway is often affected, resulting in tightness of the throat, chest tightness and difficulty breathing.

Students with severe allergies may experience an anaphylactic reaction and need an epinephrine injection quickly. These students may have a emergency action plan.

EpiPen

State Mandated Program Medication Administration Continued

How to Use EpiPen Auto-Injector Step-by-Step instructionsPrepare the EpiPen or EpiPen Jr Auto-Injector for Injection

Remove the auto-injector from the clear carrier tube. Flip open the yellow cap of your EpiPen or the green cap of your EpiPen Jr Auto-Injector carrier

tube. Tip and slide the auto-injector out of the carrier tube.

Grasp the auto-injector in your fist with the orange tip pointing downward. With your other hand, remove the blue safety release by pulling straight up without bending or

twisting it.Note: The needle comes out of the orange tip. Never put your thumb, fingers or hand over the orange tip.

Administer the EpiPen or EpiPen Jr Auto-InjectorHold the auto-injector with orange tip near the outer thigh.Swing and firmly push the orange tip against the outer thigh until it “clicks”.Keep the auto-injector firmly pushed against the thigh at a 90° angle (perpendicular) to the thigh.Hold firmly against the thigh for approximately 10 seconds to deliver the drug. The injection is now complete.

Finalize the Injection Process Remove the auto-injector from the thigh. The orange tip will extend to cover the needle. Massage the injection area for 10 seconds. Get emergency medical help right away.You may need further medical attention.You may need a second EpiPen or EpiPen Jr Auto-Injector should symptoms persist or recur.Note: Take your used auto-injector with you when you go to see the health care provider.

Video: http://www.epipen.com/How-to-Use-EpiPen

Individualized Health Care Plan/Section 504 planIndividual Health Care Plan

Emergency Action Plan

These plans are most frequently written for : • Asthma leukemia• Bee Sting allergy leukemia remission

• Concussion lymphoma

• Crohns/IBS peanut allergy• temporary use of crutches/wheelchair latex allergy• Diabetes seizures• food allergy sickel cell anemia• fracture other health concern• ImmunosuppressionNumber of students with Chronic conditions 2012-2013 are:Arthritis/Rhumatic Disease 32 Diabetes Type 1 38Asthma 1,530 Diabetes Type II 1Attention Deficit Disorder 598 Epilepsy & other seizure disorders 104Cardiovascular conditions 325 Sickle Cell Disease 1Cerebral Palsy 23 Spina Bifida 1Cystic Fibrosis 2 Tourette’s Syndrome 38

Sample Individualized Health Care Plan/Section 504 plan

Sample Individual Health Care Plan

Sample Emergency Action Plan

Serious InjuriesNature of Injury ;Burns 3Concussion 98Contusions 32Cut/Lacerations 53Dental injuries 22Dislocations (possible) 6 Eye Injuries 20Fracture (possible) 84 Sprain/Strain/Tear 63Other 19

Total Serious Injuries for 2012-2013 400

CRSD Accident Report

Council Rock School District Sudden Cardiac Arrest Awareness

CPR/AED TrainingCRSD School Board Policy 822

CRSD School Board Policy 123.2

Council Rock has two school board policies that support the placement of AED’s in our schools and supporting continuous CPR/AED training.CRSD School Board Policy # 822

“AUTOMATED EXTERNAL DEFIBRILLATOR (AED) CARDIOPULMONARY RESUSITATION (CPR) “ to maintain AED units and staff trained in CPR/AED resuscitationCRSD School Board Policy # 123.2 “Sudden Cardiac Arrest” to provide guidance for prevention and recognition of sudden cardiac arrest in student athletics.

CPR/AED Staff Training Program

AED’s are placed in all CRSD Public schools.

Staff training workshops for Emergency CPR/AED use is ongoing.

Maintenance of the AED’s in our schools is overseen by school nurses.

CPR/AED Staff Training Program

American Heart Association Cardiac Chain of Survival

Early Recognition-to prevent cardiac arrestEarly CPR-to buy timeEarly Defibrillation-to restart the heartPost Resuscitation Care to restore quality of life.

The Council Rock School District encourage teachers and staff to become trained in Cardiopulmonary Resuscitation (CPR) and the use of an automated external defibrillators (AED’s). Each month in district training workshops are offered by CRSD CPR/AED instructors in a different location throughout the district. To date over 1,000 teachers and staff have bee trained.

First Aid for Choking

First Aid for Choking

Health Services Medical Management of ConcussionsWhat should I know about Concussions?Know The Facts and Know the Symptoms

CRSD School Board Policy 123.1

Medical Access ProgramCouncil Rock School Nurses provide staff training for First aid / Heart saver/ CPR/AED for support staff as required by Access For students receiving access CRSD Nurses complete a nursing log each month

Thank you for the privilege of presenting the Academic Standards for Health Services

Every Child Deserves a School Nurse!

Thank You