HEALTH SERVICES UPDATE 20072008

1
HEALTH SERVICES UPDATE2007/2008

• Presented by
• Escambia County Health Department
• School District of Escambia County

2
Introduction

• This module is designed for staff who have
  previously completed the Initial Health Services
  Workshop
• This module fulfills the annual update
  requirement for staff administering medications

3
Steps

• Complete module
• Click link to online test
• Print completed test
• Submit completed test online
• Contact school nurse to verify skills and review
  test results
• Store documentation in Medication Administration
  notebook

4
OBJECTIVES of MODULE

• Identify health services reporting forms
• Discuss changes in medication policy, procedures
  and health guidelines
• Review established procedures for medication
  administration and documentation
• Report medication review and quality improvement
  findings

5
Health Services Forms

• v Verify Emergency Info Registration Card
• (9400-HES-003) is April 11, 2007 Revision
• Health Services Report (Due 12/15/07)
• Purpose document safety standards and health
  requirements required by law
• Submit to Karen Thoennes, Health Services
  Coordinator, Hall Center, Fax [phone]
• March FTE Week (March 4-8) Report due 03/11/08
• Purpose document number of health problems,
  medications administered, clinic visits
• Submit to School Health Office, Fax [phone]

6
Authorization for Peak Flow Monitoring

• Reminder

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Yellow Zone

• CAUTION

Yellow Zone
Less than
1. Document reading on Student Medication Record
2. Administer 1 dose of authorized
medication
3. Repeat peak flow reading in 20 mins.
-- If Green Zone Return to Class.
No exercise today.
-- If Yellow Zone Call parent to take student
home.
-- If Red Zone Call 911 Contact parent and
notify physician immediately.
8
Red Zone

• EMERGENCY

Red Zone
Less than
1. Document reading on Student Medication
Record.
2. Administer 1 dose of authorized
medication
3. Call 911 Contact parent and notify
physician immediately.
4. Continue to monitor peak flow readings every
5 minutes.
9
Authorization for Administration of Prescription
Medication

• Reminder

FOR INHALANT PRESCRIPTION OR EPINEPHRINE
AUTO-INJECTOR PRESCRIPTION ONLY (Circle One)
2006 Added to Part III. Parental Permission I
assume all risk and liability with respect to my
child's use of epinephrine, including any related
injection device.
10
Online Forms

• http//ese.escambia.k12.fl.us/eval/health/health.h
  tm
• OR v
• http//escambia.k12.fl.us/departments.htm
• Secure Health Forms
• (requires username password for health care
  providers)
• Clinic Forms(requires username password for
  clinic staff)

11
Medication Policy 6Gx17-3.07 (16)

• Revised School Board policy for administering
  medications is on Board agenda for approval
  August 21, 2007.
• Pending Proposed changes
• 1. OTC stock medication (acetaminophen
  ibuprofen calcium carbonate diphenhydramine
  (Benadryl) Sting Relief Pad.
• NOTE Pregnant or breastfeeding students will
  require an Authorization for Administration of
  Prescription Medication form for both OTC and
  prescription medications.
• 2. An Authorization for the Administration
  of Prescription Medication is required for EACH
  prescribed medication EXCEPT Diabetes Management
  and possibly OTC stock meds, if Board approves.

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Authorization for Diabetes Mgmt.2007-08 (Pilot
for Escambia)

• Part I Students Self-Care Assessment
• Part II Physicians Diagnosis Orders for
• Blood Glucose Monitoring
• Action Plan for Glucose Levels
• Part III Auth for Administration of
• 1. Insulin Adjustments
• 2. Short Acting Insulin
• 3. Glucagon

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So, what do I do NOW?

• Continue 2006-07 OTC policy pending School
  Board approval.
• 1. School Nurse will receive new protocol
  and forms before implementation
• Accept revised Diabetes Mgmt. Authorization forms
  for Pilot implementation/ Escambia County
  only.must have child specific training!

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CURRENTSCHOOL BOARD POLICY 6GX17-3.07(16)

• Administration of medication is the
  responsibility of the parent/guardian unless it
  is absolutely essential to the well being of the
  student to receive medication during the school
  day. The following regulations must be observed
  when medication (prescription/ non-prescription)
  is to be administered in the school, including
  any occasion when the student is away from school
  property on official school business, i.e.,
  extracurricular activities, field trips, band,
  and sports activities.

