Tasks
Tasks
- Mandated Health Services by RCW:
- Life Threatening Conditions
- Students with Diabetes
- Students with Asthma
- Student with Anaphylaxis
- Students with Epilepsy
- Clean Intermittent Catheterization
- Immunization
- Visual and Auditory Health Screening
Mandated Health Services by RCW:
The Washington State Legislature has created laws that require schools to provide specific health services. These services are mandated. Washington State titles the statutes the “Revised Code of
Washington” (RCW) and supported by rules titled Washington Administrative Code (WAC).
Students need health safeguards in place. In addition, by law, students with specific health care conditions must receive specific services in school or at school-sponsored activities.
The school district is under legal obligation to provide the services that have been legislated if the student and family meet specific criteria.
The following components describing nursing care in this segment of the manual are required by RCW:
•Life Threatening Conditions (40)
•Students with Diabetes (43)
•Students with Asthma (47)
•Students with Anaphylaxis (51)
•Students with Epilepsy (56)
•Clean Intermittent Catheterization (60)
•Immunizations (63)
•Visual and Auditory Health Screening (66)
Other mandated health related tasks indirectly affect student health services. However, these mandates relate to staff training (like Blood-Borne Pathogens and First Aid/CPR). Only those mandates that require care for the student by the registered nurse are covered in-depth in this manual.
Life Threatening Conditions
LIFE THREATENING CONDITIONS:
A “life threatening condition” is defined in RCW 28A.210.320 as “health condition that will put the child in danger of death during the school day if a medication or treatment order and nursing plan are not in place.” A “school day” is defined under RCW 28A.150.203 .
WHAT IS REQUIRED?
The following requirements are outlined in RCW 28A.210.320 and WAC 392-380-005 to 080:
•Identification of Students with Life Threatening Conditions.
•Medical Authorizations.
•Emergency Medications and/or Equipment.
•Nursing (emergency) Care Plans.
•Evaluate for necessary 504 accommodations (See page70)
Because the State RCW 28A.210.320 defines “life threatening condition” as a “health condition that puts a student in danger of death during the school day if a medication or treatment order and a nursing care plan are not in place,” by definition, a student with a “life threatening health condition” has a physical or mental impairment that substantially limits a major life activity, and qualifies as a disabled student under Section 504 for purposes of
Free Appropriate Public Education (FAPE).
Why:
•To protect every student with a life threatening condition
•To prepare and protect school staff members as they respond to anticipated emergencies
For Whom:
•For the school district to establish criteria and/or a process to determine elements and apply those criteria consistently to all students with potentially life threatening conditions
•For every student with a life threatening condition, if a medication or treatment order and a nursing plan are not in place
•For school staff: in-service training to prepare staff to provide care for students with life threatening conditions
When:
•Beginning of each school year, family completes a medical history form (Washington State School Directors Association (WSSDA) model policy 3414)
•Before any student with a life threatening condition attends school
•Annual assessment to create new or update Emergency Care Plans that were developed in the previous school year
How:
•Identify health concerns within the student body (student population assessment)
•Determine acuity of health concerns to determine “Life Threatening”
•Obtain medical authorization, family consent, medications, and/or equipment necessary
•Develop Emergency Care Plan and if needed, an Individual Health Plan
•Implement plan with distribution, notification, training of staff, and delegation to specific staff
•Document distribution, training and delegation of related procedures, and ongoing supervision
• Due process must be in place governing exclusion of students covered by RCW, WAC, 504, IDEA, and district policy
Regularly Review:
•Identify staff members that are new or that need review of emergency care plans.
•Practice again the school systems in place to prevent anaphylaxis (reduce exposure risk to foods, bees, etc.).
•Practice ECP implementation.
•Practice again for staff who must administer inhalers and epinephrine auto-injector in an emergency.
PROCEDURAL GUIDELINES, ROLES AND RESPONSIBILITIES:
Sequence of procedures:
1.School staff members review health registration form and note any health concern identified by family. This form is also known as student health information, and student health history.
2.School staff members give specific health-condition form to applicable families for completion.
3.Registered nurse contacts family to review health history, assess acuity of health condition, and to learn family concerns/preferences regarding student’s health and best methods to assist at school.
4.Registered nurse meets with student to assess self-management and student’s health goals.
5.Registered nurse initiates medical authorization process for administration of emergency medication and/or treatment at school.
6.School staff members accept medical authorization forms for administration of routine and/or emergency medication at school.
7.School staff members accept emergency medications at school from an adult (consider using a sign-in sheet for counting and tracking medications).
8.Registered nurse assesses student health and functioning to determine if medication and order is appropriate for student.
9.Registered nurse reviews emergency medication orders to determine issues that are in the best interest for the student to receive medication at school.
10.Registered nurse ensures that information on the medical authorization, the medication label, and the medication administration record at school are identical.
11.Registered nurse creates a system of storage for emergency medication so that there is immediate access to medication in case of emergency.
12.Registered nurse develops and completes a written emergency care plan that describes explicit step-by-step actions to take, signs of problems that might occur with the procedure, and what actions to take if problems occur.
13.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 the emergency care plan.
Registered nurse delegates as appropriate, the administration of emergency medication to
14.Registered nurse delegates as appropriate, the administration of emergency medication to unlicensed school staff for the identified student.
A 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.
•The 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 according to professional nursing assessment.
15.Registered nurse documents training and delegation.
16.School staff members document receiving and accepting delegation responsibilities by signing delegation form.
17.Registered nurse files documentation of nurse delegation and staff signature in training/delegation file.
18.Registered nurse regularly monitors student’s health status, evaluates systems and plans, and modifies plans as necessary.
19.Registered nurse provides and documents ongoing monitoring and supervision of staff members who provide emergency medication under nurse delegation.
20.Registered nurse notifies building principal of any students with life threatening conditions who are not safe at school due to any requirements that are lacking in this process.
21.Chief Administrator for the school is responsible for enforcing exclusion from school per RCW 28A.210.320, following district policy, procedures, and forms.
22.Protocols must be in place to ensure substitute teachers are informed of the student’s life threatening condition, the location of the ECP and duties associated with implementing the ECP.
For More Information on … LIFE THREATENING CONDITIONS
● OSPI Bulletin No. 61-02 Learning and Teaching Support
September 18, 2002
https://www.k12.wa.us/sites/default/files/public/healthservices/pubdocs/shb2834-essb6641/b061-02.pdf
Students with Diabetes
STUDENTS WITH DIABETES MELLITUS (DM):
The plan of care for students with diabetes is developed by a designated professional school nurse who consults and coordinates with the student, family, and health care providers. The professional school nurse also provides the training and supervision of school district personnel who provide care for students with diabetes in school (excluding specialized training required for a Parent-Designated Adult or PDA).
