This section of the manual describes the systems that are necessary to safely deliver health services within educational settings to meet the health and safety needs of students and staff and to comply with state health and education laws and regulations.  These systems provide:

1.     An infrastructure of policies, procedures, roles, and responsibilities;

2.     A schedule and process for routine, ongoing review and evaluation of the infrastructure and practices in school health services delivery.

 

A district’s health care delivery system is not dependent upon one person (nurse, administrator, secretary, etc.).  The structure and components of the system are district-wide and all staff members should be familiar with the expectations and procedures that follow. 

 

The system should be understood and implemented by:

•       All district-wide departments:  administrators, central registration, human resources, etc.

•       All school building personnel:  principals, front office staff, athletic directors and coaches, teachers, para-educators, nutrition services personnel, counselors, school nurses, custodial and maintenance staff, transportation staff and any building itinerant staff.

 

Everyone must know, understand, and implement these procedures, and have an opportunity for input in the systems review process.

 

This section describes the following components of a district-wide systems approach to support health service delivery in schools: 

•       Accidents at School (See Accidents at School)

•       Automated Electronic Defibrillators (AED) (See Automated Electronic Defibrillators)

•       Confidentiality (See Confidentiality)

•       Field Trips, Off-campus Activities, After Hours (See Field Trips, Off-campus Activities, After Hours)

•       Food Services (See Food Services)

•       Illness and Injury (See Illness and Injury)

•       Introduction to District Systems to Support Delivery of School Health Services (See Introduction to District Systems to Support Delivery of School Health Services)

•       Job Descriptions – Health Services (See Job Descriptions – Health Services)

•       Mandated Reporting of Child Abuse and Neglect (See Mandated Reporting of Child Abuse and Neglect)

•       Quality Assurance (See Quality Assurance)

•       Required Blood-Borne Pathogen Plan (See Required Blood-Borne Pathogen Plan)

•       School Staff Training (See School Staff Training)

•       Transportation (See Transportation)

●        Migrant Physicals (See Migrant Physicals)

Quality Assurance is a planned and systematic set of activities to ensure that any concerns are clearly identified, assessed, and improved. Collecting critical data to analyze health services, guides the development and implementation of improvements to achieve desired outcomes. Analysis of critical data will lead to:

•       Enhancing student success and school improvement.

•       Exploring solutions to health service challenges.

•       Reducing individual and school liability.

Data analysis provides information regarding how work is done so that efficiency, effectiveness, and adaptability increase. 

 

WHAT IS RECOMMENDED?

•       School improvement planning includes health data to identify and find solutions for
non-academic barriers to learning.

•       Identification of emerging health and safety issues and trends in the district for enhancement and/or improvement of school health services.

 

Why:

•       For safety, health, and learning in school.

•       For improvement of school functioning to:

o       Give confidence to staff, families, and students that their needs will be met.

o       Standardize systems for a consistent approach to operations.

o       Improve work processes and efficiencies.

o       Decrease gaps and duplication.

For Whom:

Stakeholders

•       Students.

•       Families.

•       School staff.

•       School administration.

•       School board members.

 

When:

•       On a daily basis.

•       At specified times during the school year.

•        At least annually.

 

PROCEDURAL GUIDELINES, ROLES, AND RESPONSIBILITIES:
School nurses work with administration to develop roles and responsibilities for the following quality assurance activities:

School Improvement Planning:

•       Registered nurse participates in a School Improvement Team to address areas of school health and student achievement.

•       Registered nurse increases staff awareness of correlation of student wellness and student success by including health-related goals in the School Improvement Plan.

•       Registered nurse guides compilation of data that demonstrates how student health influences student academic achievement. Examples include: 

o       Increased attendance for students who have well-managed health conditions.

o       Increased instructional time by decreased frequency of health room visits for minor first aid that could be managed by student or teacher.

o       Increased instructional time by nurse assessing psychosocial issues for students presenting physical complaints and referring for appropriate interventions to minimize stress. (Better coping, thus better learning.)

o       Increased attendance due to nurse evaluation of underlying causes of absenteeism; therefore, providing appropriate interventions for families: i.e. 1) family teaching, support, and empowerment; 2) providing access to health care; 3) providing community resources for basic needs; etc.

o       Decreased absenteeism by instituting a school-wide hand washing and respiratory etiquette curriculum and program.

o       Increased student engagement in learning by providing support for self-efficacy, empowerment and overall health.

 

Documentation:

•       Registered nurse documents consistently, using standard definitions and parameters so that individual data points can be combined.

o       Use district-wide approved forms.

o       Provide staff training to document and/or complete forms.

o       If electronic data is collected, ensure uniform coding and data input.

•       Registered nurse stores data so that information can be retrieved easily for analysis. Types of data may include:

o       Electronic health record system.

o       Medication and treatment logs.

o       Health room documentation system.

o       Nursing care following the nursing process: assessment, nursing diagnosis, plan, intervention, and outcome.

o       Individual health care plans.

o       Emergency care plans.

o       504/IEPs.

o       Attendance.

o       Grades.

o       Health screening data.

o       Medicaid billing.

•       Data systems support both student health information and student academic information so that correlation between health and learning is evident.

•       Documentation should follow all HIPAA and FERPA guidelines.

 

Determine Trends of Health Concerns in District:

•       Registered nurse reviews health data at least annually to determine trends of health concerns in district:

o       Communicable diseases.

o       Chronic health conditions

o       Intentional and unintentional injuries.

o       Self-harm.

o       Teen pregnancy.

o       Suicide.

o       Health room use (frequent students, times of day, type of problems).

o       Incidents of emergencies and effectiveness of district staff response.

•                 Registered nurse reviews health data as new issues are identified.

•                 Registered nurse annually completes the OSPI “Assessment of District Student Health Services”

o       Registered nurse identifies strengths and concerns in the review of data.

o       Registered nurse prepares a report of the status of health services in the district for the school board, district and building administrators, parents, OSPI, etc.

o       Registered nurse prepares recommendations for changes based on data trends, emerging health issues, evidence of most pressing health needs of the district (programs, staffing, training, equipment, etc.), and evidence-based practice recommendations.

 

Evaluate Systems, Programs, and Staff Performance:

Quality is measurably meeting expectations and requirements.

•       Registered nurse and administration collaborate so that systems and programs:

o       Reflect expectations, policies, procedures, job descriptions, roles, and responsibilities.

o       Are clearly understood by key players in school health service delivery.

o       Function properly by careful and thoughtful effort.

o       Are evaluated on a regular basis.

 

 Communicate, Plan, and Implement Changes:

•       Registered nurse provides regular updates regarding health services to:

o       School health services staff that deliver health services.

o       School staff who provide delegated nursing tasks.

o       School administration.

•       Registered nurse submits a written report and recommendations for administration and school board review.

•       Registered nurse plans for next school year based on findings and recommendations. Includes:

o       Focused professional development opportunities for school nurse and other members of the health services staff.

o       Improvements and modifications in procedures and systems.

o       Rearrangement of staffing based on student need.

o       Increased awareness and information to school staff regarding health services.

•       Registered nurse and administration build into the evaluation plan: activities, clear expectations, and timelines for completion.

Resource:

Selekman, Janice, School Nursing a Comprehensive Text, 3rd Edition. F.A. Davis Company, Philadelphia, 2019.

CONFIDENTIALITY OF STUDENT HEALTH RECORDS:

 

Individuals have the right to control the privacy of their health information. Washington State requires additional protection of health information in addition to federal confidentiality laws. Health care information is defined as: “Any information, whether oral or recorded in any medium, which identifies or can readily be associated with the identity of a patient and directly relates to the patient’s health care.”

                          

WHAT IS REQUIRED?