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• 2. An Authorization for Non-Prescription
  Medication Administration Form must be on file
  for each FDA approved non-prescription
  (over-the-counter) medication to be administered
  at school. Over-the-counter medications are
  limited to acetaminophen, calcium carbonate, and
  ibuprofen. For the purposes of this policy, cough
  drops are not considered a medication. The form
  must be completed and signed by the
  parent/guardian. This form is valid for one
  school year, or earlier stop date. All other
  over-the-counter medications require an
  Authorization for the Administration of
  Prescription Medication.

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• 3. Medications which may be administered by
  medical or trained non-medical school personnel
  include the following oral and topical
  medications, eye, ear, and nose drops, and
  inhalers. Administration of other types of
  prescribed medications are evaluated on an
  individual basis, require child specific
  training, and appropriate delegation as
  determined by the professional school nurse. All
  delegation must be in accordance with Florida
  Nurse Practice Act, Chapter 464.

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OTC Medications

• OTC medications administered in schools or at
  school functions are limited to
• Acetaminophen
• Calcium Carbonate
• Ibuprofen
• These 3 medications require a completed
  Authorization for Administration of
  Non-Prescription Medication form signed by the
  parent
• Any other OTC medications require a physician
  order on the Authorization for the Administration
  of Prescription Medication form

18

• The following slides contain information about
  the three approved OTC drugs
• It is important to know this information before
  administering these drugs to a student
• If you have questions, consult with your school
  nurse

19
Acetaminophen

• Common Names Tylenol, Tempra, Panadol,
  Feverall, Liquiprin, APAP
• Dose Age appropriate dose and time schedule per
  manufacturers label instructions
• Do not administer Regular Strength Tylenol to
  children under 6 y/o (use Childrens Strength)
• Do not exceed 325mg every 4-6 hrs for children
  6-11 y/o (1 tablet Regular Strength)
• Children 12 and older may take 650 mg every 4-6
  hours (2 tablets Regular Strength)

20
Acetaminophen

• Uses
• Headache
• Muscular aches
• Backache
• Common cold
• Toothache
• Premenstrual and menstrual cramps
• DO NOT TREAT FEVER defined as 100.5. Send student
  home if temperature is 100.5 or above.

21
Acetaminophen

• Caution
• Acetaminophen may cause liver damage
• Notify school nurse if student requests
  medication 3 days in a row or more than 5
  isolated times

22
Calcium Carbonate

• Brand Name Tums
• Dose Follow label dosing recommendations Do
  not administer to children under 6 years of age

23
Calcium Carbonate

• Uses heartburn, sour/upset stomach, acid
  indigestion
• Cautions
• May cause constipation
• Notify school nurse if student requests
  medication 3 days in a row or more than 5
  isolated times

24
Ibuprofen

• Brand Names Advil, Motrin, Nuprin, Pamprin-IB,
  Midol IB, Excedrin IB
• Dose
• 200-400 mg (1-2 tablets) every 4-6 hours for
  students 12 years or older Do not exceed 1200 mg
  (6 tablets) in 24 hours
• Review following slide for students less than 12
  years of age

25
(No Transcript)
26
Ibuprofen

• Uses temporary relief of pain
• Headache
• Toothache
• Muscular aches backache
• Menstrual cramps
• DO NOT TREAT FEVER (100.5) send student home if
  temperature is 100.5 or above.

27
Ibuprofen

• Caution
• Do not administer to aspirin sensitive patients
• May cause stomach pain, heartburn, constipation,
  or dizziness
• Do not administer to pregnant students
• Notify school nurse if student requests
  medication 3 days in a row or more than 5
  isolated times

28
Receipt of Medication

• Medications must be delivered to the school by
  parent or responsible adult
• All medications must be counted with witness and
  documented upon receipt or return to parent
• Verify expiration date
• Flag new authorizations for school nurse to review

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Steps For Administering Medications

• Wash hands
• Identify student
• Verify students name with authorization and
  medication label
• Confirm Right student, Right medicine, Right
  dose, Right time, Right route
• Administer medication and recheck the 5 rights
• Document on SMR

30
Record Keeping Reporting

• Each school is required to maintain a medication
  book
• Tick Sheet
• Alpha Index
• Authorization facing SMR
• Medication Training Checklist
• School Medical Emergency Information Form
• Copies of CPR/First Aid provider cards
• Medication Destruction Worksheet

