Communication PartnershipStudent Health Collaboration

Overview – Delaware School Nurses

May 10, 20121

The Challenge

Currently School Nurses are not able to access protected patient information due to the fact they are not routinely recognized as part of the care team.

Exchange of information about the care of students/patients would improve health outcomes for children.

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STORY (Head Injury Example)

During PE class a student received a head injury. He was taken to Nemours ED by the family.

The school nurse followed up with the family who reported, “A deep wound requiring 11 stitches, a slight skull fracture, and a concussion”. The nurse requested the discharge instructions be sent to school.

Two days later the student returned to school, without the discharge instructions.

Nurse’s action: Student restricted from PE class and recess. After several weeks of phone calls to the family requesting documentation, the mother completed a release form for the school nurse.

The records did not indicate a skull fracture or concussion.

Weeks of activity restriction, nurse/parent conflict, and staff frustration could have been avoided if the nurse was able to view the discharge instructions in a timely manner.

AuthorizationFORM

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The Response

Nemours and the Delaware Department of Education formed a multi-disciplinary team that created a process to facilitate the exchange of medical/ educational information between DE School Nurses and Nemours Clinical Providers.

A HIPAA / FERPA compliant authorization form was designed to obtain consent from parent/caregivers to allow school nurses to view the medical records of the students under their care

The authorization form reinforces that school nurses are part of the care team.

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Workgroups

Technology Dave Nichols, Chair Linda Wolfe Dave West Vicki Sanders Sam Strally Mary Zier Ann Hurst Aguida Atkinson Shari Thomassen Jamie Crooms Claudia Kane Beth Light Marina Kaplan

Implementation Design Claudia Kane, Chair Aguida Atkinson Linda Wolfe Vilma Davis Shari Thomassen Ann Hurst Jamie Crooms Vicki Sanders Mary Zier Mary Newman Andrea Littleton Beth Light Pat Guilday Sharon Gandolfo Stefanie VanStan Barbara Wilson

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Evaluation• Luanne Stratton, Chair• Steve Lawless• Linda Wolfe• Stefanie VanStan• Marina Kaplan• Katherine King• Jamie Crooms• Claudia Kane

Information Sharing

Treatment– Asthma

management/action plan– Diabetes care plan– Medications– Allergy

management/action plan– Discharge instructions– PE / Classroom

restrictions

Non-Treatment– Physical

examinations– Immunizations– Letter indicating

the types of activities in which students should be engaged

– Lead levels and TB screening

– Contact information for other care providers

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Educational– Academic

performance– Attendance– Behavioral issues– Frequency of

school nurse visits and for what reason

– Medication/ Treatment compliance

Communication PATHWAY

PATIENT

Authorization

DELAWARE SCHOOL NURSING PRACTICE

SCHOOL NURSES

NEMOURS CLINICIANS

Fax to Nemours

Informatics (V.Sanders)

Abstractor Fax to Nemours

Informatics (V.Sanders)

Send to Health Info

Management – EPIC (M. Zier)

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A web-based portal that provides access to Nemours electronic medical records (EPIC) by community health care providers

A legal contract between Nemours and School District will allow school nurses a user-account in NemoursLink.

School nurses will be able to access current medical information but will not have access to behavioral health records.

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The Partnership

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Student

Benefits

Greater efficiency in accessing current student medical information

Commonality of information seen by school nurse and medical providers

Reinforces information that families are given regarding their child’s care

Minimizes the miscommunication between care providers

Reinforces the school nurse role in the care team during the school year.

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Pilot Sites

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SchoolsRed Clay School District (4 schools)Milford School District (6 schools)

Primary Care Practices St. Francis

MilfordSpecialty SitesEndocrinology

Hematology Oncology ClinicOrthopedicsPulmonology

Role of Pilot Participants

To identify what works and what doesn’t To identify situations in which this process

improved communication and student health To identify success stories To develop workflow ideas, which can be used

universally throughout the partner schools in Delaware

To participate in evaluation interviews

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Next Steps

– School pilot sites will participate in a NemoursLink training

– Pilot sites will be invited to a meeting and greet event (if possible)

– Nemours Evaluation & Research team will reach out to school pilot sites to schedule initial (pre-implementation) interviews

– School nurses and Nemours clinicians will engage in sharing of information across sites

– Address questions coming from pilot sites – Develop plan for expansion into other school

districts and within the school district

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Measuring Success: Pilot

Short term (Process indicators)– Utilization of NemoursLink among school nurses– Reported ease of use and satisfaction

Intermediate– Increased awareness of individual patients’ care plans

among school nurses– Perceptions of improved care coordination– Change in quantity, quality and nature of communication

between school nurses and providers, parents and students

– Less time spent by school nurses on fact checking and searching for information

Timeline ≈ 3 months

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Measuring Success: Full Scale

Same short-term and intermediate outcomes as pilot

Addition: Long-term outcomes– Decreased absenteeism among students– Decreased behavioral problems & discipline

referrals among students– Improved health-related QOL among students– Improved compliance with medications– Changes in health care utilization (ER, PCP visits,

hospitalizations) Timeline: 1−3 years

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Comments from the Field

Pat Guilday – Workgroup Member Rossana Palermo, Warner Elementary,

Pilot Site

Sue Smith – Milford Central Academy, Pilot Site

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