The following requirements are outlined by Family Educational Records Privacy Act (FERPA), Health Insurance Portability and Accountability Act (HIPAA), and RCW 70.02.005 to .904:

 

•       Release of health care information (and sharing of health information) requires informed, written consent.

•       Washington State Nurse Practice Act (WAC 246-840-700) requires nurses to practice in accordance with RCW 70.02.

•       Washington Professional Educators Standards Board (WAC 181-87-060) defines a code of professional conduct for educational professionals.

•       Written family (or student) permission to share health information.

 

Why: 

•       The Washington State Legislature finds that health care information is personal and sensitive information that if improperly used or released may do significant harm to patient privacy, health care, or other interests.

 

For Whom: 

•       Any family, student, or staff member who has submitted any health information to school. 

•       Any health care provider identified in RCW 70.02 including registered nurses and licensed practical nurses.

•       Any individual, including school staff, who assists a health care provider in the delivery of healthcare services or the gathering of health information.

 

When:  

•       When family or student provides written consent to exchange health information between a health care provider or health agency and the school.

•       When a school health care provider creates health care information (as described above) at school.

•       When family or student provides written authorization to share health care information with specific school staff.

                           

 

 

PROCEDURAL GUIDELINES, ROLES, AND RESPONSIBILITIES:

Sequence of procedures at all times:

1.     School district has policies and procedures in place to protect private health care information and follow confidentiality laws specified in FERPA, HIPAA, RCWs, and WACs.

2.     Registered nurse informs and/or clarifies for school administration and staff the additional confidentiality rules for Washington State (RCW 70.02), including storage and archival information.

3.     Registered nurse ensures that confidential student health information in hard copy is kept in a locked cabinet with access limited to appropriate staff.

4.     Registered nurse ensures that confidential health information in electronic format has access limited to appropriate staff.

5.     Registered nurse trains and assigns specific staff who then sign an agreement to keep health care information confidential according to RCWs and WACs.

6.     Registered nurse oversees student health information in accordance with RCWs and WACs.

7.     Registered nurse is held accountable for confidential health care information by Nurse Practice Act and Professional Educational Standards, RCWs, and WACs.

                                    

REFERENCES & RESOURCES:

•       http://www.sos.wa.gov/archives/ecordsRetentionSchedules.aspx 

School Districts and Educational Service Districts Records Retention Schedule Version 7.2-8.  (December 2014)

Pg. 67 – 69 refer to health related records

 

•       Family Education Rights and Privacy Act (FERPA) US Department of Education

 

•       FERPA and the Disclosure of Student Information Related to Emergencies and Disasters (June,  2010)

 

•       FERPA and H1N1 (October, 2009)

 

•       Joint Guidance on the Application of the FERPA and the HIPAA to Student Health Records (2008) US Department of Health and Human Services

 

•       Understanding Health Information Privacy Rules (HIPPA) US Department of Health and Human Services

 

•       Chapter 70.02 RCW Medical Records, Health Care Information Access and Disclosure

 

•        Code of Professional Conduct for Education Practitioners (June, 2014)

            OSPI Publication 03-0063     

 

Chapter 181-87 WAC Professional Certification – Acts of Unprofessional Conduct

 

Schwab, N., et.al. Protecting and Disclosing Student Health Information: How to Develop School District Policies and Procedures (2005), American School Health Association: Kent, OH

MANDATED REPORTING OF CHILD ABUSE OR NEGLECT:

MANDATORY REPORTING (RCW 26.44.030)

When any person mandated by law (like school personnel) has reasonable cause to believe that a child has suffered abuse or neglect, he or she SHALL report such incident or cause a report to be made to the proper law enforcement agency or to the Department of Social and Health Services within 48 hours.

DUTY TO REPORT PHYSICAL ABUSE OR SEXUAL MISCONDUCT BY SCHOOL EMPLOYEES (RCW 28A.400.317)

A certificated or classified school employee who has knowledge or reasonable cause to believe that a student has been a victim of physical abuse or sexual misconduct by another school employee, shall report such abuse or misconduct to the appropriate school administrator. The school administrator shall cause a report to be made to the proper law enforcement agency if he or she has reasonable cause to believe that the misconduct or abuse has occurred as required under RCW 26.44.030. During the process of making a reasonable cause determination, the school administrator shall contact all parties involved in the complaint.

As a mandated reporter, you are required by law to report.  When you give your name, it will be documented that you have met your legal obligation to report suspected child abuse or neglect.  This also makes it possible for CPS to contact you later if additional information is needed.

DSHS Children's Administration - How to Report Child Abuse or Neglect    (July 25, 2017)

 

WHAT IS REQUIRED?

The following requirements are outlined in RCW 26.44.010 to 900, RCW 28A.300.160, RCW 28A.230.080, RCW 43.63A.066, RCW 9.69.100, RCW 28A.400.317

 

•       Oral or written reports to the Child Protective Services or the appropriate law enforcement agency must contain the following information if known:

o       Name, address, and age of the child.

o       Name and address of custodians of child.

o       Nature and extent of injury or injuries, neglect, and/or sexual abuse.

o       Any evidence of previous incidences of abuse or neglect including their nature and intent.

o       Any other information that may be helpful in establishing the cause of the child’s injury or injuries, neglect, or death, and the identity of the perpetrator or perpetrators.

•       Child Protective Services (CPS) may ask for other information that may be of assistance in the investigation, such as time and location where the abuse or neglect occurred or any special needs for communication with the family or child that may be known.

•       If a crime has been committed, law enforcement must be notified.

•       The name of the person making the report is not a requirement of the Child Abuse and Neglect law. The Department of Social and Health Services encourages responsible reporting and will receive reports with an offer of limited confidentiality. Names of confidential reporters may be released when ordered by the court or as necessary to protect the child or to comply with agency rule and policy.

•       Every school district board of directors shall develop a written policy regarding the district’s role and responsibility relating to the prevention of child abuse and neglect.

 

Why:

•       Certain persons or groups of persons who have frequent contact with children and families are required by Washington’s state law to report suspected cases of child abuse and neglect. These persons include medical practitioners and professional school personnel (including but not limited to, teachers, counselors, administrators, childcare facility personnel, and school nurses).

•       The purpose of this law is to protect children who have been non-accidentally injured, sexually exploited, or deprived of the right to minimal nurture, health, and safety by their family, custodian, or guardian. It is the intent of the law that these designated persons who are in positions to identify children who are at risk from abuse and neglect will report suspected child abuse in order that the need for protective services be assessed. 

•       The state does not intend to interfere with reasonable family discipline and child-raising practices that are not injurious to the child.

 

For Whom:

•       For any child, legally defined as a person under the age of 18, who has been non-accidentally physically or mentally injured, neglected, or sexually abused.

•       For dependent adults and developmentally disabled persons not able to provide for their own protection through the criminal justice system who have been non-accidentally physically or mentally injured, neglected, or sexually abused.

 

When:

•       At any time a school employee suspects that a child, a disabled adult, or dependent adult has been abused or neglected.

•       At the first opportunity, but in no case longer than 48 hours after there is reasonable cause to believe that the child, disabled adult, or dependent adult has suffered abuse or neglect.

         

PROCEDURAL GUIDELINES, ROLES, AND RESPONSIBILITIES:

Sequence of procedures at all times:

1. School District has policies and procedures in place for reporting and documenting suspected child abuse or neglect by school personnel.
2. Registered nurse reviews school district policies and procedures to protect students from abuse and neglect.
3. Registered nurse reviews and uses school district protocol for child abuse and neglect reporting.
4. Registered nurse confirms with building administrator the protocol for that building.
5. In all cases, the staff person who has suspicion that abuse or neglect has occurred is mandated to ensure that a report has been made to CPS within 48 hours.

