School Health ServicesKaren Hollowood RN BSN MSEdNYS Education DepartmentJuly 2012

School Health Services

Governed by NYS Education Laws, Public Health Laws and…

• EL Article 19

• EL Article 139

• 8 NYCRR §136.1-136.4

• 8 NYCRR §135.4

• PHL 2164

• PHL 3000b

School Health Services

…Federal Laws• FERPAhttp://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html

• IDEA, Section 504, Americans with Disabilities Act

http://www2.ed.gov/policy/rights/guid/ocr/disability.html

School Health Services

Section 901: “School health services for the purposes of this article shall mean the several procedures, including, but not limited to, medical examinations, dental inspection and/or screening, scoliosis screening, vision screening and audiometer tests, designed to determine the health status of the child; to inform parents or other persons in parental relation to the child, pupils and teachers of the individual child's health condition subject to federal and state confidentiality laws; to guide parents, children and teachers in procedures for preventing and correcting defects and diseases; to instruct the school personnel in procedures to take in case of accident or illness; to survey and make necessary recommendations concerning the health and safety aspects of school facilities and the provision of health information.”

Article 19

• Section 902 requires all public schools to employ a medical director (also known as the director of health services or medical officer.) “The board of education, and the trustee or board of trustees of each school district, shall employ, … a qualified physician, or a nurse practitioner …”

8 NYCRR 135.4

• Requires the medical director to approve students to participate in interscholastic athletics, and return to play after illness or injury

Article 19

• Section 902 defines a school nurse as a registered professional nurse. Any other health professionals employed may only perform duties that are within their scope of practice

“ Any such board or trustees may employ one

or more school nurses, who shall be registered

professional nurses, …”

Article 139

• This law is known as the Nurse Practice Act. The most relevant portion for schools to be familiar with define the differing scopes of practice of RNs and LPNs. Additionally the law defines the type of care that may only be performed by licensed health professionals.

Article 139

• “Licensed Practical Nurses (LPN) in New York State do not have assessment privileges; they may not interpret patient clinical data or act independently on such data; they may not triage; they may not create, initiate, or alter nursing care goals or establish nursing care plans.”

Nursing Guide to Practice, p.37

Article 139

• “Under direction LPNs may administer medications, provide nursing treatments, and gather patient measurements, signs, and symptoms that can be used by the RN in making decisions about the nursing care of specific patients. However they may not function independent of direction.”

Nursing Guide to Practice, p. 37

Article 19

• Section 903 requires students to have a physical examination in grades pre-K or K, 2, 4, 7, &10, and school entry (8 NYCRR §136.3.) Students are encouraged to have this completed by their primary medical provider (aka: a health certificate.)

• This section also requires schools to request a dental certificate at the same time a physical exam is required. The certificate is not required for school attendance. Upon request of a parent/guardian the school must furnish a list of reduced fee dentists.

Article 19

• Section 904 requires the school medical director to perform the required physical exam (aka: the health appraisal) if the parent/guardian requests, or does not provide a copy of one completed by their private medical provider. Parents must be notified in advance of the exam.

Article 19

• Section 905 requires schools to perform screenings for: vision at entry and in grades pre-K or K, 1, 2, 3, 5, 7, & 10; hearing at entry and in grades pre-k or K, 1, 3, 5, 7, &10; and scoliosis in grades 5-9 (8 NYCRR §136.3.)

• Such screenings are to be performed by the medical director or the licensed health professional that he/she designates.

New York City

Schools in NYC have different screening requirements. NYC schools should consult the Chancellor’s Regulations

http://docs.nycenet.edu/docushare/dsweb/Get/Document-313/A-701%20%206-19-08%20%20Formatted.pdf

Or contact the NYC Office of School Health at: 347-396-4714

Article 19

• Section 914 Requires schools to comply with the immunization requirements of PHL 2164, including submitting the annual immunization survey.

• Current Immunization Requirements http://www.health.ny.gov/publications/2370.pdf

Unlicensed persons trained by RN may:

• Vital signs• Applying clean dressing• Emptying ostomy bag• Observing and discontinuing (only if flush not needed) a

continuous flow G-tube feeding• Assisting a self-directed student to take their own medications • Observing continuous flow oxygen• Oral suctioning • External catheter care• Blood glucose monitoring• Administration of emergency epinephrine via auto injector to a

specific student• Administration of emergency glucagon to a specific student

http://www.schoolhealthservicesny.com/uploads/nursing_tasks.pdf Appendix B

Self-directed students and Medications

A student may be considered to be self-directed if he/she is consistently able to do all of the following:

