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ABN Update. N Genell Lee, MSN, RN, JD Executive Officer. Objectives. Identify changes to the Curriculum to Teach Unlicensed School Personnel how to Assist with Medications. Discuss case examples of substandard practice. Discuss case examples of illegal practice. Curriculum.

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Abn update

ABN Update

N Genell Lee, MSN, RN, JD

Executive Officer


Objectives
Objectives

Identify changes to the Curriculum to Teach Unlicensed School Personnel how to Assist with Medications.

Discuss case examples of substandard practice.

Discuss case examples of illegal practice.


Curriculum
Curriculum

Delegation rules moved from Chapter 610-X-6 to Chapter 610-X-7 so revision noted the new section

Curriculum reviewed by ABN and approved at June 20, 2013 meeting

Issues identified by school nurses considered


Handouts
Handouts

The handouts are the revised version; the slides will address where the changes occurred unless it is a minor change (use of hyphen, corrected spelling, etc.)

Post-test will be changed as well

Curriculum will be posted to the Board’s website


Sections
Sections

  • Section One: Introduction, no changes

  • Section Two: School Health—minor language change in most of section

    • On page 3, added section about lead or designated nurse doing comprehensive assessment of health needs of students and reporting that to superintendent. This is in school nurse law (statute).


Section two health serviees
Section Two: Health Serviees

On page 9 forward, responsibilities of school nurses mentions free of distractions for unlicensed personnel; storage of emergency health plans on buses, for extracurricular activities; and field trips.

Review of student health assessment records.


Section two more on responsibilities
Section Two: More on Responsibilities

Develops procedures for student specific routine and emergency procedures including assisting with medication while at school, during school-sponsored trips and activities, and during transportation to and from school and document in student’s IHP/EAP


Section two health services
Section Two: Health Services

Page 12: medication assistant should notify school nurse if a new medication is received at school


Page 13 orders
Page 13: Orders

Orders may be accepted by fax and email without requring a hard copy.

Third parties: certified medical assistant can transmit orders to school nurse from doctor’s office but otherwise, should not accept orders from unlicensed school personnel


More on orders
More on Orders

PARENTS: is the parent giving you ‘orders’ or providing you with information?

Example: Nemours Clinic in Pensacola and the “FIT” paper

Example: child with diabetes inspidous

Example: Order by MD vs LEA policy


Page 14 first aid
Page 14: First Aid

May keep first aid supplies including betadine, antibiotic ointment, etc without an order

Instituting first aid is within scope of practice of RN and LPN and should occur in the school if needed

Minor wounds: soap and water; if dressing changes needed, follow MD orders if they exist; if child has a band-aid and needs another one, not a problem


Field trips and other extracurricular activities
Field Trips and Other Extracurricular Activities

The LEA determines how to handle OTC medicines

Call from parent asking for clarification---school nurse was taking suit cases of OTC meds (up to 250 in some circumstances). Is that a logical solution to OTC for field trips?

Discuss with LEA—superintendent, principal, etc—how you will handle this for OTC.

What do you do if school nurse is not accompanying the field trip or football game or whatever the extracurricular activity is?

Siblings: One bottle to be shared is okay


Page 15 16
Page 15-16

Storage of medication, including controlled substances

Refrigerated medications: stored in refrigerator by themselves (not with food) and has method of checking and documenting temperature

Do not administer drugs that have been frozen!


Section three common health conditions
SECTION THREE: COMMON HEALTH CONDITIONS

Some deletions and additions of drugs for specific health conditions

You can add medications for specific children in your schools when you do the training


Section four how to assist students with medication depending on route
Section Four: How to Assist Students with Medication Depending on Route

One minor change: Don’t touch medicine with bare hands!


Section five safety
Section Five: Safety Depending on Route

Need beginning and ending dates for for medications

It is not recommended that school personnel administer any substance that could be construed as a drug or medication, including natural remedies, herbs, and nutritional supplements, without the explicit order of an authorized prescriber, parent authorization, verification that the product is safe to administer to children in the prescribed dosage, and reasonable information regarding therapeutic and untoward effects (pg 44)


Otc meds
OTC Meds Depending on Route

LEA policy determines whether you need physician order for OTC; ABN does not require it

School nurse should document details about the OTC meds


Repackaging medications
Repackaging Medications Depending on Route

School nurse and unlicensed school personnel are not authorized to repackage meds (placing them from a pill bottle, for example, into an envelope wth the student’s name on it)

Repackaging: to package again or anew; specifically: to put into a more efficient form


Disposal of medications
Disposal of Medications Depending on Route

  • Follow National Standards

    • Trash vs

    • Toilet vs

    • Bring Back programs

    • Burning


Page 50 self administration
Page 50: Self-Administration Depending on Route

Chronic health condition/illness is defined as “a physical, physiologic, developmental impairment; an anatomical, physiological or mental impairment that interferes with an individuals ability to function in the environment; one that is long-term (usually more than 3 months duration) and is either not curable or has residual features that result in limitations in daily living requiring adaptation in function or special assistance; a medical condition that interferes with daily functioning for more than three months in a year, causes hospitalization for more than one month in a year, or (at time of diagnosis) is likely to do either of these.” (Schwab & Gelfman, 2001).