 

REFERENCES & RESOURCES:

Protecting the Abused & Neglected Child: A Guide for Recognizing & Reporting Child Abuse & Neglect (DSHS 22-163) (Rev. 4-18)

JOB DESCRIPTIONS – HEALTH SERVICES:  

Any employee of a public school district or private school that performs health services must have a job description that lists all the health services that the employee may be required to perform for students.

 

WHAT IS REQUIRED?

The following requirements are outlined in RCW 28A.210.255:

 

•       Job descriptions for all school employees who perform health services for students.

•       All health services that the employee provides are listed in the job description.

 

Why: 

•       To inform employees, administrators, and families of employee roles and responsibilities related to performance of health services.

 

For Whom: 

•       For any school staff members who are assigned to perform health services for students.

 

When:  

•       For all employees currently working for the school district.

•       For any newly hired school district employee.

             

PROCEDURAL GUIDELINES, ROLES, AND RESPONSIBILITIES:

Sequence of procedures at all times:

1.     School district has policies and procedures in place to address requirements for job descriptions.

2.     School staff “right of refusal” to provide health service is legislated in RCW 28A.210.280 for Clean Intermittent Catheterization. Beginning July 1, 2014, a school district employee not licensed under chapter 18.79 RCW who is asked to administer medications or perform nursing services not previously recognized in law shall at the time he or she is asked to administer the medication or perform the nursing service file, without coercion by the employer, a voluntary written, current, and unexpired letter of intent stating the employee's willingness to administer the new medication or nursing service. RCW 28A.210.275

3.     Registered nurse has responsibility to determine if specific staff members are safe to provide health services and may only delegate to persons who are safe to provide those services. (See Delegation of Nursing Tasks)

School administrator is usually the direct supervisor for all staff (including those delivering health services) in the building, but the school nurse is responsible for the supervision of any delegated health tasks.

District system for standard, nutritious meal preparation and delivery.

 

The following requirements are outlined by “Guidance for Accommodating Children with Special Dietary Needs in the School Nutrition Programs.” (https://fns-prod.azureedge.net/sites/default/files/special_dietary_needs.pdf)

 

WHAT IS REQUIRED?

Comply with federal guidelines for school nutrition for children with special health care needs.

 

•       Identify students with health conditions that require nutrition services accommodations.

•       PRIORITY MUST BE GIVEN TO STUDENTS WITH ANAPHYLACTIC FOOD ALLERGIES.

•       Review existing individual student plans (504, IEP, ECP, IHP) to ensure accommodations.

•       Collaboration among all staff working with students who may have special dietary needs.

•       Prescription diet order.

 

Why:

•       To meet the nutritional requirements of all students.

•       For safety and health of students with special dietary needs and/or food allergies.

 

For Whom:

•       For all students using district nutrition services.

•       For all students with special health care needs using district nutrition services.

•       Any student with a nutritional health concern even if parent provides meals and snacks.

 

When:

•       Before students use district nutrition services.

•       Before school starts annually.

•       Before any school-sponsored field trip and/or extracurricular activities using district nutrition services.

 

PROCEDURAL GUIDELINES, ROLES, AND RESPONSIBILITIES:

 Planning:

•       Nutrition Services develops and maintains a system for meal preparation and delivery in school.

•       Nutrition Services, in cooperation with registered nurse and/or SPED director, develops and monitors systems to maintain safety for students with special needs.

•       Nutrition Services considers electronic systems to identify special dietary needs as student proceeds through cafeteria line or obtains school-prepared food.

•       Nutrition Services ensures that nutrition services system has ability to “flag” students with special dietary needs.

•       Nutrition Services staff has been trained to recognize those “flags” and respond accordingly.

o    Considerations: field trip requests, cultural and religious dietary practices, when student has no money for meals or when student is hungry.

 

Assessment:

•       Registered Nurse/Special Education Director (SPED), Occupational Therapist (OT), Physical Therapist (PT), Speech Language Pathologist (SLP) identifies students with special dietary needs.

•       When a student is identified as having an anaphylactic food allergy, registered nurse and nutrition services must be notified immediately.

•       Registered nurse reviews and updates at the beginning of each year and as needed - individual student plans that require:

o       Prescription diet order.

o       Food substitutes.

o       Food texture.

o       Utensils.

o       Menu nutrient calculations.

o       Tube feedings.

 

Management and Evaluation:

•       Registered nurse and/or SPED director are available for consultation and ongoing support to nutrition services staff.

•       Following any adverse nutrition incident, registered nurse debriefs with nutrition services to evaluate effectiveness of procedures and, if necessary, makes revision to prevent recurrence of adverse incidents (including but not limited to modifying procedures and instituting staff training).

 

 

Resource:  OSPI Child Nutrition, National School Lunch and Breakfast Program

District system for safe transportation of students to and from school and during school-sponsored activities requiring transportation from and returning to school.

 

WHAT IS REQUIRED?

School districts are responsible for the safe transportation of students. Specific health requirements for district transportation are outlined in the Washington State School Bus Driver Handbook. As in previous chapters, the following health requirements outline procedures to keep all children, including those with special health care needs, safe.

 

•       General (for all students):  

•       Trained First Aid provider (WAC 392-144-102(3)).

•       Readily available appropriate first aid kit (WAC 392-145-041).

•       Appropriate communication device considering geographic locations and bus routes (e.g. radio, cell phone, etc.).

•       Special Health Care Needs Students:

o       Know students with identified special health care needs.

o       Review existing individual student plans (e.g. 504, IEP, ECP, and IHP).

o       Health Care Plan delegation and training by appropriate health care professional.

•        Plan for equipment.

•        Plan for procedures.

•        Plan for routine medications.

•        Plan for emergency medications.

 

Why:

•       To provide safe transportation of all students.

•       To provide continuation of routine health services and emergency response for students with special health care needs.

 

For Whom:

•       For all students using district transportation.

•       For all students with special health care needs using district transportation.

 

When:

•       Before students use district transportation system.

•       Before school starts annually.

•       Before any school-sponsored field trip and/or extracurricular activities using district transportation.

 

 

PROCEDURAL GUIDELINES, ROLES, AND RESPONSIBILITIES:

Planning:

•       Transportation director develops and maintains general health and safety standards for all students. 

•       Transportation director ensures that systems for training are in place for all transportation staff, including regular and substitute bus drivers and dispatchers.

•       Transportation director, in cooperation with registered nurse and SPED director, develops and monitors systems to maintain safety for students with special health care needs.

o       Dispatcher or individual bus driver has immediate access to current Emergency Care Plans for students riding the bus.

o       Transportation director ensures that students have either immediate access to their emergency medications or functional plans for quick access to emergency medication.

 

Assessment:

•       Registered Nurse/Special Education (SPED) Director/Occupational Therapist (OT)/Physical Therapist (PT)/Speech Language Pathologist (SLP) identifies students with special health care needs and reviews their individual plans that require:

o       Equipment (wheelchair, ramp, glucometer, etc.).

o       Procedure (G-Tube, transferring, lifting, etc.).

o       Medication (Epi-Pens, inhalers, oxygen, etc.).

•       Transportation director, in cooperation with registered nurse and SPED director, if relevant, consider:

o       Appropriate vehicle for special needs.

o       Length of time on the bus.

o       Route of bus (i.e. remote, isolated roads, environmental risks, etc.).

o       Route of child from home to bus stop (i.e. traffic patterns, distance from emergency response, etc.).

o       Need for adult supervision on the bus in addition to bus driver.

 

Nurse Training/Delegation:

•       Registered nurse, in collaboration with transportation director, identifies transportation staff members who are competent, available, and willing to accept responsibility to assist students with special health care needs.

