HEALTH SERVICES UPDATE 2010 - 2011

HEALTH SERVICES UPDATE 2010 - 2011 PowerPoint PPT Presentation


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Introduction. This module is designed for staff who have previously completed the Initial Health Services Workshop. This module fulfills the annual update requirement for staff administering medications.. Steps. Complete moduleClick link to online testPrint out the test and completeContact school nurse to verify skills and review test resultsStore documentation in Medication Administration notebook.

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HEALTH SERVICES UPDATE 2010 - 2011

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1. HEALTH SERVICES UPDATE 2010 - 2011 Presented by: Escambia County Health Department & School District of Escambia County Welcome to the Health Services Update for 2010-2011 School Year.  Welcome to the Health Services Update for 2010-2011 School Year.  

2. Introduction This module is designed for staff who have previously completed the Initial Health Services Workshop. This module fulfills the annual update requirement for staff administering medications. This training is designed for staff who have completed the Initial Health Services training in the past and fulfills the annual update requirement for 2010/11.This training is designed for staff who have completed the Initial Health Services training in the past and fulfills the annual update requirement for 2010/11.

3. Steps Complete module Click link to online test Print out the test and complete Contact school nurse to verify skills and review test results Store documentation in Medication Administration notebook These are the steps for completing the Health Services Update Module online. Once you have completed the module, please print out the test and complete it. Once you have completed the test, please contact your school nurse who will review the test and verify your skill in administering medication. The school nurse will then complete a competency form which will be placed in the Medication Administration Book.These are the steps for completing the Health Services Update Module online. Once you have completed the module, please print out the test and complete it. Once you have completed the test, please contact your school nurse who will review the test and verify your skill in administering medication. The school nurse will then complete a competency form which will be placed in the Medication Administration Book.

4. OBJECTIVES of MODULE Identify health services reporting forms Discuss changes in medication policy, procedures and health guidelines Review established procedures for medication administration and documentation Report medication review and quality improvement findings Read slide.Read slide.

5. Health Services Forms v : Verify Emergency Info Registration Card (9400-HES-003) is May 5, 2009 Revision Health Services Report (Due 10/30/10) Purpose: document safety standards and health requirements required by law Submit to Karen Thoennes, Health Services Coordinator, Hall Center, Fax 469-5346 February FTE Week (February 7- 11, 2011); Report due 03/01/11 Purpose: document number of health problems, medications administered, & clinic visits Submit to School Health Office, Fax 484-5136

6. Authorization for Administration of Prescription Medication Last sentence under parental permission is legal reminder to parent.Last sentence under parental permission is legal reminder to parent.

7. 2010 Revised Authorization RX Meds Form A concerted effort has been made to notify family practice & pediatrician offices of revised form and how to access/ Health Services web page. Note & verify revision date at bottom left corner of form.A concerted effort has been made to notify family practice & pediatrician offices of revised form and how to access/ Health Services web page. Note & verify revision date at bottom left corner of form.

8. Implementation of Revised Form Check form at bottom left corner for correct date (June 22, 2010). Require 2010 version for all students with inhalers, epinephrine auto-injectors or pancreatic enzyme. Accept June 1, 2009 version for other prescribed meds during this transition year. Refuse versions predating the above. Fax outdated versions to 469-5346 for physician’s office to be contacted.

9. Online Forms http://ese.escambia.k12.fl.us/eval/health/health.htm Secure Health Forms required for health care providers (Health care providers can call Health Services Office at 469-5456 for username & password) Clinic Forms required for clinic staff username:health password:forms Needed forms are available on the Escambia County School District website under the Health Services Department. Secure forms are only available to health care providers. They can contact Health Services for the user name and password to access the forms.Needed forms are available on the Escambia County School District website under the Health Services Department. Secure forms are only available to health care providers. They can contact Health Services for the user name and password to access the forms.

