KDE School Health KDE School Health ServicesServices

Karen Erwin, RN, MSNKaren Erwin, RN, MSNEducation School Nurse Education School Nurse

ConsultantConsultantJuly 13, 2010July 13, 2010

School Nurse Consultant School Nurse Consultant RoleRole

KRS 156.501KRS 156.501 Consults with school districts, local Consults with school districts, local

health departments, local boards of health departments, local boards of education, other statewide education, other statewide stakeholders, etc. to improve the stakeholders, etc. to improve the delivery of school health services delivery of school health services (administration of medication, the (administration of medication, the operation, maintenance or health care operation, maintenance or health care through use of medical equipment; or through use of medical equipment; or the administration of clinical the administration of clinical procedures-KRS 156.502)procedures-KRS 156.502)

Works with state and national stakeholders to Works with state and national stakeholders to improve school health services in Kentuckyimprove school health services in Kentucky

Provides technical assistance, information Provides technical assistance, information and resources to school districts, local health and resources to school districts, local health departments that relate to the provision of departments that relate to the provision of school health servicesschool health services

Facilitates collection of school health services Facilitates collection of school health services datadata

Email: Email: Karen.Erwin@education.ky.gov Phone: 502-564-5625Phone: 502-564-5625

School Health ServicesSchool Health ServicesKRS 156.502KRS 156.502

Requires that school districts provide Requires that school districts provide school health services & defines health school health services & defines health services: services:

1. Administration of medications1. Administration of medications

2. Operation, maintenance or health 2. Operation, maintenance or health

care through use of medical care through use of medical equipment equipment

3. Administration of clinical 3. Administration of clinical proceduresprocedures

Does not detail how school health Does not detail how school health services are to be administered services are to be administered (local school district decision)(local school district decision)

KY Nursing Laws on delegation must KY Nursing Laws on delegation must be followed be followed

Provides exemption from liability for Provides exemption from liability for unlicensed school personnel if KY unlicensed school personnel if KY Nursing Laws (KRS 314) and KRS Nursing Laws (KRS 314) and KRS 156.502 are followed156.502 are followed

School Policies and School Policies and ProceduresProcedures

All school districts are responsible for All school districts are responsible for writing their own policies and writing their own policies and procedures; many utilize policy KSBA procedures; many utilize policy KSBA policy writing servicepolicy writing service

Most school district Policies & Most school district Policies & Procedures online: School Health Procedures online: School Health Policies for medication administration- Policies for medication administration- 09224, 09224109224, 092241

Policies for medication administration: Policies for medication administration:

09224 or 092241 with AP 1 or AP2109224 or 092241 with AP 1 or AP21

Family Education Rights Protection Family Education Rights Protection Act (FERPA ) governs confidentiality Act (FERPA ) governs confidentiality for all student education recordsfor all student education records

Student education records Student education records include include student health services recordsstudent health services records

Contracting for School Contracting for School Health ServicesHealth Services

School Health Coordinator School Health Coordinator 504 and IEP Coordinator504 and IEP Coordinator School Board Policies and School Board Policies and

ProceduresProcedures Specific Contract languageSpecific Contract language

Health RecordsHealth Records

Immunization CertificateImmunization Certificate Vision ExamVision Exam Physical Exam FormsPhysical Exam Forms Sports Physical FormSports Physical Form Screening ProgramsScreening Programs Cumulative Health RecordsCumulative Health Records

Immunization CertificatesImmunization CertificatesKRS 214.034KRS 214.034

Must present within two weeks of Must present within two weeks of initial initial enrollment: enrollment:

1. Regular or Provisional1. Regular or Provisional

2. Medical Exemption2. Medical Exemption

3. Religious Exemption3. Religious Exemption

(HSRG: Exhibits 3B, 3C & 3D)(HSRG: Exhibits 3B, 3C & 3D) Certificates must be presented again-Certificates must be presented again-

usually prior to entering 6usually prior to entering 6thth grade grade

Vision ExamVision ExamKRS 156.160 (10) (g)KRS 156.160 (10) (g)

Required by January 1 of the first Required by January 1 of the first year enrolled in public school, public year enrolled in public school, public preschool or Head Startpreschool or Head Start

Performed by optometrist or Performed by optometrist or ophthalmologistophthalmologist

Kentucky Vision Exam Form (HSRG: Kentucky Vision Exam Form (HSRG: Exhibit 3G)Exhibit 3G)

DentalDental Screening or Screening or ExamExam

KRS 156.160 (i) Proof of dental KRS 156.160 (i) Proof of dental screening or exam required no later screening or exam required no later than January 1 of the first year that a than January 1 of the first year that a five (5) or six (6) year old is enrolled five (5) or six (6) year old is enrolled in a public school (begins 2010-2011 in a public school (begins 2010-2011 school year)school year)