•       Registered nurse delegates one-on-one to transportation staff, any necessary nursing procedures for specific students.

•       Registered nurse documents training and delegation.

•       Transportation staff members accept delegation responsibilities by signing delegation form.

•       Registered nurse files documentation of nurse delegation and staff acceptance of delegation responsibilities.

 

Management and Evaluation:

•       Registered nurse and SPED director are available for consultation and ongoing support to transportation director and transportation staff.

•       Registered nurse debriefs with transportation director and transportation staff following any adverse student health incident involving the transportation system. Debriefing evaluates effectiveness of procedures and recommends any necessary revisions which may include but are not limited to modifying procedures and additional staff training.

There will be students and staff who become ill and/or injured while at school. It is imperative that school districts have standardized procedures for responding to illnesses and injuries.

 

WHAT IS RECOMMENDED?

Response to Cardiac Arrest and selected Life Threatening Medical Emergencies: The Medical Emergency Response Plan for Schools: A Statement for Health Care Providers, Policy Makers, School Administrators, and Community Leaders was developed and endorsed by the American Heart Association and multiple partners, including American Academy of Pediatrics, National Association of School Nurses, American Red Cross, Program for School Preparedness and Planning, and others (http://circ.ahajournals.org/cgi/content/full/109/2/278). This document is a standard for school use in developing policies and procedures for emergency response in the school setting. Recently, however, in response to the publication of the International Consensus on CPR and Emergency Cardio Vascular Care (ECC) Science with Treatment Recommendations (2020), the American Health Association released a newly revised 2020 Guidelines Update for CPR and ECC that should be considered when planning policies and procedures for school-based response to injuries and illness.  

 

The following recommendations for schools are based on Washington State School Directors Association (WSSDA) Policy Sample 3418 and other WSSDA School Health Policy Samples:

•       DOH booklet: How to Respond: Injury and Illness at School (DOH Pub 130-021).

•       Infectious Disease Control Guide for School Staff  2014

•       Staff members trained and certified in First Aid/CPR.

•       First Aid supplies (readily available).

•       Communication device (phone and/or radio).

•       Emergency care plans.

•       Emergency medications.

•                 Consistent, district-wide documentation system.

o       To document on a medical-legal record for illness and injuries.

o       To document on a medication log a record of medication administration.

 

Why:

•       To effectively and efficiently triage illness and injury for immediate needs.

•       To support students’ presence in class and discourage inappropriate use of the health room.

•       To provide expected standard of care for illness/injuries during school and school-sponsored events.

•       To manage serious injuries and shock until family and/or EMS arrives.

•       To provide basic life support in the event of cardiopulmonary failure until EMS arrives.

•       To identify students who verbalize physical symptoms as a manifestation of psychosocial stressors. It is imperative to identify these students for timely and appropriate psychosocial referral and care.

 

For Whom:

•       For all students, staff, and visitors who are ill and/or injured during school and school-sponsored events.

•       For students with known health conditions and/or Emergency Care Plans.

 

 

When:

•       Whenever illness and/or injury occur during school or school-sponsored events.

 

PROCEDURAL GUIDELINES, ROLES, AND RESPONSIBILITIES:

Planning:

•       Registered nurse collaborates with superintendent, principals, athletic director, transportation director, and other designated administrators to identify staff required to have First Aid and/or CPR training* and certification.

•       District office and building administrators maintain a list of staff with current First Aid/CPR training and certification.

•       School district facilitates annual training for specified staff members to obtain or maintain First Aid/CPR certification.

•       Registered nurse provides support for certified First Aid and CPR members but registered nurse does not delegate first aid.

•       Registered nurse collaborates to develop systems for the delivery of illness and injury care in the absence of the registered nurse.

•       Registered nurse provides training and delegation of student Emergency Care Plans and medications and/or treatment administration to appropriate staff ( See Delegation of Nursing Tasks).

•       Registered nurse monitors administration of all medications necessary during illness, injury, or emergency.

•       Superintendent and/or building administrator ensures the following staff are responsible for and will maintain adequate first aid supplies for appropriate building preparedness and response to illness and injury:

o   Registered nurse oversees and/or maintains first aid supply inventory in the building health room.

o   Physical Education teachers/coaches maintain first aid kits to be available during all physical activity practices and events.

o   Teachers in classrooms with potentially hazardous materials/activities (equipment, chemicals, etc.) maintain first aid kits in those classrooms and areas.

o   Transportation director maintains first aid kits for bus garage and all buses.

o   Food Services director maintains first aid kits for kitchen and cafeteria.

*Depending on school district needs, CPR training may include Automated External Defibrillator (AED) training.

 

First Aid for MINOR or MODERATE Illness and Injury:

•       Note: For students with asthma, diabetes, and other health conditions who may have emergent episodes, always ensure that someone responsible accompanies the student to the health room or office.

•       The teacher, before a student is directed to seek help outside of the classroom,

o       Provides care as appropriate in the classroom (e.g. wash hands, apply bandage, rest head on desk, etc.).

o       Begins the documentation process on the health room pass that includes (or notes):

•        Student name.

•        Teacher name.

•        Date and time.

•        Student complaint(s).

•        Teacher observation and actions (e.g. rested for __ minutes).

•       Teacher determines if the student requires additional care; the student is sent or accompanied to the health room/office.

•       School staff assigned to cover the health room reviews request form, gathers more information about student complaint, and continues documentation on the request form.

•       Provides first aid according to the DOH booklet How to Respond: Injury and Illness at School (DOH Pub 130-021).

o        Calls family/guardian to take student home or sends student back to class.

•       Principal and other First Aid/CPR trained, certified school staff assists health room school staff as necessary.

 

First Aid / Care for SERIOUS Illness and Injury (in the absence of the registered nurse):

•       Note: For students with asthma, diabetes, and other health conditions who may have emergency episodes, always ensure that someone responsible accompanies the student to the health room.

•       Teacher escorts or assigns an appropriate adult to escort student to health room, or calls trained staff member to the location of the student within the school.

•       School staff assigned to cover the health room provides first aid according to the DOH booklet How to Respond: Injury and Illness at School (DOH Pub 130-021), and student Emergency Care Plans if applicable.

•       First Aid/CPR trained staff member

      EITHER

o       Initiates care and immediately contacts the registered nurse by phone or two-way radio IF the registered nurse is assigned for consultation.

•             Registered nurse provides direction for management of sickness and injury, and responds to manage care as necessary.

•             Registered nurse or staff member who has had nurse delegation administers emergency medication as needed.

•             Registered nurse and district school staff follows district/building communication protocol for emergencies.

•             Registered nurse or other staff member will contact family members(s) and 911 as needed.

•             Once at the school setting, 911 staff direct and provide care of the injured or ill person.

            OR

o   Initiates care and immediately calls 911 if the registered nurse is unavailable. Once at the school setting, 911 staff direct and provide care for the injured or ill person.

 

 

 

 

First Aid / CPR for EMERGENCY Illness and Injury:

(See AED section for additional guidance if AEDs are available or being considered in your district)

•       Registered nurse and district school staff follows district/building communication protocol for emergencies. Protocols are to include arrangements for:

o       One staff always stays with student or staff person needing emergency care.

o       Staff to call 911 or designate another staff member to place the call.

o       Staff to initiate accepted emergency care procedures or CPR until EMS arrives.

o       Staff to call for registered nurse to come to site (if nurse is available in district).

o       Staff to notify principal.

o       Staff to notify family member(s).

o       If registered nurse is present, he/she attends to sick or injured person; others call 911, call parent, attend to environmental control, etc.