10. Medication Policy 6Gx17-3.07 (16) (a) Implementation of School Board Medication policy regarding OTC stock meds.: Over-the-counter medications are limited to acetaminophen, calcium carbonate, diphenhydramine, ibuprofen and sting relief pad w/2% lidocaine. These medications are stocked in school clinics with standing orders from the Escambia County Health Department Director, Dr. John Lanza. Prior to administration of these stocked over-the-counter medications, the Authorization for Administration of Non-Prescription/Over-the-Counter (OTC) Medication form must be completed and signed by the parent/guardian. This form is valid for one school year, or earlier stop date. These changes were made to protect student safety and to maintain better control over the variety of OTC medications that staff were asked to administer.These changes were made to protect student safety and to maintain better control over the variety of OTC medications that staff were asked to administer.

11. Medication Policy 6Gx17-3.07 (16) (a) Reminders: For purpose of this policy, cough drops are not considered a medication. Over-the-counter medications will not be administered to pregnant or breastfeeding students without an Authorization for Prescription Medication Administration form from the student's physician. All other Food and Drug Administration (FDA) approved over-the-counter medications require an Authorization for the Administration of Prescription Medication. An Authorization for the Administration of Prescription Medication is required for EACH prescribed medication EXCEPT Diabetes Management and OTC stock meds. Read slide.Read slide.

12. Remember: Administration of medication is the responsibility of the parent/guardian unless it is absolutely essential to the well being of the student to receive medication during the school day. The following regulations must be observed when medication (prescription/ non-prescription) is to be administered in the school, this includes any occasion when the student is away from school property on official school business, i.e., band, field trips, sports and extracurricular activities. It is always best for the parent/guardian to administer any needed medications whenever possible. If a medication is prescribed for once or twice a day, it should be given at home unless there are extenuating circumstances.It is always best for the parent/guardian to administer any needed medications whenever possible. If a medication is prescribed for once or twice a day, it should be given at home unless there are extenuating circumstances.

13. Medications which may be administered by medical or trained non-medical school personnel include the following: oral and topical medications, eye, ear, and nose drops, and inhalers. Administration of other types of prescribed medications are evaluated on an individual basis, require child specific training, and appropriate delegation as determined by the professional school nurse. All delegation must be in accordance with Florida Nurse Practice Act, Chapter 464. Read slide.Read slide.

14. The following slides contain information about the five approved OTC drugs It is important to know this information before administering these drugs to a student If you have questions, consult with your school nurse Know the drugs you are administering. If you have questions, talk with your school nurse.Know the drugs you are administering. If you have questions, talk with your school nurse.

15. Calcium Carbonate (Tums) Dosage: Administer 1-2 tablets per Dr. Lanza otherwise follow manufacturer's label. Conditions/Symptoms: For stomachache or heartburn. Possible Side Effects: Constipation ALERT – NOT to be used in children less than 6 years old

16. Acetaminophen (Tylenol) Dosage and Time: Administer according to the manufacturer’s label (*a label will be available in the clinic for parental viewing if desired) Conditions/Symptoms: For relief of minor aches & pain. Fever (100.5) will NOT be treated at school. Possible Side Effects: None significant if administered per manufacturer’s label. ALERT – Students with temperature of 100.5 or higher must be sent home. Make sure that you read and follow the manufacturer’s instructions on the label since that is what is prescribed by the physician in the standing order.Make sure that you read and follow the manufacturer’s instructions on the label since that is what is prescribed by the physician in the standing order.

17. Diphenhydramine (Benadryl) Dosage and Time: Administer according to manufacturer’s label (if you have questions, contact your school nurse). Conditions/Symptoms: For allergy symptoms. Possible Side Effects: Drowsiness or excitability. ALERT – Students will NOT be allowed to drive within 4 hours of taking Benadryl. Due to the drowsiness that is often a side effect of taking Benadryl, for safety reasons we cannot allow the student to drive until the medication is out of their system (approximately 4 hours).Due to the drowsiness that is often a side effect of taking Benadryl, for safety reasons we cannot allow the student to drive until the medication is out of their system (approximately 4 hours).