WHAT IS REQUIRED?
The following requirements are outlined in RCW 28A.210.330 to 350.
● School policy for the Care of Student with Diabetes, including but not limited to:
Accommodations.
Annual All-Staff Training.
●Identification of Students with Diabetes.
●Parental Consents, Parental Authorizations, Medical Authorizations.
●Medications and/or Equipment at school.
●Nursing Care Plans – BOTH Emergency Care Plans and Individual Health Care Plans/504 plan (See American Disability Act—504).
Why:
● Provide safe medical management for students with diabetes, protect students from untoward effects of diabetes, and provide a safe and healthy learning environment for those students.
●To prepare and protect school staff members as they provide care for students with diabetes.
For Whom:
●For all students with diabetes mellitus enrolled in school.
●For school staff: in-service training on symptoms, treatment, and monitoring of students with diabetes.
When:
●Beginning of each school year, family completes a medical history form (WSSDA model policy 3414).
●At the beginning of the school year, school systems must be in place.
●Prior to students attending school:
1. Staff training is complete.
2. Emergency medication and all authorizations are at school.
3. Care plans are written, training provided, and the plans distributed to staff that need to know how to respond to student needs, especially an emergency.
How:
● Identify students with diabetes mellitus.
● Obtain medical authorization and treatment plan, family consent, medications, and equipment.
● Develop IHPs, ECPs, and 504s.
● Implement individualized plans with distribution, notification, and specific staff training on each individual student plan.
● Provide and document general diabetes in-service to all staff. (See Washington State School Staff Health Training Guide)
● Incorporate the role of parent-designated adult (PDA) if the family requests and assigns a PDA.
● Ensure student accommodations regarding accessibility to snacks and medication, school meals, scheduling of exercise, planning for field trips, and possible disaster (transferring student to different location or shelter in place). For more information about 504 accommodations refer to “Parent and Educator Guide to Free Appropriate Public Education” (FAPE).
● Due process must be in place governing exclusion of students covered by RCW, WAC, 504, IDEA, McKinney-Vento and district policy.
PROCEDURAL GUIDELINES, ROLES, AND RESPONSIBILITIES:
Sequence of procedures:
1. School staff members (secretary, registrar, para-educator, etc.) review health registration forms and identify students with diabetes.
2. School staff members provide family with diabetes history form to complete (updated annually).
3. Registered nurse contacts family to review health history, assess acuity of diabetes, and learn family concerns/preferences regarding student’s health status and best methods to assist at school.
4. Registered nurse meets with student to assess self-management and student’s health goals.
5. Registered nurse initiates medical authorization process.
6. School staff members accept medical authorization forms for administration of routine and/or emergency medication at school.
7. School staff members accept medications at school from an adult (consider using a sign-in sheet for counting and tracking medications).
8. Registered nurse assesses student health and functioning to determine if medication and medical authorization are appropriate for student.
9. Registered nurse reviews medical orders to determine issues that are in the best interest for the student to receive medication at school.
10. Registered nurse ensures that information on the medical authorization, the medication label, and the medication administration record at school are exactly the same.
11. Registered nurse prepares a comprehensive, individualized health care plan (IHP) to assist school staff members to monitor and support student to achieve optimum health and ability to learn throughout the school day and at school-sponsored activities. The IHP is to include instructions to assist in the daily management of student's diabetic needs for:
● Accessibility to medications and equipment.
● Permission to monitor glucose and self-medicate as needed in any location.
● Timing of physical exercise.
● Plans for food services accommodations.
● Plans for timing of meals, snacks, and counting carbohydrates.
● Plans for transportation accommodations.
● Plans for school-sponsored activities.
12. Registered nurse prepares explicit, unambiguous instructions in the Emergency Care Plan (ECP) for staff to follow in case of an emergency at school.
13. Registered nurse collaborates with 504 Accommodations Coordinator in the school/district in development of 504 Plan, that for students with diabetes, will include both the ECP and IHP.
14. Registered nurse identifies appropriate school staff members who are competent, available, and willing to accept responsibility to assist student by following the individual health plan (IHP) and the emergency care plan (ECP).
o A 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 The registered nurse holds responsibility for all delegated activities and therefore the registered nurse must decide what tasks may or may not be delegated according to professional nursing assessment.
15. Registered nurse works with PDA, if assigned by the parent, to incorporate the roles and responsibilities of the PDA, school staff, and the registered nurse in the ECP, IHP and 504 Plan so a seamless and coordinated system of care exists in school for the student with diabetes.
When parents request and assign a Parent-Designated Adult (PDA):
RCW 28A.210.330-350 allows parents to designate an adult through proper legal procedures to assist the student in managing his or her diabetes. The statute defines a Parent-Designated Adult as:
● Parent-Designated Adult (PDA) - A volunteer, who may be a school employee, who receives additional training from a health care professional or expert in diabetic care selected by the parents (not school personnel), and who provides care for the child consistent with the individual health plan.
Key points to consider when parents request a PDA (See Appendix D):
● By law, PDA's only provide care for students with diabetes and per RCW 28A.210.260 , students with seizures. PDA's do not provide care for students with other health conditions.
● The district's professional registered nurse in the school is not responsible for the supervision of the PDA for those procedures authorized by the parent that cannot be delegated by the registered nurse in the school setting.
● Parents are responsible for finding and arranging for training and supervising the PDA.
● The district’s professional registered nurse is responsible for assessing, monitoring, responding to, and reporting the student’s health status in school, to school administration, including outcomes associated with care provided by the PDA, etc.
● Building principal and registered nurse meet with family to discuss legal responsibilities of the school, family, and PDA.
● Building principal ensures that all documentation required for PDA (including required training) is completed before PDA may function in the school setting.
● PDAs should renew their training annually in order to remain aware of updated technology and medical best practice related to diabetes care.
Sequence of procedures for student's first day of school:
1. Registered nurse notifies building principal of any students with diabetes that meet criteria of the life threatening conditions RCW 28A.210.320 and who are not safe at school due to any requirements that are lacking in this process, then…
2. Chief Administrator for the school is responsible for enforcing exclusion from school per RCW 28A.210.320, following district policy, procedures, and forms.
Sequence of procedures for beginning of school and annually:
1. Registered nurse provides specific training to staff to follow the IHP and ECP.
2. Registered nurse provides or arranges general training for all school staff regarding symptoms, treatment, and monitoring of students with diabetes.