 

Documentation:

•       School staff member providing first aid and/or CPR care immediately documents the event, response, and outcome. Check district policy for guidance about when to complete a Student Accident Report.

•       School staff uses consistent, district-wide documentation system. For Emergency Care Plan, staff may document on the plan and send it with EMS. Nurses’ notes may be used for documenting details of emergencies.

o       Documentation must include:

•        Name of the person who is sick or injured.

•        Date.

•        Time.

•        Complaint.

•        Description of sickness or injury.

•        Registered nurse assessment.

•        Interventions (medications, pressure, cleaned, bandaged, rest, ice, etc.).

•        Outcome (improved, same, worsening, etc.).

•        Disposition of the person who is sick or injured (i.e. back to class, sent home, sent with EMS, etc.).

•        Name/Initials of person providing care.

•       Registered nurse will maintain all documents related to any sickness and injuries in a locked file cabinet in health room per confidentiality laws (See Confidentiality Section).

 

Follow-Up:

•       Registered nurse will ensure that principal has been notified of more serious sickness and injuries, potential communicable disease outbreaks, and emergencies.

•       Registered nurse will contact local health jurisdiction for reportable diseases (See Infectious Disease Control Guide for School Staff – OSPI).

•       Registered nurse will follow up with family/guardian, student, or staff members following more serious sickness and injuries or emergencies.

 

Management and Evaluation:

•       Registered nurse debriefs with staff members to review illness and injury response to determine effectiveness of the system; then, if necessary, makes needed modifications and/or institutes staff training to improve future responses.

•       Registered nurse analyzes health room data periodically (at least annually) to evaluate health room use and identify patterns of use:

o       Reasons for contact with health service system.

o       Timing and any correlations with specific events (e.g. P. E. class, recess)

o       Times of specific educational topics use (i.e., tries to skip math class).

o       Specific classroom use (i.e., certain teachers send students more often, or classroom may have an environmental risk).

o       Playground injuries (certain playground equipment).

o       Incidence of specific symptoms (e.g. headaches, nausea and vomiting, etc.).

o       Incidence of specific diseases (e.g. asthma, diabetes, etc.).

o       Frequent use of “as needed” medication.

 

Recommendations:

•       Based on data above, make recommendations regarding:

o       Student health: identify students who may be using the health room to relieve stress and institute further assessment and then appropriate interventions for students’ actual problems.

o       Specific staff training.

o       Environmental changes.

o       Improved disease management strategies.

o       Improved documentation methodology.

 

REFERENCES & RESOURCES

•         WSSDA Policy: 3418

 

•       How to Respond: Injury and Illness at School (DOH Pub 130-021).

Washington State Department of Health

DOH Publication 130-021 10/2016

When an accidental injury occurs with a student/staff/visitor, for legal purposes and district liability, there are accepted procedures for care and documentation.

 

WHAT IS REQUIRED?
Consult with district liability insurance carrier for guidelines and forms required by that carrier.

 

•       For Students:

o    Student accident report form (per district policy).

o    Guidance for when to complete a Student Accident Report (per district policy).

•       For Staff:

o    District incident report form (per district policy).

o    Medical claim form (per district policy).

 

Why:

•       To prevent accidents when possible.

•       To provide expected standard of care for a student, staff member, or visitor following an accident.

•       To create legal medical records to document accidents, including nature of injuries and the steps taken to manage those injuries.

•       To analyze documentation data (above) to institute measures to prevent future incidents.

 

For Whom:

•       For all student, staff, and visitor injuries that need immediate and emergent response.

•       For all staff and visitor injuries that require medical attention for additional               treatment/management of the injury.

 

When:

•       Immediately following the accident.

 

STUDENT ACCIDENTS – PROCEDURES

. School nurse role in first aid:

•       Nurse role for minor first aid: Talking Points:

o    Students need to be in class.

o    Each teacher should keep student in class if possible.

o    Each teacher has Band-Aids, gloves, tissues, etc.

o    Develop a system to document the concerns that initiates being sent to the health room.  This system includes documentation by each adult who interacts with the student starting with the teacher or other person who sends the student to the health room.  This documentation is a legal record and should be maintained with other health records and maintained as outlined in state guidelines.  One method is:

●       If teacher sends student to health room, the teacher begins the documentation form to be used as a pass for the health room. The teacher writes on the pass: student name, student complaint or teacher concern, remedies offered in the classroom, date and time sent to health room, and teacher initials.

●       The health room pass becomes legal documentation and nurse or first aid-trained staff completes documentation on the pass with results of activities in the health room and disposition of student. Note: all documentation is a legal part of the students’ educational record and must be maintained and retained per

Public Schools Record Retention Schedule.

▪        If the registered school nurse is available, he/she always responds to ill or injured students who need nursing assessment and nursing clinical judgment using established criteria.

 

Planning

•       Ensure first responders in each building have current First Aid/CPR training.

•       District policies and procedures written to guide documentation of accidental injury at school.

•       District forms available for documenting and reporting accidents.

•       District forms available for medical claims.

•       District maintains a supply of these forms.

•       Staff receives training on procedures and forms.

 

 

Prevention

•       All staff report known risk areas and activities to principals and to the Safety Committee.

•       Registered nurse may assist in the analysis of accident data with designated district staff and reports patterns of injuries minor and major. This information is shared with building principals and safety committees.

•       All staff work to reduce risks as they become known.

 

Responding to a Student Accident

•       First aid will be provided as described in the DOH booklet, “How to Respond: Injury and Illness at School.”  

•       If necessary, staff will immediately call 911 for help.

•       School staff will notify school nurse.

•       School staff will notify the principal.

•       School staff will notify the family member(s).

 

Documentation

•       School staff providing care will use the district-wide documentation system to describe accidents (forms/procedures) and care provided.

•       School staff providing care will complete a Student Accident Report per district policy. 

•       Principal signs the completed Student Accident Report.

•       Completed Student Accident Reports are filed as follows:

o       Copy filed by registered nurse with a copy of the district documentation form in Student Accident file.

o       Copy sent to district office.

o       Copy sent to school insurance carrier per district policy.

o       Copy sent to Migrant Records clerk if enrolled in Migrant Program (Migrant clerk can assist family if they are eligible for financial assistance with medical costs through the Migrant Program).

 

Follow-up

•       Registered nurse contacts family member(s) and/or student regarding student condition following accident.

•       Registered nurse debriefs with all staff members who were involved (to maintain confidentiality and comply with “need to know” guidelines) to review the incident response for effectiveness and then, if necessary, modifies the response or institutes staff training to improve future responses.

•       Principal confirms that changes are made as needed to prevent future occurrences.

•       Registered nurse presents incident (maintaining student confidentiality) to the Safety Committee.

 

STAFF ACCIDENTS – PROCEDURES

 

Planning

•       See DOH Booklet: “How to Respond: Injury and Illness at School.”

•       District policies and procedures are written to guide documentation of accidental injury at school.

•       School district has forms available for documenting and reporting incidents and accidents.

•       School district has forms available for medical claims.

•       School district maintains a supply of these forms.

•       School staff receives training on procedures and forms.

 

Prevention

•       Registered nurse reports known risk areas and activities to principals and to the Safety Committee.

•       Registered nurse may assist the district in the analysis of data and reporting of patterns of injuries (minor and major) to principals and to the Safety Committee.

•       All staff work to reduce known risks as they become known.

 

Responding to a Staff Accident

•       Emergency care is provided as described in the DOH Booklet: “How to Respond: Illness and Injury at School.”

•       School staff providing care to the injured staff notifies staff member’s supervisor if staff member has not or is not able to do so.

•       Supervisor notifies staff member’s emergency contact(s) if staff member is unable to do so.

