School Health Services

1. School Health Services Karen Hollowood RN BSN MSEd NYS Education Department July 2011

2. 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

3. School Health Services …Federal Laws • FERPA http://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html • HIPAA http://www2.ed.gov/policy/gen/guid/fpco/pdf/ferpa-h1n1.pdf • IDEA, Section 504, Americans with Disabilities Act http://www2.ed.gov/policy/rights/guid/ocr/disability.html

4. 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.”

5. 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 …”

6. Article 19 • Section 902 defines a school nurse as a registered professional nurse. Any other health professionals must only perform duties within their scope of practice “ Any such board or trustees may employ one or more school nurses, who shall be registered professional nurses, … Such registered professional nurses and other health professionals shall aid the director of school health services of the district and shall perform such duties, … in compliance with each such health professional's practice act. “

7. Article 19 • Section 903 requires students to have a physical examination in grades outlined in 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.

8. 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.

9. Article 19 • Section 905 requires schools to perform screenings for vision, hearing, and scoliosis as outlined in 8 NYCRR §136.3. Such screenings are to be performed by the medical director or the licensed health professional that he/she designates.

10. Article 19 • Section 914 Requires schools to comply with the immunization requirements of PHL 2164, including submitting the annual immunization survey.

11. 8 NYCRR 135.4 • Requires the medical director to approve students to participate in interscholastic athletics, and return to play after illness or injury

12. 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.

13. Article 139 • “Licensed Practical Nurses 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

14. 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

15. 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

16. Self-directed students 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.

17. Self-directed students • 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.

18. 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 training

19. 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.

20. 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.

21. Automatic External Defibrillators (AED) Commissioner’s Regulation 136.4 http://www.p12.nysed.gov/sss/lawsregs/136-terms.html Public Access Providers (PAD) requirements- PHL §3000b http://www.health.state.ny.us/nysdoh/ems/art30.htm#BM3000b Bureau of Emergency Medical Services (EMS) http://www.health.state.ny.us/nysdoh/ems/main.htm

22. Resources NYS Education Department, Office of Student Support Services School Health Services http://www.p12.nysed.gov/sss/schoolhealth/ schoolhealthservices/ 518-486-6090 NYS Education Department, Office of Professions Nursing http://www.op.nysed.gov/prof/nurse/ 518-474-3817 x120 Statewide School Health Services Center www.schoolhealthny.com 585-617-2380 NYS Department of Health- Bureau of Immunization http://www.nyhealth.gov/prevention/immunization/schools/ 518-473-4437