31
Student Medication Record (SMR)

• A SMR must be initiated for each student
  authorization form received
• Archive completed/outdated SMR in students Cum
  Health Record
• To transfer student within the district, send SMR
  and Authorization form in Cum Health Record to
  receiving school
• 07/08 SMR is available online
• http//ese.escambia.k12.fl.us/eval/health/health
  .htm

32
Documenting Medication Errors

• Complete Medication Error form (kept in
  medication book) and submit within 24 hours
• Adverse reactions must be documented on Student
  Treatment Record by health staff
• Alert Notify principal, school nurse, and
  parent of error

33
Disposal of Medication

• Notify parent of 1 week time limit for picking-up
  discontinued medications. Medications remaining
  at end of school year must be picked by the last
  day of school.
• Medication must be destroyed in a manner that it
  cannot be retrieved. Do NOT FLUSH. Destruction
  should be witnessed and documented on SMR (legal
  record).
• Document on Medication Destruction Worksheet.
• All medications on hand must be for current
  school year.

34
Medication Related Emergencies

• An allergic reaction to a medication can occur at
  any time, no matter how long the student has been
  taking medication.
• Allergic symptoms
• Rash
• Swelling and Itching
• Breathing problems
• Bluish color of skin
• Increasing anxiety

35
Responding to Medication Emergencies

• Never leave student alone
• Notify parent and principal immediately, and
  school nurse if available
• Initiate 911 call if indicated
• If student is sent to emergency room, send
  medication container and copy of students
  emergency information card
• Document on SMR and cum health folder
• Health staff will document on Student Treatment
  Record

36
Anaphylaxis

• Medical term for life-threatening systemic
  allergic reaction that may occur when allergic
  individuals are exposed to specific allergens.
  Anaphylaxis is a collection of symptoms affecting
  multiple systems in the body.
• Epinephrine (adrenaline) single most important
  medication for treating anaphylactic reactions
  should be administered at the first sign of a
  systemic allergic reaction.

37
Anaphylaxis Signs Symptoms

• Hives, itching (of any body part)
• Flushed, pale skin, dizziness
• Swelling (of any body part)
• Red, watery eyes, runny nose
• Fainting, or loss of consciousness
• Wheezing, coughing, difficulty breathing
  shortness of breath
• Change in mental status increasing anxiety
• Throat tightness or closing difficulty
  swallowing.

38
Emergency Evacuation Plan

• Review Emergency Evacuation Plan with school
  nurse to identify your role
• Plan is posted in the front office and clinic

39
Field Trip Procedures

• Submit completed ESE Field Trip Request form to
  the district ESE office for ESE students who need
  health assistance on a field trip
• Refer overnight field trip needs to school nurse
• Field trip guidelines are available in the Blue
  Health Services Guidelines book

40
Professional Responsibilities Regarding
Medication and Medical Diagnosis

• School Personnel Do Not
• Suggest or diagnose any health condition
• Recommend a specific health care provider
• Recommend medication or treatment
• Exclude any student for not having medication
• Contact medical provider to recommend diagnosis
  or treatment for student
• Do refer student health information and issues to
• the school nurse

41
Other Professional Responsibilities Regarding
Medication

• Do not use white out for corrections
• Draw line through error and initial above the
  line
• Make correct entry
• Keep medication cabinet key secured
• Each school must have a plan for managing key
  security during the school day and after hours
• Refer health questions to school nurse

42
Confidentiality

• In the course of caring for a student,
  information of a private or personal nature may
  be divulged
• It is imperative that you keep in confidence such
  information this is an ethical and legal
  standard that must be upheld
• Before sharing any information with any staff
  member, stop and ask yourself, Does this person
  have a legitimate need to know?
• Do not discuss students with others who are not
  directly involved in care

43
Medication Audits

• Performed twice a year by school nurse to monitor
  administration of medications and identify
  procedural problems
• Medications on hand are counted during audit and
  counts reconciled
• Do not have to count sealed bottles of
  over-the-counter medications

44
2006/2007 Medication Errors

• All medication errors are reviewed by a joint
  school district and health department Quality
  Improvement Committee
• Average number of medications administered a day
  during the February FTE week 507
• Total number of medications administered during
  the 06/07 school year 76,971
• Number of medication errors reported 47
• Medication error rate 6.1 errors/10,000 meds
  administered

45
QI Annual Comparison
The number of medications administered have
decreased. What has happened to the medication
error rate?
46
Errors happen when the 5 Rights are not verified.