 

Documentation

•       School staff providing care uses the district-wide documentation system to describe incident (forms/procedures) and care provided.

•       Injured staff member or staff member’s supervisor completes an incident form per district policy (if injured staff member is unable to do so).

•       School staff member’s supervisor reviews and signs the completed incident form (per district policy).

•       Completed incident forms (per district policy) are filed as follows:

o       Original sent to district office.

o       Copy filed by registered nurse with a copy of the incident’s documentation record in Staff Accident file.

o       Copy kept by staff member.

o       If staff member seeks medical attention for the injury, he/she completes district claim form per district policy.

 

Follow-up

•       Registered nurse debriefs with all staff members involved in the accident to review the incident response for effectiveness and then, if necessary, modifies the response or institutes staff training to improve future responses.

•       Principal confirms that changes are made as needed to prevent future occurrences.

•       Registered nurse (or other designated staff member) presents incident description (maintaining staff confidentiality) with the Safety Committee.

A device that analyzes the heart's rhythm for any abnormalities and, if necessary, directs the rescuer

to deliver an electrical shock to the victim. This shock may help the heart to reestablish an effective

rhythm of its own. In schools, an AED may assist with the immediate cardiac arrest of staff, students, or visitors.

 

NOTE: For information about implementing an AED Program see “Guidelines for Implementing an AED Program” from WASBO Risk Management Committee.  

 

The following document addresses the procedures for using an AED. It is essential that the AED user has had prior CPR training and understands CPR procedures. Use of the AED is authorized for staff trained in performing CPR and using an AED. If the AED is not immediately available, perform CPR until the AED arrives on the scene.

See publication: “Response to Cardiac Arrest and Selected Life-Threatening Medical Emergencies - The Medical Response Plan for Schools” and the newly published 2020 Guidelines Update for CPR and ECC.

 

WHAT IS REQUIRED?

 

•       Automated External Defibrillator (AED) and CPR supplies.

•       First Aid/CPR/AED training for designated staff.

•       Medical director: licensed physician who authorizes AED for school.

•       Coordination with local Emergency Medical Services (EMS).

•       Communication device (phone and/or radio).

 

Why:

•       To provide basic life support for individuals experiencing cardiac arrest during school and school-sponsored events until EMS arrives.

 

For Whom:

•       For all students, staff, and visitors who experience cardiac arrest in schools, especially those individuals with increased risk related to known cardiac conditions.

 

When:

•       If cardiac arrest occurs

 

 

 

PROCEDURAL GUIDELINES, ROLES, AND RESPONSIBILITIES:

Planning & Responsibilities:

•       Registered nurse collaborates with principals, athletic director/coaches, maintenance/facilities director, and superintendent to identify location of AED (i.e. which buildings, where in the building, plan for athletic events on campus and off campus, etc.).

•       Registered nurse collaborates with principals, athletic director/coach, maintenance/facilities director, and superintendent to identify the staff required to have First Aid/CPR/AED training/certification.

•       School district provides required annual training for specified staff members to obtain initial or maintenance First Aid/CPR/AED certification.

•       Human Resources office and building administrator maintain a list of staff with current First Aid/CPR/AED training/certification.

•       Registered nurse:

o       Coordinates the maintenance of the AED, including annual maintenance, repairs, and replacement of supplies as needed.

o       Maintains communication with the medical director of EMS on issues related to AED program, including post-event reviews.

o       Communicates and coordinates with local EMS (ongoing).

o       Maintains all necessary records.

•       Facilities director maintains AED locations and wall mount boxes, including alarms, lights, and signage.

 

AED Use for Cardiac Arrest:

●        Trained staff assess the victim to determine need for CPR per training.

●        Trained staff initiate appropriate First Aid/CPR per training.

●        When additional personnel are present, trained staff:

o    Designate another staff member/bystander to call 911.

o    Designate an additional staff member/bystander to get the AED.

o    Administer CPR immediately and attaches AED to victim as soon as it is available.

●        If trained staff member is alone:

o    Get the AED and attach it to victim before beginning CPR.

o    Call 911.

o    Follow the commands given by AED, including continuing CPR if indicated, until EMS arrives.

 

Documentation:

●        Immediately following CPR and/or use of AED, documentation of the event must be completed by the staff member providing the care.

o    Staff uses consistent, district-wide documentation system.

o    Notes by a nurse may be used for documenting details of emergencies.

●      Documentation must include:

o    Name of the victim.

o    Date.

o    Time.

o    Description of event.

o    Interventions (e.g. CPR, AED shock delivered, etc.) and time of intervention.

o    Disposition of the victim (e.g. transported to hospital per EMS).

o    Name/Initials of person providing care.

●        Registered nurse will maintain all documents related to any events in a locked file cabinet in health room per confidentiality laws and RCW 70.02.005 to .904.

 

 

Follow-up, Management, and Evaluation:

●        Registered nurse will notify principal of any use of an AED. Conversely, staff will notify nurse if it is used when nurse is not present.

●        Registered nurse will follow up with victim, parent/guardian, or family member regarding his/her condition following use of the AED.

●        Registered nurse will notify regional EMS medical director of emergency and provide data regarding use of the AED.

●        Registered nurse and, as appropriate, EMS staff, debriefs with staff members involved to review emergency response for effectiveness and then, if necessary, modifies the response or institutes staff training to improve future responses.

 

Recommendations:

•       Registered nurse, building administrator, and/or EMS staff review above data and make recommendations:

o    Specific staff training.

o    Environmental changes.

o    Improved emergency management strategies.

o    Improved documentation methodology.

 

References:

•        RCW 4.24.300 Persons rendering emergency care or transportation – Immunity from liability-Exclusions.

 

RCW 70.54.310 Semiautomatic external defibrillator – Duty of acquirer – Immunity from civil liability.

Schools, as employers, are regulated by Occupational Safety and Health Administration (OSHA) and Washington Industrial Safety and Health Act (WISHA). The Washington State Program is administered by the Department of Labor and Industries (DL&I) and the Division of Occupational Safety and Health (DOSH). These laws require that employers have a Blood-Borne Pathogen Exposure Plan. The exposure control plan is the employer’s written program that outlines the protective measures an employer will take to eliminate or minimize exposure to blood and other potentially infectious materials (OPIM).

 

WHAT IS REQUIRED FOR BBP EXPOSURE PLAN?

 The following components are required by WAC 296-823.

 

•       An exposure determination if employees have occupational exposure to blood or other potentially infectious material (OPIM).

•       The exposure determination must contain:

o   A list of job classifications where all employees have occupational exposure.

o   A list of job classifications where some employees have occupational exposure and a description of all tasks and procedures or groups of related tasks and procedures with occupational exposure for these employees.

•       The exposure control plan must be designed to eliminate or minimize employee exposure in the workplace.

•       The exposure control plan must contain a procedure for evaluating the circumstances surrounding exposure incidents, including documentation of the routes of exposure, and the circumstances under which the exposure incidence happened.

•       The exposure control plan must be accessible at the workplace when exposed employees are present.

 

Why: 

•       For the health and safety of all employees.

•       Risk management for the school district.

 

For Whom: 

•       Any school district with one or more employees with occupational exposure to blood or other potentially infectious materials is required to comply with the requirements of the blood-borne pathogens standard.

 

When:  

•       Annual review and update of the BBP Exposure Plan. Responsibility for this task should be outlined in the plan.

•       Update plan to reflect new or revised job classifications with occupational exposure.

•       Update plan when changes in technology may increase or decrease occupational exposure.

 

Training: 

OSPI’s Guidelines for Implementation of School Employee Training on HIV/Aids and Other Bloodborne Pathogens is available online on the Health Services page of their website.  The training is required for school employees.