Sequence of procedures throughout the school year:
1. Registered nurse regularly monitors (may need once daily or multiple times during the school day) student’s health status, evaluates systems and plans, and modifies plans as necessary.
2. Registered nurse provides ongoing training and support to staff members who assist with care of students with diabetes.
3. Registered nurse provides and documents ongoing monitoring and supervision of staff members who provide or assist with medication and treatments under nurse delegation.
4. Protocols must be in place to ensure substitute teachers are informed of the student’s life-threatening condition, the location of the ECP and duties associated with implementing the ECP.
For More Information on … STUDENTS WITH DIABETES
• Guidelines for Care of Students with Diabetes
http://www.k12.wa.us/HealthServices/pubdocs/SHB2834-ESSB6641/B061-02.pdf
• Helping the Student with Diabetes Succeed: A Guide for School Personnel 2012
• Curriculum Standards for Developing Curricula to Train Parent-Designated Adults Working with Diabetes, (2009): https://www.k12.wa.us/sites/default/files/public/healthservices/pubdocs/pdacurriculumstandards.pdf
• Washington State School Staff Heath Training Guide
https://www.nwesd.org/wp-content/uploads/2018/01/Merged-Staff-Training-Guide-9-2017.pdf
Students with Asthma
The plan of care for students with asthma is developed by a designated registered nurse who consults and coordinates with the student, family, and health care providers. The registered nurse also provides the training and supervision of school district personnel who provide care for students with asthma in school.
WHAT IS REQUIRED?
The following requirements are outlined in RCW 28A.210.370:
● School Policy for the Care of Students with Asthma in School.
● Staff Training Regarding Asthma Care at School.
● Asthma Rescue Procedures.
● Parental Consent and Medical Authorizations.
● Emergency Medication at School.
● Demonstration of Competency by Student to School Nurse for Student to Self-Carry and Self-Administer Rescue Medications.
Why:
● Provide safe medical management for students with asthma, protect students from untoward effects of asthma, and provide a safe and healthy learning environment for those students.
● To prepare and protect school staff members as they provide care for students with asthma.
For Whom:
● For every student with asthma who needs rescue medications at school.
● For school staff: in-service training on symptoms, treatment, and monitoring of students with asthma.
When:
● Beginning of each school year, family completes a medical history form (WSSDA model policy 3414).
● At the beginning of the school year, school systems are in place.
● Prior to students attending school:
1. Staff training is complete.
2. Emergency medication and all authorizations are at school.
3. Emergency care plans are written, training provided, and the plans distributed to staff that need to know how to respond to an emergency.
How:
● Identify students with asthma.
● Obtain asthma history, medical authorization, and asthma action plan developed by the health care provider, family consent, medications, and equipment.
● Demonstration of competency by student to registered school nurse for student to self-carry and self-administer rescue medications (including inhalers and Epi-Pens).
● Develop ECPs, IHPs and 504 plans.
● Implement individualized plans with distribution, notification, and specific staff training on each individual student plan.
● Provide and document general asthma in-service to all staff.
(See Washington State School Staff Health Training Guide)
● Ensure student accommodations regarding accessibility to medication, scheduling of exercise, planning for field trips, and possible disaster (transferring student to different location or shelter in place). For more information about 504 accommodations, refer to “Parent and Educator Guide to Free Appropriate Public Education”.
● Due process must be in place governing exclusion of students covered by RCW, WAC, 504, IDEA, McKinney-Vento and district policy.
SYSTEMS, ROLES, AND RESPONSIBILITIES:
Sequence of procedures:
1. School staff members (secretary, registrar, para-educator, etc.) review health registration forms and identify students with asthma.
2. School staff provides family with asthma history to complete (updated annually).
3. Registered nurse contacts family to review health history, assess acuity of asthma, and learn family concerns/preferences regarding student’s health status and best methods to assist at school.
4. Registered nurse meets with student to assess self-management and student’s health goals.
5. Registered nurse initiates medical authorization process.
6. School staff members obtain/accept medical authorization forms for administration of emergency medication at school.
7. School staff members accept routine and emergency medications at school from an adult and use a sign-in sheet for counting medications.
8. Registered nurse assesses student health and functioning to determine if medication and order are appropriate for student.
9. Registered nurse assesses student ability to self-manage, self-carry, and self-administer asthma medication at school.
10. Registered nurse reviews emergency medication orders to determine issues that are in the best interest for the student to receive medication at school.
11. Registered nurse ensures that information on the medical authorization, the medication label, and the medication administration record at school are identical.
12. Registered nurse creates a system of storage for emergency medication so that there is immediate access to medication in case of emergency.
13. Registered nurse prepares individualized, explicit, unambiguous instructions on an Emergency Care Plan for staff to follow in case of an emergency at school.
14. Registered nurse, in collaboration with the building administrator, identifies appropriate school staff members who are competent, available, and willing to accept responsibility to assist student by following the emergency care plan.
15. Registered nurse delegates as appropriate, the administration of emergency medication to unlicensed school staff for the identified student.
• A 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.
The registered nurse holds responsibility for all delegated activities and therefore the registered nurse must decide what tasks may be delegated and what may not be delegated according to professional nursing assessment.
16. Registered nurse documents training and delegation.
17. School staff members document receiving and accepting delegation responsibilities by signing delegation form.
18. Registered nurse files documentation of nurse delegation and staff signature in training/delegation file.
Sequence of procedures for student's first day of school:
1. Registered nurse notifies building principal of any students with asthma that meet criteria of the life threatening conditions RCW 28A.210.320 and who are not safe at school due to any requirements that are lacking in this process, then…
2. Chief Administrator for the school is responsible for enforcing exclusion from school per RCW 28A.210.320, following district policy, procedures, and forms.
Sequence of procedures for beginning of school and annually:
1. Registered nurse provides specific training to staff to follow each student's ECP.
2. Registered nurse provides or arranges general training for all school staff regarding symptoms, treatment, and monitoring of students with asthma.
Sequence of procedures throughout school year:
1. Registered nurse, with other school staff members, remains alert to prevent student contact with triggers generating asthma symptoms or an asthma attack.
2. Registered nurse regularly monitors (may need once daily or multiple times during the school day) student’s health status, evaluates systems and plans, and modifies plans as necessary.
3. Registered nurse provides and documents ongoing monitoring and supervision of staff who provide or assist with asthma medication under nurse delegation.
