Cindy Galemore MSEd, BSN, RN, NCSN Director of Health Services Olathe District Schools, Olathe, KS Editor NASN School Nurse Professional Standards Chair for Kansas School Nurses Organization
Identify three or more
current issues in school
nursing and discuss
effective strategies for
management
House Bill 675/Senate Bill 211 – Management
of Diabetes in Elementary and Secondary
Schools
Optional training for non-licensed staff (not mandatory)
Training tools are under development by the Dept. of Elementary and Secondary
Education(Due date by statute is Jan. 15, 2014) Developed in consultation with DHHS, ADA, AADE,
School Nurses Association, Diabetes Control Program, and MO state board of nursing.
Training Content
Recognition and treatment of hypo &
hyperglycemia
Understanding physician instructions for medication
drug dosage, frequency, and manner of administration
Performance and documentation of blood glucose
monitoring and ketone checks
Administration and documentation of glucagon and
insulin
Understanding basic insulin pump functions Recognizing diabetic emergencies
Understanding schedules and food intake for meals
and snacks, effect of physical activity upon blood glucose levels, and actions for schedule disruptions
Training Requirements
Minimum of three employees at each school attended by a student with diabetes
Participation in training is voluntary by employees
Trained personnel are protected from liability School employees shall not be subject to any
penalty or disciplinary action for refusing to serve
Coordinated by a school nurse
Take place prior to the star of each school year or within 30 days following the enrollment or diagnosis of a student with diabetes.
Miscellaneous stipulations
Coordination, delegation, and supervision of care shall be performed by a school nurse or other
qualified health care professional.
All school personnel may be trained in the
recognition of hypo/hyperglycemia and actions to take in response to emergency situations.
The school nurse or at least one trained diabetes care personnel may be on site and available to during regular school hours, all school sponsored activities including before and after school
programs, field trips, extended off-site
excursions, extracurricular activities, and on
Conclusion
No physician, nurse, school employee,
charter school or school district shall be
liable for civil damages . . .
Speaks to students with diabetes being
allowed to self-care if authorized in
medical management plan, to possess
all necessary supplies, and to be
provided a private area if needed for
care.
Not a new issue, but becoming more
complicated
Number of children attending school with special healthcare needs & complex medication
conditions continue to increase (26.6%) (Van Cleave, Gortmaker, & Perrin, 2010)
Federal laws protect all students’ rights to participate in Field trips (Section 504 of the
Rehabilitation Act 1973, Title II of the American Disabilities Act of 1990, IDEIA reauthorization in 2004)
Delegation laws vary greatly by state
School nurses are responsible for knowing the
scope of practice
First thing to determine is if the
destination state allows nurses from
another state to practice “temporarily”
in their state
Second thing to determine is if the
destination state allows nurses from
another state to delegate in their state
If yes, what can be delegated. This
might be different than your own
state.
Now the Third Ingredient - Nursing
Licensure Compact States (NLC)
Allows nurses from NLC states to
practice in another NLSC state without a
second license
Similar to a driver’s license
Currently 24 NLC states
Applies to RNs and LPNs
Does not apply to unlicensed personnel
NASN’s conversations with the National Council
of State Boards of Nursing (NCSBN) concluded
that school nurses need to contact each
board of nursing prior to a field trip to ask
permission to practice nursing temporarily in
that state.
It is hoped that by increasing the number of
school nurses contacting boards of nursing
across the nation, states WILL ask the NCSBN
to work on national recommendations
allowing the regulations of the state of origin
to cover the student on field trips and to
allow all licensed nurses to practice in other
states for the purpose of school field trips
and activities that cross state lines.
Kentucky has conducted extensive research
in this area and compiled helpful information
and charts specific to each state at the
following link:
http://education.ky.gov/districts/SHS/Pages
/Field-Trips-and-Medication-Administration.aspx
More helpful for Missouri than Kansas, since
Missouri is a compact state
Use the chart cautiously with an
understanding of limitations (become
outdated quickly)
Inform your administrator of the need for advance notice
of all out-of-state field trips (at least 2 months notice).
Brainstorm avenues to remove the need for nursing care
and/or delegation on field trips (e.g. students self-carry asthma and severe allergy medication if capable, parent of student attends field trip – possibly even incentivizing by offering to pay the parent, annual per-planning discussion of field trip plans for students with severe health needs discouraging teachers from field trips that cross the state lines wherever possible, training staff that will be
attending field trip in basic CPR and First Aid – for
example, the First Aid courses now include information on assisting someone who self-carries an inhaler or
auto-injector epinephrine).
Contact the Board of Nursing for state’s that will be
receiving students where nursing care is needed.
Determine from information received how the health needs will be managed (e.g. school nurse will attend,
delegation is allowed, parent will accompany and provide care, and/or agency nurse in visiting state will be hired to care for the student).
Effective January 1sts, 2013
Medicaid and HealthWave became
KanCare
Three managed care organizations
(MCOs)
Amerigroup of Kansas, Inc
Sunflower State Health Plan
UnitedHealthcare of the Midwest
(Brown, Kim. 2013. Presentation at Kansas School Nurse Conference, July 17, Director, Managed Care, KS Dept. for Aging and Disability Services)
Goals
Improve care coordination
Reduce cost growth in the program Improve quality of care overall
Reforms how care is delivered
Eligibility is the same
Services are the same. Providers may be paid more, but cannot be paid less
Moves the focus to promoting health rather
This year’s enrollment ended April 4
th
New consumers have 90 days to choose plan
If the covered individual did not choose a plan,
it was assigned according to an algorithm.
Around end of November, enrollees will be
contacted and informed of the open enrollment
period for the new year which goes from January
1 to April 4
th(consumer makes phone call)
otherwise they will stay with the same MCO.
Participants must also show continued eligibility
annually.
For all plans:
Rewards/incentive programs for health behaviors like completing wellness/KBH exams
Health pregnancy programs
Free cell phones for high-risk members
For Amerigroup:
Free hypo-allergenic bedding for members with asthma and allergies
For Sunflower and United:
Free memberships to Boys and Girls club, 4-H, Brownies, and other community programs
DSM-5 Terminology Changes
Roman numeral replaced with a number
Intellectual Disability (forbids use of Mental
Retardation)
Attention-Deficit Hyperactivity Disorder (do not use
ADD)
Autism Spectrum Disorder (use to include Asperger’s,
childhood disintegrative disorder, Rett’s disorder, pervasive developmental disorder not otherwise
specified, and autism. Asperger’s disorder no longer exists)
Communication Disorders – now called speech sound
disorder and stuttering is now called Childhood-onset Fluency Disorder
Do not send home Head Lice letters when a
case of head lice is found. Causes
unnecessary treatment, hysteria, risk of
privacy breech, etc. Much better to do
periodic parent generalized teaching.
Health Information Exchange
Being developed in all states
Kansas network is called the KHIN – Kansas Health Information Network
School nurses can become users – requires annual fee ($50.00) and other things like a security
officer who will perform a privacy audit every month
New NASN Allergy and Epinephrine resources
available – too numerous to mention all. Go to
http://www.nasn.org/ToolsResources/FoodAllergyan
dAnaphylaxis
Amy Wehr, BSN, RN, NCSN
wehramy@rockwood.k12.mo.us
Barbara Brommelhorst, BSN, RN
barbarabrommelhorst@wentzville.k12.mo.us
Deborah Haar Scales, BSN, RN
scales@stjustinmartyr.org
Cindy Galemore, MSEd, BSN, RN, NCSN