• Identify the correct medication (e.g., color, shape)• Identify the purpose of the medication (e.g., to improve

attention)• Determine the correct dosage is being administered (e.g., one

pill)• Identify the time the medication is needed during the school

day (e.g., lunch time,)• Describe what will happen if medication is not taken (e.g.,

unable to complete school work)• Refuse to take medication if student has any concerns about its

appropriateness.• http://www.schoolhealthservicesny.com/uploads/AdminMed.pdf

Self-directed students and Medications

• Whether a student should be considered self-directed should be based on the student’s cognitive and/or emotional development rather than age or grade. A student is determined to be self directed by their private medical provider and the school nurse or school medical director. http://www.schoolhealthservicesny.com/uploads/AdminMed.pdf

Medication Administration

• http://www.schoolhealthservicesny.com/files/filesystem/Assistance%20in%20Medication%20Delivery%206-5-12.pdf

Unlicensed persons may perform without training:

• Personal care ( hygiene & assist with clothing)

• Preparing nourishment • Feeding student with no feeding problems• Care of incontinent student; Assistance with

bedpan or urinal• Assistance non-medical aspects of bowel or

bladder traininghttp://www.schoolhealthservicesny.com/uploads/nursing_tasks.pdf

Appendix C

If there is no school nurse:

Within the context of a school’s health services program, assessment and interpretation of clinical data, triaging, and decision making about the disposition of students relating to illness or injury is the function of a school nurse (RN) and cannot be delegated to LPNs or unlicensed personnel (see Education Law §§6901, 6902; 8 NYCRR §29.1[b][10]). If a student becomes ill or injured and a school nurse is not available, schools are encouraged to contact the parent/guardian to pick up the student or follow district policy for obtaining emergency medical services if necessary.

Automatic External Defibrillators (AED)

• Required in all public schools and at school sponsored events.

• PAD application must be filed with regional EMS office. Requires a collaborative agreement with an emergency health care provider; a physician, NP, or PA certified in emergency medicine

• Staff currently certified in CPR/AED must be on site during school day and at school sponsored events

• Use of an AED must be reported to regional EMS office.

• AED must be maintained and checked on a regular basis to ensure function.

Concussion Management and Awareness Act

• Requires all public school coaches, physical education teachers school nurses and athletic trainers to complete biennially, a course approved by the Department, related to recognizing the symptoms of mild traumatic brain injuries.

Concussion Management and Awareness Act

• Require the Department along with the Department of Health, to post information on mild traumatic brain injuries and guidelines for the return to school and to certain school activities after a student has suffered such injury regardless of where the injury occurred on their respective websites. Districts would be required to provide guidance on how to obtain such information as part of their permission or consent forms that may be required for students to participate in interscholastic sports.

Concussion Management and Awareness Act

• During school athletic activities, schools would be required to remove from activity, any student suspected of having sustained a mild traumatic brain injury. The student would not be permitted to return to athletic activity until they have been symptom free for not less than 24 hours, and have been evaluated by and received written signed authorization from a licensed physician. Students would be required to receive clearance by the district’s medical director in order to participate in strenuous physical activities in extra class athletics. Such authorization is required to be kept in the student’s permanent health record. Schools are also required to follow any guidance from the student’s treating physician in regards to limitations on school attendance and activities.

Concussion Management and Awareness Act

• Permits school districts to choose to establish a concussion management team to oversee the implementation of the regulations and may establish a program which provides information on mild traumatic brain injuries to parent(s)/guardian(s).

Updates to School Health

All Memos and Guidelines available on our website at

http://www.p12.nysed.gov/sss/schoolhealth/schoolhealthservices/

New Memos and Guidelines:

• Clarification on Insulin Pumps• Immunization Certificates for Graduates• Stocking Albuterol• Guidelines for Concussion Management June 2012

Updates to School Health

Updates to school health are disseminated to the field via our technical assistance website’s list serve available at www.schoolhealthservicesny.com

All school health personnel are requested to register

Automatic External Defibrillators (AED)

Commissioner’s Regulation 136.4http://www.p12.nysed.gov/sss/lawsregs/136-terms.htmlPublic Access Providers (PAD) requirements-

PHL §3000bhttp://www.health.state.ny.us/nysdoh/ems/art30.htm#BM3000bBureau of Emergency Medical Services (EMS)http://www.health.state.ny.us/nysdoh/ems/main.htm

Resources

NYS Education Department, Office of Student Support ServicesSchool Health Serviceshttp://www.p12.nysed.gov/sss/schoolhealth/schoolhealthservices/518-486-6090

NYS Education Department, Office of ProfessionsNursinghttp://www.op.nysed.gov/prof/nurse/518-474-3817 x120

Statewide School Health Services Center www.schoolhealthservicesny.com585-617-2380

NYS Department of Health- Bureau of Immunization http://www.nyhealth.gov/prevention/immunization/schools/518-473-4437