18. Ibuprofen (Motrin, Advil) Dosage and Time: Administer according to manufacturer’s label (*a label will be available in the clinic for parent to review when requested) Conditions/Symptoms: For relief of body aches & pain or menstrual cramps. Fever (100.5) will NOT be treated at school. Possible Side Effects: Stomach upset ALERT – Contains no aspirin, but should not be given if student has allergy to aspirin; may cause stomach bleeding.

20. Sting Relief Pad w/2% Lidocaine for External Use Only Dosage and Time: Administer according to manufacturer’s label (*a label will be available in the clinic for parent to review upon request) Conditions/Symptoms: For temporary relief of pain and itching caused by insect bites and stings. Possible Side Effects: None significant if administered per manufacturers label. ALERT – Do NOT use on broken skin, near eyes or mucous membranes. These Sting Relief Pads are available through the School District warehouse (Item # 120046 Box of 20 pads $1.06/box).These Sting Relief Pads are available through the School District warehouse (Item # 120046 Box of 20 pads $1.06/box).

21. OTC Medications Monitor frequency and pattern of students taking OTC medication. Notify the school nurse if student requests medication 3 days in a row or more than 5 isolated times so that a nursing assessment can be done. Anyone taking any kind of medication on a regular basis should be monitored. If a student, or even an adult, is taking an OTC medication frequently, they should be assessed by the school nurse since it may be an indication of an underlying health condition. While it is helpful to have the stock medications available for staff in the event of an emergency, it is expected that school and health department staff will supply whatever medications they may need during the school day.Anyone taking any kind of medication on a regular basis should be monitored. If a student, or even an adult, is taking an OTC medication frequently, they should be assessed by the school nurse since it may be an indication of an underlying health condition. While it is helpful to have the stock medications available for staff in the event of an emergency, it is expected that school and health department staff will supply whatever medications they may need during the school day.

22. Receipt of Medication Medications must be delivered to the school by parent or responsible adult. All medications must be counted with parent and documented upon receipt or return to parent. Check expiration date of inhalers on the bottom of the canister, the side of an Epinephrine auto-injector, and Diastat syringe, not the boxes. Document expiration date of inhalers, epinephrine auto-injectors & Diastat on SMR….Slide #27 Flag all new authorizations for school nurse to review Medications must be delivered to the school by the parent or another responsible adult. In hardship cases, please send the parent to the principal to work out another acceptable plan for the delivery of medication. The parent, or person delivering the medication, should witness the count and initial the Student Medication Record. Do NOT accept any medication that is expired or about to expire. Medications must be delivered to the school by the parent or another responsible adult. In hardship cases, please send the parent to the principal to work out another acceptable plan for the delivery of medication. The parent, or person delivering the medication, should witness the count and initial the Student Medication Record. Do NOT accept any medication that is expired or about to expire.

23. Steps For Administering Medications Wash hands Identify student Verify student’s name with authorization and medication label Always confirm: Right student, Right medicine, Right dose, Right time, & Right route Administer medication and recheck the 5 rights Document on SMR

24. Record Keeping & Reporting Each school is required to maintain a prescription and an OTC medication book. Prescription book contains: Tick Sheet Alpha Index Authorization facing SMR Medication Training Checklist School Medical Emergency Information Form Copies of CPR/First Aid provider cards Medication Destruction Worksheet Read slide.Read slide.

25. Record Keeping & Reporting con’t Over-the-Counter book contains: School Board Medication Policy Standing order from Dr. Lanza Stock Medication Inventory (9400-HES-505) Alpha-indexed Authorization for Administration for Non-Prescription\Over-the-Counter Medication form facing the SMR for the student.

26. Student Medication Record (SMR) A SMR must be initiated for each student authorization form Archive completed/outdated SMR in student’s Cum Health Record To transfer student within the district, send SMR and Authorization form in Cum Health Record to receiving school 10/11 SMR is available online at http://ese.escambia.k12.fl.us/eval/health/health.htm Read slide.Read slide.