4. Protocols must be in place to ensure substitute teachers are informed of the student’s life-threatening condition, the location of the ECP and duties associated with implementing the ECP.
For More Information on … STUDENTS WITH ASTHMA
• American Academy of Allergy, Asthma and Immunization
• Asthma and Allergy Foundation of America
• Centers for Disease Control and Prevention
● Taking Asthma Care to School Asthma Management in Educational Settings revised 2013
https://www.k12.wa.us/sites/default/files/public/healthservices/pubdocs/asthmamanual.pdf
Washington State School Staff Health Training Guide: https://www.nwesd.org/wp-content/uploads/2018/01/Merged-Staff-Training-Guide-9-2017.pdf
Student with Anaphylaxis
The plan of care for students with anaphylaxis is developed by a designated registered nurse who consults and coordinates with the student, family, and health care providers. The registered nurse also provides the training and supervision of school district personnel who provide care for students with anaphylaxis in school.
● WHAT IS REQUIRED?
The following requirements are outlined in RCW 28A.210.380:
● School Policy for the Care of Students with Potential Anaphylaxis in School.
● Staff Training Regarding Anaphylaxis Care at School.
● Anaphylaxis Rescue Procedures.
● Parental Consent and Medical Authorizations.
● Emergency Medication at School.
● Demonstration of Competency by Student to School Nurse for Student to Self-Carry and Self-Administer Rescue Medications.
WHAT IS RECOMMENDED?
From OSPI’s Guidelines for Care of Students with Anaphylaxis:
It is recommended school districts follow these guidelines when addressing the treatment of anaphylaxis during the school day:
1. If a student, known to have anaphylaxis, has an exposure or a suspected exposure to an allergen, epinephrine is to be given immediately and the EMS (911) system activated.
2. If a LHP orders the administration of an antihistamine and/or epinephrine, the R.N. may use the Scope of Practice Decision Tree, to determine if a non-licensed staff member may carry out the ECP in accordance with RCW 18.79.040.
It is important to address the unique circumstances for each student while retaining adherence to the scope of nursing practice.
Legislation passed in 2013 allows schools to keep a supply of epinephrine auto-injectors in a designated location based on the number of students enrolled. RCW 28A.210.383.
OSPI has provided guidance for the implementation of this new law which can be found on their Health Services webpage:
Key information from this guidance:
1. A licensed health professional with the authority to prescribe epinephrine auto-injectors may prescribe epinephrine auto-injectors in the name of the school district or school to be maintained for use when necessary. Epinephrine prescriptions must be accompanied by a standing order for the administration of school-supplied, undesignated epinephrine auto-injectors for potentially life-threatening allergic reactions.
- There are no changes to current prescription or self-administration practices for children with existing epinephrine auto-injector prescriptions or a guided anaphylaxis care plan.
- When a student has a prescription for an epinephrine auto-injector on file, the school nurse or designated trained school personnel may utilize the school district or school supply of epinephrine auto-injectors to respond to an anaphylactic reaction under a standing protocol.
- When a student does not have an epinephrine auto-injector or prescription for an epinephrine auto-injector on file, the school nurse may utilize the school district or school supply of epinephrine auto-injectors to respond to an anaphylactic reaction under a standing protocol.
Why:
● Provide safe medical management for students with or without anaphylaxis, protect students from untoward effects of anaphylaxis, and provide a safe and healthy learning environment for all students.
● To prepare and protect school staff members as they provide care for students with anaphylaxis.
For Whom:
● For every student with or without known anaphylaxis who needs rescue medications at school.
● For school staff: in-service training on symptoms, treatment, and monitoring of students with anaphylaxis.
When:
● Beginning of each school year, family completes a medical history form (WSSDA model policy 3414).
● At the beginning of the school year, school systems are in place.
• Prior to students attending school:
1. Staff training is complete;
2. Emergency medication and all authorizations are at school;
3. Emergency care plans are written, training provided, and the plans distributed to staff that need to know how to respond to an emergency.
How:
● Identify students with anaphylaxis.
● Obtain allergy history, medical authorization and anaphylaxis action plan developed by student’s health care provider, family consent, medications and equipment.
● Demonstration of competency by student to registered school nurse for student to self-carry and self-administer rescue medications (including injected epinephrine).
● Develop ECPs, IHPs and 504s.
● Implement individualized plans with distribution, notification, and specific staff training on each individual student plan.
● Provide and document general anaphylaxis in-service to all staff.
● Ensure student accommodations regarding accessibility to medication, scheduling of exercise, planning for field trips, and possible disaster (transferring student to different location or shelter in place). For more information about 504 accommodations, refer to “Parent and Educator Guide to Free Appropriate Public Education”
● Due process must be in place governing exclusion of students covered by RCW, WAC, 504, IDEA, McKinney-Vento and district policy.
SYSTEMS, ROLES, AND RESPONSIBILITIES:
Sequence of procedures:
1. School staff members (secretary, registrar, para-pro, etc.) review health registration forms and identify students with potential anaphylaxis.
2. School staff members provide family with severe allergy history form to complete (updated annually).
3. Registered nurse contacts family to review health history, assess acuity of severe allergy, and learn family concerns/preferences regarding student’s health status and best methods to assist at school.
4. Registered nurse informs school staff immediately (classroom teacher, food services, etc.) to prevent allergen from coming into contact with student to PREVENT anaphylaxis.
5. Registered nurse meets with student to assess self-management and student’s health goals.
6. Registered nurse initiates medical authorization process.
7. School staff members obtain/accept medical authorization forms for administration of emergency medication at school and avoidance of allergen & necessary dietary substitutions for Food Services dept. and give to RN.
8. School staff members accept routine and emergency medications at school from an adult (consider using a sign-in sheet for counting and tracking medications).
9. Registered nurse assesses student health and functioning to determine if medication and order is appropriate for student.
10. Registered nurse assesses student ability to self-manage, self-carry, and self-administer anaphylaxis emergency medication at school.
11. Registered nurse reviews emergency medication orders to determine issues that are in the best interest for the student to receive medication at school.
12. Registered nurse ensures that information on the medical authorization, the medication label, and the medication administration record at school are exactly the same.
13. Registered nurse creates a system of storage for emergency medication so that there is immediate access to medication (both individually prescribed and the school supply of epinephrine auto-injectors) in case of emergency.
14. Registered nurse prepares individualized, explicit, unambiguous instructions on an Emergency Care Plan (ECP) for staff to follow in case of an emergency at school.
15. Registered nurse, in collaboration with the building administrator, identifies appropriate school staff members who are competent, available and willing to accept responsibility to assist student by following the emergency care plan.
