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Coordination of Care Vision and Hearing Referral

Coordination of Care Vision and Hearing Referral. DPAS 2 Component 5 Growth Goals Indicator 3 and 4 Susan Hoffmann MSN, RN, NCSN. School nurses provide quality health care and intervene with actual and potential health problems.

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Coordination of Care Vision and Hearing Referral

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  1. Coordination of Care Vision and Hearing Referral DPAS 2 Component 5 Growth Goals Indicator 3 and 4 Susan Hoffmann MSN, RN, NCSN

  2. School nurses provide quality health care and intervene with actual and potential health problems

  3. School nursing interventions impact the student’s health & well-being • Optimal student health impacts the student’s ability to learn • Hearing and vision are critical to academic success

  4. The school nurse coordinates care delivery… Students referred from vision or hearing screening Will be seen by a healthcare provider

  5. Why would a school nurse would want to choose this indicator? 2.0 Regulation: Vision and Hearing Screening 2.1.1 Each public school student in kindergarten and in grades 2, 4, 7 and grades 9 or 10 shall receive a vision and a hearing screening by January 15th of each school year. 2.1.1.1 In addition to the screening requirements in 2.1.1, screening shall also be provided to new enterers, studentsreferred by a teacher or an administrator, and students considered for special education. 2.1.1.1.1 Driver education students shall have a vision screening within a year prior to their in car driving hours. 2.1.2 The school nurse shall record the results on the Delaware School HealthRecord Form and shall notify the parent, guardian or Relative Caregiver or the student if 18 years or older, or an unaccompanied homeless youth (asdefined by 42 USC 11434a) if the student has a suspected problem.

  6. Which students should have a vision screening? • Grades kindergarten, grades 2, 4, 7 and grades 9 or 10 shall receive a vision and a hearing screening by January 15th of each school year. • New enterers • Those being considered for special education • Teacher referrals • Driver education students shall have a vision screening within a year prior to their in car driving hours.

  7. Mandated hearing screenings • Grades kindergarten, grades 2, 4, 7 and grades 9 or 10 shall receive a vision and a hearing screening by January 15th of each school year. • New enterers • Those being considered for special education • Teacher referrals

  8. What type of tests should be used? • First time screening • Routine screenings • Referral criteria

  9. How to choose a cohort: • Include the entire school and should not be broken into smaller cohorts • Screening Completion Rate from previous year compared to current year • There must be a minimum of 10 students referred in the previous year

  10. How to get a baseline • Cognos Report Standard DOE Public Reports > Medical Reports > Annual Reports > Incomplete Referrals Current • Consider using percentage of a comparable cohort of schools

  11. Calculate the baseline • Determine the Vision Screening Referral Completion • Divide the Number of Completions by the Number of Referrals to determine the percentage of Completions.

  12. Do the math….. # of Completions = percentage complete Total # referred Example: 25 complete = .50 (50%) 50 referred

  13. How to calculate the growth FY12 State Hearing Screening Referral Completion Rates STATEWIDE:               53%                GRADES PreK – 2:     53%                GRADES 3 – 5:             38%                GRADES 6 – 8:             21%                GRADES 9 – 12:          46% FY12 State Vision Screening Referral Completion Rates STATEWIDE:               38%                GRADES PreK – 2:     42%                GRADES 3 – 5:             34%                GRADES 6 – 8:             29%                GRADES 9 – 12:          44%

  14. Target goal –Close the gap Between baseline percentages by 50% or other agreed upon %

  15. Set the growth measure If previous year’s percentage is less than the state or district completion percentage Set a goal to close the percentage difference by 50% Or percentage agreed upon with administrator

  16. Setting the growth goal if: Nurse is new school nursing Nurse is new to the school Or if the school has changed student configuration (by adding or subtracting grades or cohorts of students) Targeted goal district or state percentage minus 5%.

  17. A completed referral can be documented if: • A healthcare provider’s note is received • The student has new glasses • The healthcare provider’s office will verbally confirm a visit • The parent/guardian confirms a visit • A re-screening by the school nurse indicates there is no need for a referral

  18. A completed referral can NOT be documented • based on the number of contacts the nurse makes • For example, the nurse may have made multiple interventions without success but this is not a completed referral.

  19. Strategies for ensuring growth Identify the root cause for non-completion

  20. Review Documentation • What codes to use (Is the coding correct?) • Document better in the future • So you can use the data next year • Were all REFERRAL Completions? • Check with the student to ascertain if the referral was completed but not reported to the school nurse. • A doctor’s note is not required for the school nurse to document completion.

  21. Did the referral letter ever make it home? Send home with child along with other important papers, like the report card or a daily communication book Send letter via certified mail Send the letter under that principal’s signature Consult with the student’s teacher (Best way to communicate with the family?) Print on brightly colored paper Call before sending the letter

  22. Strategies for successGet support • Communicate with parent/ guardian and staff on the impact of diminished vision on student performance and well-being (newsletters, global calls…) • Meet with parent/guardian and staff • Schedule a parent/guardian conference • Participate in Parent/Teacher Conference event • Work with the IEP or student assistance team • Engage the student • Work with the student’s teacher(s), staff, counselor, administration, and outside agencies • Social worker may be an asset with home visits or connecting with the family

  23. Address barriers to care providers • Transportation may need to be provided • Financial needs • Available resources: VSP vouchers member benefit of DSNA/NASN State vision program Medicaid/Delaware Healthy children’s program Lion’s club

  24. Some activities could actually be the same for multiple measures

  25. Questions ????

  26. Resources • Selekman, J.School Nursing: A Comprehensive Text. Philadelphia: F.A. Davis. • www.nasn.org • http://nasn.org/ToolsResources/Vision Delaware technical assistance manual • http://www.doe.k12.de.us/infosuites/schools/files/de_schoolnursemanual_b1.pdf The Role of the School Nurse (2011) http://nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNPositionStatementsFullView/tabid/462/ArticleId/87/Role-of-the-School-Nurse-Revised-2011 • www.dsna.org

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