Epi pen
Epi Depending on Route-Pen

National movement to have an epi-pen available to use at school for someone with an anaphylactic condition that occurs at school

Would be considered “stock” medication

ABN does not object to having epi-pen in school for these one-time events

Issues: who will prescribe; who will pay for it; and would the unlicensed school personnel give it?


Documentation of training
Documentation of Training Depending on Route

It is the school nurse’s responsibility to document training of unlicensed school personnel who are assisting with medications!

No documentation: didn’t do it.

Documented but didn’t do it: false documentation.


Some situations to consider
Some Situations to Consider Depending on Route

  • Kindergarten girl with itching and redness in perineal area. School nurse looked at it. Applied some sort of cream.

    • Problem: No documentation of assessment.

    • Problem: No phone call to parent.

    • Problem: “Cream” was not ordered nor was there documentation.

    • Problem: No communication with lead nurse


Parental consent
Parental Consent Depending on Route

1st grader self-catheterized. School nurse allowed nursing student to observe.

Problem: child was asked if okay and while the child said ‘yes’, the child felt pushed into it.

Problem: child was sensitive about having to perform the procedure and school nurse overlooked the anxiety

Problem: What does a nursing student gain from observing this self-procedure?

Problem: No communication with parent even though parent made it known that child was sensitive about issue.


Field trip and otc meds
Field Trip and OTC Meds Depending on Route

Mother called and asked about OTC meds for field trip. Had called Superintendent, School Nurse, Board of Pharmacy, Department of Public Health, and finally ABN

Problem: suitcases full of OTC meds for prior field trip

Problem: Mother believed she was given the ‘run around’ about policy

Problem: Decision made by LEA but told Mother it was the law


Medications
Medications Depending on Route

School Nurse administered insulin that had been frozen.

Problem: School nurse did not contact parent.

Problem: School nurse knew the insulin had been frozen previously and now thawed.

Problem: School nurse did not understand that freezing insulin can change the efficacy of the drug


Storage of medications
Storage of Medications Depending on Route

School Nurse written up 3 times for failure to keep medications secure.

Problem: Student came in to health room and took another student’s medications.

Problem: School nurse resisted locking up medications even after employment action.

Problem: School nurse disciplined for failing to secure medications


Assessment
Assessment Depending on Route

3rd grader sent to health room by teacher because of shortness of breath and wheezing (history of asthma).

Problem: LPN School Nurse allegedly “assessed” child and sent child back to classroom.

Teacher sent child back to health room 10 minutes later for continued SOB.

LPN School Nurse gave child inhaler and then sent child back to classroom.

Father called. Child admitted to hospital. HR 160 in ED, RR 36. Acute asthma attack. School nurse response: “I didn’t think the child was that sick.”

NO DOCUMENTATION of any sort of assessment


Boundary issue
Boundary Issue Depending on Route

Anonymous email received by ABN that school system hired a school nurse that was not competent to provide care to a ventilator-dependent student

Problem: Turns out it was another nurse who sent the email

Problem: Interfering with a patient’s care can result in charge of boundary violation---the anonymous nurse did not get the job and therefore questioned the hiring of someone else and was communicating with parent


How can i stay current with procedures
How can I stay current with procedures? Depending on Route

Lead/designated nurse will have skills lab at Children’s of Alabama on July 26, 2013

Many hospitals and schools of nursing have simulation labs---talk with local area resources to see if training can occur in setting with simulation lab for things like replace G tube, ventilator management, etc.

There is no ‘official certification’ requirement—must be able to demonstrate training (Organized Program of Study)


Documentation
DOCUMENTATION Depending on Route

Lack of documentation regarding medications being administered by school nurse

Lack of documentation regarding carbohydrate count at mealtime for student

Lack of documentation regarding communication with parent

Lack of documentation regarding first-aid care

If you didn’t do it, don’t document it!

If you don’t document it, you didn’t do it!


Glucagon pilot
Glucagon Pilot Depending on Route

Started in July 2013

Specific to school-sponsored activities—camps, athletics, summer school, etc.

Urban, suburban, and rural schools

Focus: PREVENTION

ABN and SDE will evaluate in Fall 2013


Curriculum1
Curriculum Depending on Route

Volunteers to tape so we can put the curriculum/teaching online?

Do we put the demonstration of how to do things such as eye drops online?

Focus on individual student needs part of training and that will not be online.

Post-test will change.

Be sure to document training!


Annual survey
Annual Survey Depending on Route

SDE will conduct this next year but information is shared with ABN

One of the few states that actually gathers data about health services

Number of nurses important because latest information is Alabama has a low nurse:student ratio compared to other states


Illegal practice
Illegal Practice Depending on Route

Continuing to practice when license not renewed

LPNs renew in 2013. Should check LPN licenses for renewed status before January 1, 2013.

If LPN not renewed by January 1, 2013, should not be allowed to return to work until can prove licensure.

Subscriber or license look up: close to real time updates during renewal


Citizenship legal presence
Citizenship/Legal Presence Depending on Route

I am not a Communist!

Must prove citizenship or legal presence in US in order to renew

As of Friday, July 12, only 18% LPNs verified

Sent an email via list serv to provide how to login and check if citizenship/legal presence verified


Conclusion
Conclusion Depending on Route


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