16. Registered nurse delegates as appropriate, the administration of emergency medication to unlicensed school staff for the identified student. The 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 according to professional nursing assessment.
o A 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.
• The administration of the school supply stock epinephrine auto-injector to a student without a diagnosed known severe allergy
17. Registered nurse documents training, delegation and supervision.
18. School staff members document receiving and accepting delegation responsibilities by signing delegation form.
19. Registered nurse files documentation of nurse delegation and staff signature in training/delegation file.
Sequence of procedures for student's first day of school:
1. Registered nurse notifies building principal of any students with potential anaphylaxis that meet criteria of the life threatening conditions RCW 28A.210.320 and who are not safe at school due to any requirements that are lacking in this process, then…
2. Chief Administrator for the school is responsible for enforcing exclusion from school per RCW 28A.210.320, following district policy, procedures, and forms.
Sequence of procedures for beginning of school and annually:
1. Registered nurse provides specific training to selected school staff to follow the ECP.
2. Registered nurse provides or arranges general training for all school staff regarding symptoms, treatment (including epi-pen training) and monitoring of students with potential anaphylaxis.
Sequence of procedures throughout school year:
1. Registered nurse regularly monitors (may need once daily or multiple times during the school day) student’s health status, evaluates systems and plans, and modifies plans as necessary.
2. Registered nurse, with other team members, is alert to prevent student contact with any allergen that causes anaphylaxis.
3. Registered nurse provides and documents ongoing monitoring and supervision of staff members who provide or assist with anaphylaxis medication under nurse delegation.
4. Protocols must be in place to inform substitute teachers of the student’s life-threatening allergy, the location of the ECP and duties associated with implementing the ECP.
5. Field Trips must be planned carefully to ensure that the student is NOT EXPOSED to the allergen and that accommodations, medications, staff training and delegation have been completed.
Additional Information on … STUDENTS WITH ANAPHYLAXIS
• Accommodating Children with Special Dietary Needs in the School Nutrition Programs: Guidance for School Food Service Staff (2001) https://www.fns.usda.gov/school-meals/guidance-and-resources
• CDC Food Allergies in School http://www.cdc.gov/healthyyouth/foodallergies/
• Food Allergy Research and Education (FARE) http://www.foodallergy.org/
• Guidelines for the Care of Students with Anaphylaxis http://www.k12.wa.us/HealthServices/Publications/09-0009.aspx
Washington State School Staff Health Training Guide https://www.nwesd.org/wp-content/uploads/2018/01/Merged-Staff-Training-Guide-9-2017.pdf
Students with Epilepsy
The plan of care for students with epilepsy is developed by a designated registered nurse who consults and coordinates with the student, family, and health care providers. The registered nurse also provides the training, delegation and supervision of school district personnel who provide care for students with epilepsy in school.
WHAT IS REQUIRED?
Some students with epilepsy may have a life-threatening health condition as defined in RCW 28A.210.320 (See Life Threatening Health Condition).
Additionally, RCW 28A.210.260 (section 5) addresses the requirements for the administration of legend nasal spray emergency medication for seizure management. Other requirements for emergency care plans go into effect for the 2022-23 school year RCW 28A.210.355:
● Identification of Students with Epilepsy.
● All students with epilepsy or other seizure disorder should have an individual healthcare plan.
o School Policy for the accommodations and care of students with Epilepsy or other seizure disorders in school. ((WSSDA policy #3411)
● Staff Training Regarding Seizure Care at School.
● Emergency Care Plans for students with seizures.
● Parental Requests, Instruction, Consent and Medical Authorizations for the monitoring and treatment of seizures while the student is at school.
● Provision and storage of Emergency Medication and/or Equipment at School.
Why:
• Provide safe medical management for students with epilepsy, protect students from untoward effects of epileptic seizures, and provide a safe and healthy learning environment for those students.
• To prepare and protect school staff members as they provide care for students with epilepsy.
For Whom:
• For every student with seizures.
• For school staff: in-service training on symptoms, treatment, and monitoring of students with epilepsy.
When:
• Beginning of each school year, family completes a medical history form (WSSDA model policy 3414).
• At the beginning of the school year, school systems are in place.
• Prior to students attending school:
o Staff training is complete;
o Emergency medication and all authorizations are at school;
o Emergency care plans are written, training provided, and the plans distributed to staff that need to know how to respond to an emergency.
How:
• Identify students with epilepsy.
• Obtain seizure history, medical authorization and treatment plan, family consent, medications, and equipment.
• Develop IHPs, ECPs, and 504s.
• Implement individualized plans with distribution, notification, and specific staff training on each individual student plan.
• Provide and document general seizure management in-service to all staff.
• Incorporate the role of parent-designated adult (PDA) if the family requests and assigns a
PDA.
● Ensure student accommodations regarding necessary medication, emergency school health services, planning for field trips, and possible disaster (transferring student to different location or shelter in place). For more information about 504 accommodations refer to “Parent and Educator Guide to Free Appropriate Public Education” (FAPE).
• Due process must be in place governing exclusion of students covered by RCW, WAC, 504, IDEA, McKinney-Vento and district policy.
SYSTEMS, ROLES, AND RESPONSIBILITIES:
Sequence of procedures:
1. School staff members (secretary, registrar, paraprofessional, etc.) review health registration forms and identify students with epilepsy.
2. School staff members provide family with seizure history form to complete (updated annually).
3. Registered nurse contacts family to review health history, assess acuity of seizures, and learn family concerns/preferences regarding student’s health status and best methods to assist at school.
4. Registered nurse initiates medical authorization process.
5. School staff members obtain/accept medical authorization forms for administration of emergency medication at school.
8. School staff members accept routine and emergency medications at school from an adult
(consider using a sign-in sheet for counting and tracking medications).
9. Registered nurse assesses student health and functioning to determine if medication and order is appropriate for student.
11. Registered nurse reviews emergency medication orders to determine issues that are in the best interest for the student to receive medication at school.
12. Registered nurse ensures that information on the medical authorization, the medication label, and the medication administration record at school are exactly the same.
13. Registered nurse creates a system of storage for emergency medication so that there is immediate access to medication in case of emergency.
14. Registered nurse prepares individualized, explicit, unambiguous instructions on an
Emergency Care Plan (ECP) for staff to follow in case of an emergency at school.
15. Registered nurse, in collaboration with the building administrator, identifies appropriate school staff members who are competent, available and willing to accept responsibility to assist a student by following the emergency care plan.