Dental screening form can be found Dental screening form can be found on the KDE website on the KDE website http://www.education.ky.gov/KDE/Administrative+Resources/Coordinated+School+Health/Health+Services/School+Health+Forms.htm

Physical Exam FormsPhysical Exam Forms704 KAR 4:020 Section 2704 KAR 4:020 Section 2

Required 1 year prior to initial Required 1 year prior to initial enrollment and enrollment and

within 1 year prior to entering 6within 1 year prior to entering 6thth grade grade Must be on a KDE Preventative Health Must be on a KDE Preventative Health

Exam Form (HSRG: Exhibit 3E and 3F)Exam Form (HSRG: Exhibit 3E and 3F) Exam may be performed by MD, PA, Exam may be performed by MD, PA,

ARNP, or EPSDT providerARNP, or EPSDT provider TB skin test requirement removed from TB skin test requirement removed from

KRS 214.034 in 1998KRS 214.034 in 1998

Deadline to present exam may be Deadline to present exam may be extended up to two (2) months…extended up to two (2) months…know your district policy!know your district policy!

Out-of-state transfer students must Out-of-state transfer students must present evidence of a physical exampresent evidence of a physical exam—may download KY preventative —may download KY preventative health exam form and have their health exam form and have their LMD fill out before moving to LMD fill out before moving to KentuckyKentucky

Sports Physical Exam Sports Physical Exam FormsForms

KRS 156.070 (d)KRS 156.070 (d) Sports Physical Exam Form is required if Sports Physical Exam Form is required if

student is enrolled in high school athletic student is enrolled in high school athletic activity or sports (updated 2009)activity or sports (updated 2009)

Content of Sports Physical Form not as Content of Sports Physical Form not as extensive as the Preventative Health extensive as the Preventative Health Exam Form (cannot substitute for 6Exam Form (cannot substitute for 6thth grade physical)grade physical)

May be performed by MD, PA, ARNP or May be performed by MD, PA, ARNP or ChiropractorChiropractor

School Screening ProgramsSchool Screening Programs704 KAR 4:020 Section 2 704 KAR 4:020 Section 2

(11)(11) Each school district shall adopt a Each school district shall adopt a

program of continuous health supervisionprogram of continuous health supervision Continuous health supervision shall Continuous health supervision shall

include scheduled, appropriate screening include scheduled, appropriate screening tests for vision, hearing and scoliosistests for vision, hearing and scoliosis

School districts determine the grades to School districts determine the grades to be screened for vision and hearing be screened for vision and hearing during school yrduring school yr

Scoliosis screening for 6Scoliosis screening for 6thth and 8 and 8thth grades grades

Keeping Health RecordsKeeping Health Records Cumulative Health RecordCumulative Health Record 1. Health Information1. Health Information 2. Medication Information2. Medication Information 3. Other Health Services documentation3. Other Health Services documentation 4. HSRG – Exhibit 3I4. HSRG – Exhibit 3I Record RetentionRecord Retention

1. Hard copy1. Hard copy 2. Electronic2. Electronic 3. Records Retention Schedule (HSRG – 3. Records Retention Schedule (HSRG –

Appendix C)Appendix C)

FERPA/HIPAAFERPA/HIPAA FERPA (Family Educational Rights and FERPA (Family Educational Rights and

Privacy Acts) applies to any educational Privacy Acts) applies to any educational agency that receives funds from the U.S agency that receives funds from the U.S Department of EducationDepartment of Education

FERPA protects privacy interests of FERPA protects privacy interests of students and their educational records students and their educational records

Preamble to HIPAA specifically excludes Preamble to HIPAA specifically excludes schools as “covered entities” since they are schools as “covered entities” since they are covered under FERPAcovered under FERPA

Student educational records are not subject Student educational records are not subject to HIPAA except for the billing statementto HIPAA except for the billing statement

Educational Records Educational Records Include:Include:

Health records maintained by school Health records maintained by school employees or contracted employees employees or contracted employees who provide “school health services”who provide “school health services”

Health Services may include: health Health Services may include: health promotion, health maintenance and promotion, health maintenance and “related or supportive” services“related or supportive” services

FERPA Related/Supportive FERPA Related/Supportive ServicesServices

Anything that enables a student Anything that enables a student (especially student special healthcare (especially student special healthcare needs) to:needs) to:

1. Attend school1. Attend school 2. Maintain (or improve) health 2. Maintain (or improve) health

status during status during the school day the school day 3. Progress toward independence 3. Progress toward independence

in self-care in self-care in school setting in school setting and achieve educational and achieve educational success success