28. Documenting Medication Errors Complete Medication Error/Medical Event form (kept in medication book) and submit within 24 hours. Adverse reactions must be documented on Student Treatment Record by health staff. Alert: Notify principal, school nurse, and parent of error or event.

29. Disposal of Medication Discontinued Medication must be picked up by Parent within one week of the stop date. Notify Parents to pick up Medication by the last day of School year. Medication must be destroyed in a manner that it cannot be retrieved. DO NOT FLUSH. Destruction must be witnessed and documented on SMR (legal record). Document on Medication Destruction Worksheet. All medications on hand must be for current school year.

30. Medication Related Emergencies An allergic reaction to a medication can occur at any time, no matter how long the student has been taking medication. Allergic symptoms: Rash Swelling and Itching Breathing problems Bluish color of skin Increasing anxiety

31. Responding to Medication Emergencies Never leave student alone Notify parent and principal immediately, and school nurse if available Initiate 911 call, if indicated If student is sent to emergency room, send medication container and copy of student’s emergency information card Document on SMR and cum health folder Health staff will document on Student Treatment Record Read slide.Read slide.

32. Anaphylaxis Medical term for life-threatening systemic allergic reaction that may occur when allergic individuals are exposed to specific allergens. Anaphylaxis is a collection of symptoms affecting multiple systems in the body. Epinephrine (adrenaline): single most important medication for treating anaphylactic reactions; should be administered at the first sign of a systemic allergic reaction. Anaphylaxis is a medical emergency.Anaphylaxis is a medical emergency.

33. Anaphylaxis Signs & Symptoms Hives, itching (of any body part); Flushed, pale skin, dizziness; Swelling (of any body part); Red, watery eyes, runny nose; Fainting, or loss of consciousness; Wheezing, coughing, difficulty breathing; shortness of breath; Change in mental status; increasing anxiety Throat tightness or closing; difficulty swallowing. Read slide.Read slide.

34. Emergency Evacuation Plan Review Emergency Evacuation Plan with school nurse to identify your role Plan is posted in the front office and clinic

35. Field Trip Procedures Submit completed “REQUEST FOR NURSING SERVICES ON FIELD/COMMUNITY-BASED INSTRUCTION TRIPS ” form to the district ESE office for ESE students who need health assistance on a field trip Refer overnight field trip needs to school nurse Field trip guidelines and forms are available in the Blue Health Services Guidelines book

36. Responsibilities Regarding Medication and Medical Diagnosis School Personnel Do Not: Suggest or diagnose any health condition. Recommend a specific health care provider. Recommend medication or treatment. Exclude any student for not having medication. Contact medical provider to recommend diagnosis or treatment for student. Do refer student health information and issues to the school nurse. Read slide.Read slide.

37. Other Responsibilities Regarding Medication Do not use white out for corrections: Draw line through error and initial above the line. Make correct entry. Keep medication cabinet key secured: Each school must have a plan for managing key security during the school day and after hours. Refer health questions to school nurse.

38. Confidentiality In the course of caring for a student, information of a private or personal nature may be divulged. It is imperative that you keep in confidence such information; this is an ethical and legal standard that must be upheld. Before sharing any information with any staff member, stop and ask yourself, “Does this person have a legitimate need to know?” Do not discuss students with others who are not directly involved in care. Read slide.Read slide.

39. Medication Audits Performed twice a year by school nurse to monitor administration of medications and identify procedural problems. Medications on hand are counted during audit and counts reconciled.

40. 2009 - 2010 Medication Errors All medication errors are reviewed by the joint school district and health department Quality Improvement Committee. Average number of medications administered a day during the February FTE week: 3,101. Total number of medications administered during the 09/10 school year: 96,268. Number of medication errors reported: 34. Medication error rate: 3.5 errors/10,000 meds administered.

