Getting Started: Understanding School Health Services Program Requirements

Karen Erwin, RN, MSNEducation School Nurse Consultant

July, 2014

Federal law: IDEA – 34 CFR 300.34 (13) Section 504 of the Rehabilitation Act 1973 HIPAA

FERPA

State laws: KRS 156.502 KRS 314.021 All other federal (CFR), state laws (KRS) and administrative regulations (KAR) compliment these

Listing of all laws on health services delivery available in KDE Health Services Reference Guide (2012) http://education.ky.gov/districts/SHS/Pages/Health-Services-Reference-Guide.aspx

What are the laws ?

Statutes are laws that mandate a requirement or compliance

Ex: KRS 156.160 requires written standards for school entrance: physical exam, vision

exam, dental exam, immunizations, etc. Administrative Regulations describe the way

a statute (law) will be implemented Ex. 702 KAR 1:160 School Health Services describes when student must have physical exam, vision and dental exams, immunizations,

forms to be used and how these records will be kept at school

Statues and Regulations

Bill introduced into House or Senate and assigned to a committee

Committee determines whether bill will pass out of committee or not

If passed out of committee, voted on by first legislative chamber (House or Senate)

If passed, goes to other chamber (House or Senate)

If both chambers vote to pass bill, goes to Governor to be signed into law

How a bill becomes law

Statutes (laws) describe role of the local school board, student enrollment requirements, attendance requirements and school health services administration

Regulations provide more information regarding the implementation and compliance of the statutes

KY Education Laws/Regulations

Is a Kentucky Education statute (law) Requires school districts to provide any necessary health

service to student who needs the health service to attend school or a school sponsored function

Does not specify how school district is to provide the service, only says they must provide it ( gives flexibility to school district)

KRS 156.502

Defines school health services as1. Administration of medications2. Operation or maintenance of health care through

use of medical equipment3. Administration of a clinical procedure4. Does not include ER meds or first aid

KRS 156.502

Only RN, APRN or MD may delegate a health service to unlicensed school personnel

Delegated health service must be something that is within the RN, APRN or MD scope of practice to delegate

Provides exemption from liability for unlicensed school personnel if trained and delegated according to KRS 156.502

KRS 156.502

Administrative Regulation

Describes health exams and forms necessary for employment or to enroll in school:

1. School employee physical exam 2. Student preventative physical exam

3. Immunizations 4. Vision exam 5. Dental exam or dental screening

702 KAR 1:160 School Health Services

Mandates use of provided standardized training materials in training of unlicensed school personnel who are delegated to administer a school health service (medications or a procedure)

References requirements for school health room

702 KAR 1:160 School Health Services

Describes health records to be kept (student cumulative record)and how records may be stored

1. Student Cumulative Folder (paper file) “green card” 2. Electronically via KY Student Information System (KSIS-Infinite Campus)

702 KAR 1:160 School Health Services

Promote health and prevent disease

Statutes include: 1. Immunization Requirements 2. Immunization Exemptions 3. Closing of school for epidemic

KY Public Health Laws and Regulations

Regulations include: 1. Immunization Schedule 2. Immunization Reporting 3. School Sanitation and first aid

requirements

KY Public Health Laws and Regulations

KY Board of Nursing is the licensing agency and determines the scope of nursing practice, including in the school setting

Statues describe the scope of practice for APRN, RN and LPN

Regulations describe implementation of scope of practice

School Nursing Laws

Unlicensed school personnel do not have a “scope of practice” and must be supervised

School nurses must know state’s nursing laws, nursing scope of practice, as well as education laws on providing school health services!

School Nursing Laws

School Policy- a document that states how the school district will implement a statute and/or regulation

Provide support and directs protocols or procedures

Policies may protect schools, employees and/or students

School districts may subscribe to KY School Board Association (KSBA) policy writing service. Service provides template which district can “tweak”

Local School Policy and Procedures

Protocols/Procedures-step by step actions on implementing the related policy; may not require local board approval

▶ Local school board policy/procedure must comply with the state’s stature (KRS) and/or administrative regulation (KAR)

Local Site Based Councils must comply with school board policy

Standardized Kentucky School Forms Preventative physical exam Vision exam Dental screening or Dental Exam Immunization form KY Sports Physical (KHSAA)

School District Forms Student Health History Authorization for treatment

Forms

Some school district contract with an outside provider (LHD) for school health services

School district policies and procedures that have been established by the local school board of education govern all activities and staff that operate on all school properties

Contract between the school district and contracting agency needs to include language for compliance with school policies, procedures and school forms

Contracted School Health Services

Superintendent- “CEO” for school district Assistant Superintendent/Deputy Superintendent- Assists

in district operations Director of Pupil Personnel(DPP)- involved with student

attendance, truancy, day to day operations of school district

District Health Coordinator-Responsible for oversight of all school health services, including necessary services for school sponsored functions

Important People to Know

School Principal- Building level school administrator School Nurse – RN may be assigned to perform daily school nursing services, or may serve as role of School Health Coordinator.

School nurse may also be an LPN, but must be supervised by an RN

Important People to Know

▶Community stakeholders – local health departments, hospitals, physician offices

▶FRYSC- Family Resource Youth Service Center Director

Important People to Know

▶School Health Technician- (2014) an unlicensed school employee hired for the purpose of assisting the RN in the administration of school health services and has completed all the training requirements per KRS 156.502

▶Unlicensed school personnel- school employee who consents to be trained and delegated to provide a health service per KRS 156.502

Important People to Know

Schools must provide health services for student to be able to attend school or school sponsored function

KDE’s Health Services Webpage excellent resource for forms, laws, resource manuals, etc.

http://education.ky.gov/districts/SHS/Pages/default.aspx

Things to Remember

KDE Health Services Reference Guidehttp://education.ky.gov/districts/SHS/Pages/Health-Services-Reference-Guide.aspx School District Policies & Procedures available at local

school district central office (KSBA policy manual code for Students (09)

Kentucky Board of Nursing http://www.kbn.ky.gov/▶ National Association for School Nurses (NASN) http://www.nasn.org/

Resources

Karen Erwin, KDE School Nurse Consultant Karen.Erwin@education.ky.gov

Sandi Clark, KY DPH School Health Nurse Consultant

SandiK.Clark@ky.gov

Contact Information