4. Achieve educational success4. Achieve educational success

For More InformationFor More Information

NASN School Nursing: A NASN School Nursing: A Comprehensive TextComprehensive Text, Chapter 13, pp , Chapter 13, pp 296-298296-298

U.S. Department of Education, U.S. Department of Education, The The Privacy of Student Information, A Privacy of Student Information, A Resource for SchoolsResource for Schools

wwww.nces.ed.gov/pubs2006/stu_privacy/ferpa.asp

Communicable DiseasesCommunicable Diseases Bloodborne Pathogen TrainingBloodborne Pathogen Training

1. Required by OSHA 1. Required by OSHA

2. Must be reviewed yearly2. Must be reviewed yearly

3. Training must be “interactive” –ability to ask 3. Training must be “interactive” –ability to ask questions and receive answers during training sessionquestions and receive answers during training session

KSBA has OSHA training for school district each year-KSBA has OSHA training for school district each year-ask who is responsible for Exposure Control Plan in ask who is responsible for Exposure Control Plan in your districtyour district

Some school districts have this training onlineSome school districts have this training online

Communicable Diseases Communicable Diseases

Head Lice – KSBA Policy excludes Head Lice – KSBA Policy excludes only for only for livelive lice lice

The American Academy of Pediatrics The American Academy of Pediatrics and the Harvard School of Public and the Harvard School of Public Health do not recommend exclusion Health do not recommend exclusion from school for nitsfrom school for nits

Know you district policyKnow you district policy

Reportable Communicable Reportable Communicable DiseasesDiseases

HSRG Chapter 5HSRG Chapter 5 KRS 158.160KRS 158.160 MRSA is not a reportable diseaseMRSA is not a reportable disease Reportable Disease Form (HSRG: Reportable Disease Form (HSRG:

Exhibit 5A)Exhibit 5A) Pandemic Flu-H1N1Pandemic Flu-H1N1

TB Risk AssessmentTB Risk Assessment

TB skin test no longer required for new TB skin test no longer required for new school employees (704 KAR 4:020 school employees (704 KAR 4:020 Section 1)Section 1)

At time of employment physical, At time of employment physical, assessed for risk of TB infectionassessed for risk of TB infection

New employee school physical exam New employee school physical exam form available KDE web site and HSRGform available KDE web site and HSRG

www.education.ky.gov/KDE/www.education.ky.gov/KDE/Administrative+Resources/School+Health/Administrative+Resources/School+Health/Health+Services/School+Health+Forms.htmHealth+Services/School+Health+Forms.htm

End of Year ReportsEnd of Year Reports

School health data to entered in to data base School health data to entered in to data base (Infinite Campus)(Infinite Campus)

KDE Standards Document describes what KDE Standards Document describes what data to be entered and reported: data to be entered and reported:

1. Health Conditions1. Health Conditions

2. Health Conditions Flags2. Health Conditions Flags

3. Immunizations3. Immunizations

4. Physical Exams documented for initial 4. Physical Exams documented for initial entryentry

and 6and 6thth grade grade

5. Vision exam for initial entry5. Vision exam for initial entry

6. Dental exam/screening6. Dental exam/screening

7. Screening results for vision , hearing and 7. Screening results for vision , hearing and

scoliosis screening (grades 6 & 8)scoliosis screening (grades 6 & 8)

KDE will have BOY WebEx trainings – know KDE will have BOY WebEx trainings – know who is your IC Point of Contact who is your IC Point of Contact

End of Year ReportsEnd of Year Reports Three reports: Three reports:

1. Health Conditions and Health 1. Health Conditions and Health Condition Condition FlagsFlags

2. Immunization Summary2. Immunization Summary

3. Screening Summary3. Screening Summary Be sure to attend BOY and EOY trainingsBe sure to attend BOY and EOY trainings

(Trainings are via WebEx-know who (Trainings are via WebEx-know who your IC Point of Contact is for your your IC Point of Contact is for your district)district)

REPORTS DUE last Friday in MayREPORTS DUE last Friday in May..

Health Services Standards Health Services Standards Document available on the KDE web Document available on the KDE web site (Data Policy, Management and site (Data Policy, Management and Research):Research):

www.education.ky.gov/KDE/www.education.ky.gov/KDE/Administrative+Resources/Administrative+Resources/Data+and+Research/Data+and+Research/Student+Information+System/Student+Information+System/Data+StandardsData+Standards

KDE Health Services Reference GuideKDE Health Services Reference Guide

http://www.education.ky.gov/KDE/http://www.education.ky.gov/KDE/Administrative+Resources/Administrative+Resources/School+Health/Health+Services/School+Health/Health+Services/HSRG+Table+of+Contents.htmHSRG+Table+of+Contents.htm

Email: Email: Karen.Erwin@education.ky.gov

Phone: 502-564-5625Phone: 502-564-5625