41. QI Annual Comparison

42. Errors happen when the 5 Rights are not verified Right student? Right medication? Right dose? Right time? Right route (mouth, injection, etc)? Administer the medication only after you have answered yes to all 5 questions.

43. Help prevent wrong dose Messages from parents regarding medication changes should be delivered directly to the clinic staff. If message is received by other personnel, it must be immediately reported to the clinic staff. Read slide. Read slide.

44. When can a routine medication be administered? Approved window for administration at school is 1 hr before until 1 hr after prescribed time (2 hr window of time) Exception: Medications that must be given at meal times (i.e. Reglan 30 minutes before meals) Use Tick sheet to prevent missed doses. Use of tick sheet is NOT optional.

45. Common Policy Issues Do not administer any medication without an authorization. - Do not accept parent’s request to alter physician’s order; a new physician form must be obtained. Parent always has option to come to school and administer medication. Do not administer OTC medication dose greater than the stock medication label per standing order. Do not administer non-approved FDA drugs.

46. Infection Control Guidelines Handwashing is the best defense against infection for you and the student Use anti-bacterial soap: Item # 120010. Use hand sanitizer only if water not available: Item #120015 18 oz. Change cot paper between students: Item #145471 24”X1000‘ per roll. Items available through Central Warehouse.Items available through Central Warehouse.

47. Universal Precautions Treat ALL blood and other body fluids as potentially infectious. Maintain disposable plastic Sharps Container: Item # 120047. Clean surfaces with Anti-TB Sanizide Plus. Wear gloves whenever handling body fluids. Wash hands after removing gloves. Read slide.Read slide.

48. Sharps Container Disposal Seal and date container when ¾ full of sharps. School Health personnel will transport sharps container to ECHD: Fairfield or Northside. If saturated material is placed in container: Date container and start 30 day clock. Seal container on 30th day. Transport sharps container to ECHD biomedical waste room. Read slide.Read slide.

49. 2nd MMR is required for grades K-12 Hepatitis B is required for Pre K – K-12 Tdap Booster is required for grades 7-12 Varicella #1 is required for Pre K – 9 Varicella #2 is required for Kg - 2 Students repeating a grade must meet that grade’s requirements 10/11 Immunizations at a Glance available @ http://ese.escambia.k12.fl.us/eval/health/health.htm Immunization Requirements Note: #1 varicella shot increases annually through sequential grades, now grade 9. #2 varicella shot increases annually through sequential grades until all grades are required to have 2 varicella shots, e.g. grade 2. Note: #1 varicella shot increases annually through sequential grades, now grade 9. #2 varicella shot increases annually through sequential grades until all grades are required to have 2 varicella shots, e.g. grade 2.

50. Head Lice Management Truth: the problem is Lice, not nits Only exclude students who have live bugs or nits less than ¼” from the scalp. Students may return to school after being treated with a lice killing product and no live lice are found. Students are allowed one day of excused absence for head lice.

51. DIABETES

52. Seizure Management Review the First-Aid Flowsheet for Seizure Management located in the Clinic’s Health Services Guidelines Book. Child-specific training must be provided by the school nurse if Vagal Nerve Stimulator or Diastat is authorized.

53. Call 911: If seizure lasts longer than 5 minutes. If student has repeated seizures. If student has trouble breathing after a seizure. If student cannot be aroused after a seizure. If student is pregnant, diabetic, or has no known history of seizures. When in doubt...call 911.When in doubt...call 911.

54. Final Reminders There are no short cuts to medication administration – ALWAYS check the 5 rights. All health services forms are available Online. It takes team work between the nurse, health support tech, school staff, parent, and student to provide high quality and safe health services. Be sure to assist the clinic staff frequently so you remain competent and comfortable with administering medications to students. Be familiar with the students listed on the tick sheet. Read slide.Read slide.

55. Steps Complete module Click link to online test Print out the test and complete Contact school nurse to verify skills and review test results Store documentation in Medication Administration notebook

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