16. Registered nurse delegates as appropriate, the administration of emergency medication to unlicensed staff for the identified student.
• A registered nurse may not delegate nursing activities that include:
o The core of the nursing process (assessment, diagnosis, planning and evaluation) or procedures that require specialized knowledge, judgment, and/or skill.
● The 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 according to professional nursing assessment.
17. Registered nurse documents training, delegation and supervision.
18. School staff members document receiving and accepting delegation responsibilities by signing delegation form.
19. Registered nurse files documentation of nurse delegation and staff signature in training/delegation file.
When parents request and assign a Parent-Designated Adult (PDA):
RCW 28A.210.260 and RCW 28A.210.355 allows parents to designate an adult through proper legal procedures to assist the student in managing his or her epilepsy. The statute defines a Parent-Designated Adult as:
• Parent-Designated Adult (PDA) - A volunteer, who may be a school employee, who
receives additional training from a health care professional or expert in epilepsy or other seizure disorder care, selected by the parents (not school personnel), and who provides care for the child consistent with the individual health plan.
Key points to consider when parents request a PDA (See Appendix D):
• By law, PDA's only provide care for students with epilepsy or diabetes (PDA's do not provide care for students with other health conditions).
• The district's professional registered nurse in the school is not responsible for the
supervision of the PDA for those procedures authorized by the parent for the PDA to provide, and cannot be delegated by the registered nurse in the school setting.
• Parents are responsible for finding and arranging for training and supervising the PDA.
• The district’s professional registered nurse is responsible for assessing, monitoring,
responding to, and reporting the student’s health status to school administration,
including outcomes associated with care provided by the PDA, etc.
• Building principal and registered nurse meet with family to discuss legal responsibilities of the school, family, and PDA.
• Building principal ensures that all documentation required for PDA (including required
training) is completed before PDA may function in the school setting.
• PDAs should renew their training annually in order to remain aware of updated technology and medical best practice related to seizure care.
Sequence of procedures for student's first day of school:
1. Registered nurse notifies building principal of any students with epilepsy that meet criteria of the life threatening conditions RCW 28A.210.320 and who are not safe at school due to any requirements that are lacking in this process, then…
2. Chief Administrator for the school is responsible for enforcing exclusion from school per
RCW 28A.210.320, following district policy, procedures, and forms.
Sequence of procedures for beginning of school and annually:
1. Registered nurse provides specific training to selected school staff to follow the ECP.
2. Registered nurse provides or arranges general training for all school staff regarding symptoms, treatment and monitoring of students with epilepsy.
Sequence of procedures throughout school year:
1. Registered nurse regularly monitors (may need once daily or multiple times during the school day) student’s health status, evaluates systems and plans, and modifies plans as necessary.
2. Registered nurse provides ongoing monitoring and supervision of staff members who provide or assist with seizure management under nurse delegation.
3. Protocols must be in place to ensure substitute teachers are informed of the student’s life-threatening condition, the location of the ECP and duties associated with implementing the ECP.
For More Information on … STUDENTS WITH Epilepsy
• Centers for Disease Control and Prevention: Epilepsy in Schools
https://www.cdc.gov/healthyschools/npao/epilepsy.htm
• Epilepsy Foundation Education Programs: School Nurses
http://www.epilepsy.com/get-help/services-and-support/education-programs
• Seattle Children's Outreach Education resource:
Seizure Management and Seizure Rescue Medications Online Video Library
o Guidelines for Medication Administration in Schools: https://www.k12.wa.us/sites/default/files/public/healthservices/pubdocs/guidelinesformedicationadministrationinschools.pdf
Clean Intermittent Catheterization
The insertion of a clean catheter into the urinary bladder to empty urine several times during the day for students who do not have functional bladder emptying.
WHAT IS REQUIRED?
The following requirements are outlined in RCW 28A.210.280 and WAC 246-840-820:
• Clean Intermittent Catheterization – Assisted Self-Catheterization.
• Clean Intermittent Catheterization – Catheterization by School Staff.
• Training and Supervision of Unlicensed Staff.
• Parental Consent and Medical Authorizations.
Why:
Most people empty their bladders by going to the bathroom four or five times a day. When the bladder is not emptied, infections or other problems may occur. Some medical conditions interfere with the sensation and ability to empty the bladder. Clean Intermittent Catheterization (CIC) can prevent serious consequences of bladder dysfunction.
• To provide safe medical management for students needing CIC, protect students from untoward effects of CIC, and provide a safe and healthy learning environment for those students.
• To prepare and protect school staff members as they provide care for students needing CIC.
For Whom:
• For every student who requires CIC at school.
• For school staff who assist with or perform CIC: in-service training and ongoing supervision on procedures and symptoms of complications of CIC.
When:
• Whenever family and health care provider requests CIC to be performed at school.
• Prior to staff performing or assisting with CIC, staff has training and supervision by RN.
• Prior to delegation process being completed and staff being prepared to provide CIC, family may come to school to perform CIC.
PROCEDURAL GUIDELINES, ROLES, AND RESPONSIBILITIES:
Sequence of procedures (to be performed at any time):
1. Family responsibilities:
• Requests CIC at school and gives written authorization for CIC to be performed in school.
• Obtains and brings signed medical authorization signed by health care provider with information about the procedure and orders for the procedure to be performed at school, including directions and frequency of CIC treatment.
2. Registered nurse initiates medical authorization process if not completed by family.
3. School staff members accept medical authorization for CIC at school and give to registered nurse.
4. Registered nurse assesses student health and functioning (with student and parent) to determine if CIC and order is appropriate for student.
5. Registered nurse reviews CIC orders to develop instructions specific to the needs of the student to receive CIC at school.
6. Registered nurse develops an Individual Health Plan (IHP) consistent with health care provider orders. IHP describes explicit step-by-step actions of the procedure, signs of problems that might occur with the procedure, and what actions to take if problems occur.
7. Registered nurse develops format for documentation of CIC procedure consistent with health care provider orders. Form is to be completed by school staff members trained to perform CIC.
8. Registered Nurse develops or ensures that documentation of care form is consistent with health care provider orders.
9. Registered nurse, in collaboration with building administrator, identifies appropriate school staff members who are competent, available, and willing to accept responsibility to provide or assist with CIC for student.
10. Registered nurse delegates specific school staff to perform or assist with CIC for a specific student. The 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 according to professional nursing assessment.
A registered nurse may not delegate nursing activities that include:
o The core of the nursing process (assessment, diagnosis, planning and evaluation) or procedures that require specialized knowledge, judgment, and/or skill.