•       Annual training for selected employees.

•       New district employees must receive HIV/AIDS training within six months from the first day of employment. (WAC 392-198-025)

o    Washington State School Staff Health Training Guide

 

PROCEDURAL GUIDELINES, ROLES AND RESPONSIBILITIES:

Sequence of procedures at all times:

1.     School district has policies and procedures in place to conform to BBP Standards.

2.     Registered nurse collaborates with district administration to develop training, procedures, documentation of certification, etc.

 

REFERENCES & RESOURCES:

•       See District-Specific Blood-Borne Pathogens Exposure Plan

 

•       Division of Occupational Safety and Health (http://www.osha.gov/dcsp/osp/stateprogs/washington.html)

 

•       Occupational Exposure to Bloodborne Pathogens

 

Guidelines for Implementation of School Employee Training on HIV/AIDS and other Blood-Borne Pathogens

Field trips and extracurricular activities provide a valuable educational experience for students. While students participate in school-sponsored events, the same safeguards for health are required as if the student were in the school during a regular school day.

 

“The [Latin] term in loco parentis means ‘in the place of the parent’ and refers to the authority of school personnel, in the absence of a parent, to exercise judgment regarding, and to act toward, a student in the same way a parent would judge and act in similar circumstances.”

-Schwab, N. and Gelfman, M. (2001). Legal Issues in School Health Services: A Resource for School Administrators, School Attorneys, and School Nurses. North Branch, MN: Sunrise River Press.

 

“Students have a right to a safe environment, and teachers, administrators, and the school board have the duty to provide a safe environment within the limits of their capabilities. The district has the responsibility to protect students under its care, custody, and control as students may be unable to do so (due to mental or physical limitations) or may not be knowledgeable enough (not understanding the potential dangers) to take care of themselves.”

- Peggy Sandberg, ESD 112, Director of Risk Management 

 

WHAT IS REQUIRED?

 

•       Family Consent Form for Field Trip (to include emergency contact information and current health concerns).

•       Medication Authorization Form(s).

•       Emergency/routine medications and/or equipment.

•       Nursing delegation and training.

•       Emergency Care Plan training.

•       Documentation form.

•       First Aid kit.

•       Trained First Aid/CPR provider.

•       Communication device.

 

Why:

•       For continuation of routine health services to students while student is attending school-sponsored events away from the school or outside of regular school hours.

•       For safety of all students while student is attending school-sponsored events away from the school or outside of regular school hours.

 

For Whom:

•       For all students with health conditions requiring routine nursing procedures or medications during regular school hours.

•       For safety of students with health conditions that may require emergency response.

•       For all students who do not normally receive nursing procedures or medications at school because the care is given at home. If these students are on overnight trips or will be gone from home (at a school-sponsored event) during the time of a scheduled procedure or medication, the registered nurse will delegate the procedure/medication administration to unlicensed school personnel if it is appropriate.

 

When:

•       Before any students with health conditions requiring nursing care:

o   Leave campus for a school-sponsored event.

o   Attend an activity outside of regular school hours.

o   Attend summer school.

                   

PROCEDURAL GUIDELINES, ROLES, AND RESPONSIBILITIES:

 

Planning Prior to Field Trip (at least two weeks):

•       School staff in charge of field trip notifies registered nurse of all students attending field trip at least two weeks prior to date of trip.

•       Teacher obtains family consent documenting emergency contacts, special health needs, and medications.

•       Teacher completes a Field Trip Request Form that includes a list of all students attending field trip.

•       Two weeks before the field trip date, a form is completed documenting that all the staff below mentioned have been informed of the field trip:

o       Principal

o       Registered nurse

o       And as special health needs demand:

•        SPED director

•        Food services

▪        Transportation director

•       School staff keeps record of field trips and files forms in a designated folder.

•       Registered nurse keeps a copy of the Field Trip Request Form and student list in health office.

 

Registered Nurse Assessment:

•       Registered nurse reviews list of students to identify those with known health conditions.

•       Registered nurse reviews consent forms from family to identify students with previously unknown health conditions.

•       Registered nurse verifies for students needing special health care that their medical authorizations, routine and emergency medications, supplies, and Emergency Care Plans are in place.

•       Registered nurse works with and assists family to ensure that all authorizations, medications, and equipment are ready for the day of the event.

•       Registered nurse, if necessary, communicates with family the risk to the student if he/she participates in event without emergency safeguards in place.

•       If safeguards are not in place after the above steps, follow Life Threatening Conditions and Medication in School guidelines.

 

Principal Authorization:

•       Registered nurse notifies principal and teacher if there are any students who are unsafe to participate in activity due to lack of medications, authorizations, Emergency Care Plans, etc.

•       Registered nurse presents medical-risk rationale based on clinical judgment and makes recommendations in writing to superintendent designee and teacher regarding any students with specific health conditions who are unsafe to attend the field trip activity.

o    Superintendent designee may exclude student from the field trip based on district policy and procedures.

o    Superintendent designee notifies family of administrative decision for student not to attend event due to medical risk to the student.

o    Superintendent designee works with family and school staff to identify an equivalent educational experience.

 

Registered Nurse Training/Delegation:

•       Registered nurse works with teacher to designate a responsible staff member(s) who is assigned to each student with special health needs and/or Emergency Care Plans.

•       Registered nurse, in collaboration with building administrator, identifies appropriate school staff members who are competent, available, and willing to accept responsibility to assist student by following registered nurse’s explicit instructions.

•       Registered nurse delegates specific school staff to administer medication or perform nursing tasks for specific student.

o    Registered nurse may not delegate nursing activities that include:

●        The core of the nursing process (assessment, diagnosis, planning, and evaluation).

●        Or procedures that require specialized knowledge, judgment, and/or skill.

o   Registered nurse holds responsibility for all delegated activities, and therefore the:

•       Registered nurse must decide what may be delegated and what may not be delegated.

•       Registered nurse makes decision according to professional nursing assessment.

•       Registered nurse documents training and delegation.

•       School staff documents receiving and accepting delegation responsibilities by signing the delegation form.

•       Registered nurse files documentation of nurse delegation and staff signature in training/delegation file.

 

Immediately Prior to Trip/School Activity:

•       Registered nurse meets with teacher and/or the responsible staff person who has received training/delegation and gives them the necessary medications, supplies, medication log, and/or Emergency Care Plans for each student with special health care needs and/or life-threatening conditions.

•       Registered nurse reviews proper, legal medication storage procedures with the teacher.

•       Teacher obtains first aid kit.

•       Teacher verifies device for communication to call for help if necessary.

 

Immediately Following Trip/School Activity:

•       Teacher returns medications, supplies, completed medication and/or procedure logs, and other paperwork to the registered nurse.

•       Teacher reports to registered nurse any medical situations that occurred during field trip/activity.

•       Registered nurse and teacher review the medical situation that occurred to evaluate if planning and training was adequate to prepare staff and keep students safe.

 

RESOURCES & REFERENCES

 

•       Guidelines for Medication Administration in Schools, 2015

Schools, as employers, are regulated by Occupational Safety and Health Organization (OSHA) and Washington Industrial Safety and Health Act (WISHA). The Washington State Program is administered by the Department of Labor and Industries (DL&I) and the Division of Occupational Safety and Health (DOSH). There are required topics of annual training for selected employees to meet health and safety requirements.

 

Washington Industrial Safety and Health Act (WISHA) requires two topics of employee training:

•       Blood-Borne Pathogens (BBP) Training WAC 296-823-120.

•       First Aid Training WAC 296-800-15005.

The Revised Code of Washington RCW 70.24.250 to 290 requires that school employees have training for specific content regarding HIV/AIDS:

•       Transmission.