• Right student?
• Right medication?
• Right dose?
• Right time?
• Right route (mouth, injection, etc)?
• Administer the medication only after you have
  answered yes to all 5 questions.

47
Help prevent wrong dose

• Messages from parents regarding medication
  changes should be delivered directly to the
  clinic staff.
• If message is received by other personnel, it
  must be immediately reported to the clinic staff.

48
When can a routine medication be administered?

• Approved window for administration at school is 1
  hr before until 1 hr after prescribed time (2 hr
  window of time)
• Exception Medications that must be given at meal
  times (i.e. Reglan 30 minutes before meals)
• Use Tick sheet to help prevent missed doses. Use
  of tick sheet is NOT optional.

Any medication given outside of the 2 hour window
is a medication error.
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Common Policy Issues

• Do not administer any medication without an
  authorization
• Do not accept parents verbal request to
  administer over-the-counter medications
• Do not accept parents request to alter
  physicians order a new form from physician must
  be obtained
• Parent always has option to come to school and
  administer medication
• Do not administer OTC medication greater than
  recommended dose on manufacturers label or
  outside of recommended age range
• Do not administer non-approved FDA drugs

50
Infection Control Guidelines

• Handwashing is the best defense against infection
  for you and the student
• Use anti-bacterial soap
• Item 0305181 for 1 gal. / Warehouse
• Use hand sanitizer only if water not available
  Item 0120009 for 8 oz.
• Item 0120010 for 16 oz.
• Change cot paper between students Item 0145471/
  24X1000 roll

51
Universal Precautions

• Treat ALL blood and other body fluids as
  potentially infectious
• Maintain disposable plastic Sharps Container
  Item 0120047, 1 gal. or 0120048, 1 qt.
• Clean surfaces with Anti-TB Sanizide Plus Item
  0120014
• Wear gloves whenever handling body fluids
• Wash hands after removing gloves

52
Sharps Container Disposal

• Seal and date container when ¾ full of sharps
• School Health personnel will transport Sharps
  container to ECHDFairfield or Northside
• If saturated material is placed in container
• Date container and start 30 day clock
• Seal container on 30th day
• Transport Sharps container to ECHD biomedical
  waste room

53
Immunization Requirements

• 2nd MMR is required for grades K-12
• Hepatitis B is required for Pre K K-12
• Td/Tdap Booster is required for grades 7-12
• Varicella is required for Pre K - 6
• Students repeating 6th grade must meet 6th
  grade requirements
• 07/08 Immunizations at a Glance available _at_
• http//ese.escambia.k12.fl.us/eval/health/health.h
  tm

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NEW A06 Panel
55
Head Lice ManagementTruth the problem is Lice,
not nits

• Only exclude students who have live bugs or nits
  less than ¼ from the scalp
• Students may return to school after being treated
  with a lice killing product and no live lice are
  found
• Students are allowed one day of excused absence
  for head lice

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DIABETES

• ALWAYS notify your school nurse of a new student
  with diabetes
• Child-specific training is required before you
  can provide care for a student with diabetes
• Managing Diabetes in the School Setting
  notebook is available in your clinic

57
Seizure Management

• Review the First-Aid Flowsheet for Seizure
  Management located in the Health Services
  Guidelines Book (blue) located in the school
  clinic
• Child-specific training must be provided by the
  school nurse if Vagal Nerve Stimulator or Diastat
  is ordered

58
Call 911

• If seizure lasts longer than 5 minutes
• If student has repeated seizures
• If student has trouble breathing after a seizure
• If student cannot be aroused after seizure
• If student is pregnant, diabetic, or has no known
  seizure history

59
Final Reminders

• There are no short cuts to medication
  administration follow the 5 rights
• All health services forms are available Online
• It takes team work between the nurse, health
  support tech, school staff, parent, and student
  to provide high quality and safe health services
• Be sure to assist the clinic staff frequently so
  you remain competent and comfortable with
  administering medications to students. Be
  familiar with the students listed on the tick
  sheet.

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Steps
v

• Complete module
• Click link to online test
• Print completed test
• Submit completed test online
• Contact school nurse to verify skills and review
  test results
• Store documentation in Medication Administration
  notebook