11. Registered nurse documents training and delegation.
12. School staff members document receiving and accepting delegation responsibilities by signing delegation form.
13. Registered nurse files documentation of nurse delegation and staff signature in training/delegation file.
14. Registered nurse regularly monitors (often daily) student’s health status, evaluates systems and plans, and modifies plans as necessary.
Sequence of procedures for student's first day of school:
1. Registered nurse ensures that appropriate staff are trained and that all necessary forms and equipment are in place so that student can safely attend school.
Sequence of procedures throughout school year:
1. Registered nurse regularly monitors (may need once daily or multiple times during the school day) student’s health status, evaluates systems and plans, and modifies plans as necessary.
2. Registered nurse provides ongoing monitoring and supervision of staff members who provide or assist with clean intermittent catheterization under nurse delegation. Supervision is documented.
For More Information on … CIC
• Catheterization of public and private school students
• Provision for clean, intermittent catheterization in schools
• Catheterization of students — Rules
Immunization
It is the judgment of the legislature that it is necessary to protect the health of the public and individuals by providing a means for the eventual achievement of full immunization of school-aged children against certain vaccine-preventable diseases.
WHAT IS REQUIRED?
• The requirements are outlined in RCW 28A.210.060 to 170 and WAC 180-38-005 to 070. Each year, the Washington State Department of Health publishes the Required Vaccines for School Attendance for the upcoming school year. It is the school’s responsibility to know the requirements and to adequately screen the students for compliance.
• As of 2020, all new immunization documentation needs to be medically verified per WAC 246-105-050. Parents must turn in a certificate of immunization using one of the approved methods outlined in Acceptable Versions of a Certificate of Immunization Status.
• Effective August 1, 2020, RCW 28A.210.080 and WAC 392-380-045 specify that the attendance of every child at every public and private school shall be conditioned upon the presentation before or on the first day of school, proof of full immunization, the initiation of a schedule of immunization or a certificate of exemption. In addition, the chief administrator of each public school shall prohibit the further presence at school for each student who has failed to provide proof of immunization. Students who are covered under the McKinney-Vento Act may not be excluded. Written notice of exclusion must be provided as set forth in WAC 392-380-050.
• In May of 2011, the Washington State Legislature passed SB5005 which amends part of the immunization codes. This law is known as the Washington Immunization Exemption Law. For specific guidance about implementation of Immunization Exemption Law, visit the Department of Health Immunization Program: School and Child Care Exemptions from Immunization Requirements.
o Children who are in the process of completing their required immunizations may remain in school in what is called a conditional status. FAQ About Conditional Immunization Status.
Why:
• Protection of students and staff from vaccine-preventable illness.
For Whom:
• Washington State immunization requirements apply to every student enrolled in school.
By Whom:
• The School Nurse plays an important role in educating staff and parents and interpreting immunization data to meet State immunization requirements, however, a team of staff designated by a school administrator is necessary for the collection, recording and filing of pertinent and current student immunization data.
When:
• Before any student attends school.
• Annual notification to families of students in selected grades regarding specific diseases and resources. See RCW 28A.210.080
o Beginning with sixth grade entry, every public and private school in the state shall provide parents and guardians with information about meningococcal disease and the meningococcal vaccine at the beginning of every school year.
o Beginning with sixth grade entry, every public school in the state shall provide parents and guardians with information about human papillomavirus and the HPV vaccine at the beginning of every school year.
• On November 1st of each school year, unless otherwise notified, the annual immunization report is due to Washington State Department of Health. http://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/SchoolStatusReporting.
• The School Module is the preferred reporting method: https://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/SchoolModule
How:
• Family presents immunization record at initial registration and/or before student attends school.
• Documentation of required immunizations on Certificate of Immunization Status (CIS) form completed by the family and accompanied by medically verified information OR.
• School staff may generate a student’s electronic record system CIS form from the Washington State Immunization Information System (WSIIS). For more information about WSIIS: https://waiis.doh.wa.gov/iweb/ OR
• Parents and families may register at MyIR to obtain a printed CIS.
• Family signature on CIS form is only required if the student enters in conditional status or if data from the WSIIS system will be entered onto the CIS from the school module.
• Information is given to families of students in specific grades as required by legislation.
o Due process must be in place governing exclusion of students covered by RCW, WAC, 504, IDEA, McKinney-Vento, and district policy.
PROCEDURAL GUIDELINES, ROLES, AND RESPONSIBILITIES:
Annually:
• Review current immunization statutes and rules for schools (may change annually) and develop a plan for implementation and compliance with the statutes. http://www.doh.wa.gov/YouandYourFamily/Immunization/SchoolandChildCare
• School staff members ensure that current laws regarding family notification of specified diseases and resources are carried out.
Procedures at registration:
• Family completes, signs, and dates Certificate of Immunization Status (CIS) and provides validated records of vaccination or a copy of the CIS can be printed from the IIS by either the school staff or parent, as listed above.
• School staff members review CIS immunization record completed by family for accuracy and compliance.
• School staff members notify family of student immunizations requirements that are not compliant with school district policy and procedures and state immunizations requirements for schools.
• School staff members transfer immunization information into electronic student database or, for schools participating in the DOH School Module, verify school module for completed immunization information. If school module immunizations are not complete for student, school staff requests validated records from family for entry into the module.
• School staff members inform families of immunization resources in the community if needed.
• Registered nurse is available to consult with school staff regarding any questions about immunization records.
• School staff members notify building principal and school nurse of any students out of compliance.
• Chief Administrator for the school is responsible for enforcing exclusion from school per RCW 28A.210.080 and WAC 392-380-045 following district policy, procedures, and forms.
Sequence of procedures on November 1st:
1. Designated school staff member or school nurse submits annual immunization report to the Department of Health. Schools participating in the DOH School Module will have the report automatically generated.
2. Department of Health Immunization Program notifies schools of any changes in report requirements or timing of report submission.
Sequence of procedures in case of student with compromised immunological status in school:
1. Registered nurse notifies principal and classroom teacher that immunocompromised student could be at risk if they are exposed to un-immunized or under-immunized students.
2. Registered nurse, health care provider, family, teacher, and principal determine risk and develop plan for immunocompromised student’s safety against vaccine-preventable illness.
Sequence of procedures in case of disease outbreak:
1. County medical officer or state medical officer determines disease outbreak status.
2. Registered nurse reviews immunization status for student body and staff to identify persons who are not adequately immunized. Individuals with known impaired immunity due to disease or medical treatments will be included in the School Susceptible List.