•       Prevention.

•       Treatment.

 

WHAT IS REQUIRED FOR BBP TRAINING?

The following requirements are outlined by WAC 296-823-120

 

•       All new employees receive training.

•       Annual training for all employees with occupational exposure risk.

•       Training by person knowledgeable about the subject matter.

•       Accessibility to agency-specific BBP Exposure Plan.

•       Maintenance of training documentation records.

 

Why:

•       For the health and safety of all employees.

•       Risk management for the school district.

 

For Whom: 

•       Any school district with one or more employees with occupational exposure to blood or other potentially infectious materials (OPIM) is required to comply with the requirements of the blood-borne pathogens standards.

 

When:  

•       Annual training for selected employees.

•       Training at time of employment for all new employees.

 

 

 

 

 

WHAT IS REQUIRED FOR FIRST AID TRAINING?

The following requirements are outlined by WAC 296-800-15005:

 

•       First Aid trained personnel (with current certification) are available to provide quick and effective first aid.

•       First Aid supplies are available.

 

Why:

•       For the health and safety of all employees.

•       Risk management for the school district.

 

For Whom: 

•       Any employee designated by administration to administer first aid.

 

When:  

•       Before the employee’s certification as a First Aid provider expires (every two years)

 

WHAT IS REQUIRED FOR HIV/AIDS TRAINING?

The following requirements are outlined by WAC 392-198-010:

 

•       Content requirements include the transmission, prevention, and treatment of HIV/AIDS.

•       Significant new discoveries or changes in accepted knowledge of transmission, prevention, and treatment for HIV/AIDS are provided to all public school employees.

•       Federal, state, and local resources for HIV/AIDS.

•       Impact of HIV/AIDS on infected individuals and their families.

•       Global impact of HIV/AIDS.

•       Anonymous and confidential testing for HIV antibodies.

 

Why:

•       For the health and safety of all employees.

•       Risk management for the school district.

 

For Whom: 

•       All employees of the school district.

 

When:  

•       At employment: within 6 months.

•       Within one year of notification of new information.

 

PROCEDURAL GUIDELINES, ROLES AND RESPONSIBILITIES:

Sequence of procedures at all times:

1.     School district has policies and procedures in place to conform to BBP, HIV/AIDS, and
First Aid statutes.

2.     School nurse or designee collaborates with district administration to develop training, procedures, documentation of certification, etc.

 

 

REFERENCES & RESOURCES:

 

•       Washington State School Staff Health Training Guide

 

•       See District-Specific Blood-Borne Pathogens Exposure Plan and related policy and procedure

 

OSPI’s Guidelines for Implementation of School Employee Training on HIV/AIDS and Other Bloodborne Pathogens.

The health of migrant students is influenced by a mobile, rural lifestyle. Access to care for health problems may be difficult and unresolved health issues can be a barrier to learning. Physical examinations for migrant students can help to identify health problems so that referral for health services can be instituted and access supported.

 

WHAT IS REQUIRED?

The following requirements are outlined in the Title I Migrant Education Federal Grant:

 

•       Training provided by Migrant Education Health Program (MEHP).

•       Computer with access to Migrant Student Data & Recruitment (MSDR), Migrant Student Information System (MSIS), and Migrant Education Health Programs (MEHP)

•       Physical Exam and Health Data Reporting forms (available from MEHP).

•       Family/Guardian Consent forms, which are electronically generated from the electronic Summary/Claim Form system on MSIS

 

Why:

•       To provide routine physical examinations to migrant students who have difficulty accessing health care due to mobility, poverty, and/or cultural barriers in the host country (language, health practices, etc.).

•       To identify migrant students who have health conditions (including dental).

•       To assist the family to access care for those identified health conditions.

 

For Whom:

•       For all eligible migrant students, especially those with suspected health conditions, no health care provider, and/or health care coverage (Enrolled migrant students are eligible for one physical examination every three years or if they have a current health concern).

 

When:

•       Annually, as requested by the school district via the Migrant Physical Examination Survey, scheduled by Migrant Education Health Program (May be in the fall or spring).

 

PROCEDURAL GUIDELINES, ROLES, AND RESPONSIBILITIES:

Planning:

•       Migrant school staff completes annual Migrant Physical Examination Survey and submits to MEHP.

•       Migrant Education Health Program (MEHP) submits the Migrant Physical Examination Survey and requests the local contractor (who conducts the physical examinations) to schedule dates for migrant physicals and verify date(s) with building principals

•       Registered nurse, migrant records clerk, and home visitor or designated school staff may attend the annual migrant physical training, usually offered in September by the MEHP.

•       Migrant school staff works with the school’s migrant records clerk to draft a list of students who may be eligible to receive a physical exam. This must be submitted in the MSIS electronic Claim/Summary Form program.

•       Migrant records clerk will work with the home visitor to obtain the required family/guardian consent generated electronically on the Claim/Summary Form program and health histories for each student scheduled to receive a migrant physical.

•       Migrant Federal Projects director (FPD) or school staff will create a schedule for the physicals by completing the Migrant Physical Examination Survey sent to the FPD in the spring.

 

Before Exam Date(s):

•       Migrant records clerk completes the top portion of the Migrant Physical Exam forms, including student name, family/guardian name, migrant number, etc.

•       Migrant school staff measures and records each student’s height and weight on the Migrant Physical Exam Form.

•       Migrant school staff conducts vision and auditory screening for students scheduled for a migrant physical.

•       Registered nurse re-screens failed vision and auditory screenings.

•       Migrant school staff completes the areas of the Migrant Physical Exam forms requesting immunization information (may print immunization report from electronic student record, or copy the Certificate of Immunization and attach to the exam form).

•       Registered nurse reviews the Migrant Physical Exam forms and adds information regarding any health condition(s) indicated by the family/guardian on the health history.

•       Migrant school staff submits the schedule for the exams and the completed Family/Guardian Consent forms and health history forms to the local contractor prior to scheduled migrant physical date(s).

•       Migrant school staff provides teachers with the date of the migrant physical with a list of students from their class scheduled to receive a physical, 1-2 weeks prior to scheduled dates.

•       Migrant school staff sends reminder letter to families/guardians of students scheduled for migrant physicals at least 2 weeks prior to physical examination date(s) that:

o   Invites family member(s)/guardian to attend exam (attendance is welcome and preferred, not required).

o   Includes the location, date, and time scheduled for their child’s migrant physical.

 

Day of Migrant Physicals:

•       Migrant school staff or designee escorts students to and from classroom and/or school to location of exam.

•       Registered nurse reviews exam results and referrals on the Migrant Physical Exam forms.

•       Registered nurse collaborates with contractor regarding any questions or concerns documented on the Migrant Physical Exam forms.  

 

Following Exams:

•       Registered nurse or designee (specifically trained to read Purified Protein Derivatives [PPDs]) meets with each student 2 to 3 days following exams to read results of their PPD (screening for tuberculosis) and records the findings on the Migrant Physical Exam forms.

•       Registered nurse or trained designee reports any positive PPD results to the local health jurisdiction for follow-up. If a student has health care insurance and a primary care provider, the student is referred to that provider.

•       Migrant school staff sends letters to family/guardian of students who received a migrant physical, with the results of the physical to include any abnormal findings and referral information. For serious problems, a home visit is required.

•       Migrant records clerk inputs results of exams into the MEHP systems.

 

Follow-up:

•       Registered nurse follows up with students and family/guardian for status regarding referrals or abnormal findings.

•       Registered nurse maintains all migrant physical exam records in a locked file cabinet in health room (See Confidentiality of Student Health Records section).

 

REFERENCES & RESOURCES:

 

 

•       OSPI Migrant Education Program