3. Registered nurse collaborates with county medical officer or state medical officer and communicates with district administration.
4. County medical officer or state medical officer may order student(s) and/or staff member(s) who do not have documentation of adequate immune status from vaccine-preventable diseases, to be excluded from school.
5. County medical officer or state medical officer may order school closure.
For More Information on … IMMUNIZATIONS
• Immunization Manual for Schools, Preschools, and Child Care Facilities; Department of Health, http://www.doh.wa.gov/Portals/1/Documents/Pubs/348-124_ImmunizationSchoolManual.pdf
• Washington State Immunization Information System (WAIIS), (formerly Child Profile Immunization Registry). If your school is not currently enrolled in the WAIIS system, the process is outlined on their website,https://waiis.doh.wa.gov/iweb/
• School Immunization Status Reporting http://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/SchoolStatusReporting
Vaccine Safety http://www.doh.wa.gov/YouandYourFamily/Immunization/VaccineSafety
Visual and Auditory Health Screening
Every Board of school directors shall have the power, and it shall be their duty, to provide screening of the visual and auditory acuity of all children attending schools in their districts to ascertain which, if any, of such children have defects sufficient to impact their ability to learn.
In 2016, the Washington State Legislature amended the vision screening law to include both distance and near vision screening (see SB 6245).
WHAT IS REQUIRED?
The requirements are outlined in RCW 28A.210.020 and WAC 246-760-001-100.
Note: Before screening, students with previously identified visual or auditory problems should be contacted to ensure they have had the necessary follow-up and appropriate corrective lenses or hearing aids. Teachers should be alerted to ensure students are using their corrective devices at school. Children with corrective lenses for distance viewing should be screened wearing their corrective lenses.
Why:
• Early identification and referral for correction of vision and/or auditory problems that may interfere with learning and to prevent long-term effects from any deficits.
For Whom:
• All students in grades K, 1, 2, 3, 5, and 7 annually (except those who are under medical care and have had a recent evaluation).
• Any student showing signs or symptoms of possible lack of auditory or visual acuity referred to the district by parents, guardians, school staff, or student self-report.
• If resources and time permit, schools shall annually screen students at other grade levels.
When:
• As early as possible in the school year and if at all possible, within the first half of the year (for both vision and auditory screenings).
• Vision rescreening timing is not regulated by state guidelines. Rescreening is necessary if the first screening is performed by a lay person. It may be done immediately, within two weeks, or as soon as possible before referring to a licensed vision care professional for students who did not meet “pass” criteria on initial vision screening Auditory rescreening must be done within 6 weeks of initial auditory screen for students who did not meet “pass” criteria.
• Calibrate audiometer annually.
How:
• Work with Lions Club and other local resources for vision resources.
• Clarify registered nurse role in screening (serving as consultant for re-screens and referrals).
• Identify and train screening team (may use school staff and/or volunteers).
• Finalize schedule for vision/hearing screenings (grades K, 1, 2, 3, 5, and 7).
• Prepare paperwork for screenings: classroom lists, etc.
• Ensure completion of screenings.
• Complete re-screenings and referrals (staff assists with documentation of screening results and mailing referral letters to parents).
• Set up procedure school-wide (preferably schedule when the school calendar is being developed at the end of the previous school year) to minimize interruption of learning.
• Conduct screenings in an environment free of extraneous noise and distraction.
• Screen and document findings for each student as “pass/fail” or indicate the actual numeric results.
• Re-screen students who do not “pass” initial vision screen when the first screening is done by a lay person. Vision rescreening is at the discretion of the school nurse, principal, or principal designee when the first screening is done by the school nurse
• Document results of the re-screen or reason for referral if other than screening results.
• Notify teachers of students who meet referral criteria so that the teacher can provide classroom accommodations until the student has further assessment of the vision or auditory concern.
• Notify families in writing to seek a vision and/or auditory examination for all students who meet referral criteria.
• In addition, if school personnel observe a child with other signs or symptoms related to vision or hearing problems, and if the signs and symptoms negatively influence the child in his or her studies, school personnel shall make a referral to the school nurse for evaluation.
• Follow up with families and teachers regarding students who need vision and/or auditory assistance.
VISION SCREENING ROLES AND RESPONSIBILITIES:
Visual and auditory screening of pupils — Rules and regulations. RCW 28A.210.020
Persons performing visual screenings may include (but are not limited to) ophthalmologists, optometrists, and opticians who donate their professional services to schools or school districts. If a vision professional who donates his or her services identifies a vision defect sufficient to affect a student’s learning, the vision professional must notify the school nurse and/or school principal in writing and may not contact the parents or guardians directly. A school official shall inform parents or guardian of student, in writing, recommending further visual examination; however, the name or contact information of the vision professional donating time and conducting the screening may not be communicated.
PROCEDURAL GUIDELINES:
Sequence of procedures at beginning of school:
1. School Staff coordinate with all teachers, including special education, to set up screening schedules.
2. School staff members schedule training for school staff or volunteers who do initial screens.
3. Registered nurse or community vision professional volunteer train volunteers and/or school staff on screening techniques and competencies.
4. School staff members prepare equipment, paperwork, location, and times for screening to be completed.
Sequence of procedures on day of initial screening:
1. School staff members and volunteers organize, oversee, perform, and document initial screening results.
Sequence of procedures after initial screen:
1. Registered nurse completes vision re-screens of those students not meeting “pass” criteria – either immediately, within two weeks or as soon as possible after initial screen if initial screening was done by a lay person. For students who do not meet “pass” criteria when the initial screener is the school nurse, principal, or designee, then student may be referred immediately or re-screened at the discretion of the school nurse.
2. Registered nurse completes auditory re-screens within 6 weeks of initial auditory screen.
3. Registered nurse notifies and works with teachers regarding students who meet referral criteria.
4. Under the school nurse, principal, or designee’s direction, school staff members notify families of students who do not pass vision and/or auditory rescreen and refer for professional evaluation. For vision referrals, a written referral shall indicate that school-based vision screening is not a substitute for a comprehensive eye examination and recommend that the parent or guardian take the child for a comprehensive vision examination.
5. School staff members document referrals and follow-up.
6. Registered nurse assists families in health care access and any other barriers to completing referral and acquiring vision or auditory corrections or treatment.
Sequence of procedures after corrective devices are obtained:
1. Registered nurse works with teachers and students to ensure vision and/or auditory corrective devices are available and used at school.
Registered Nurse works with Special Ed. Director and 504 team to determine and write 504 accommodations if necessary.