Transcript Hanover Public Schools Health Services

Hanover Public Schools
Health Services
School Health Update
2007-2008
Prepared by
Jean Hight R.N., BSN
Nurse Leader
February 2008
Mission Statement
The primary mission of the Hanover Public
Schools Health Services is to support educational
achievement for all students. The Hanover
School Nurses strive to accomplish this goal by
providing quality holistic health care to all
students. Through health education and
promotion we encourage the establishment of
healthy behaviors and healthy life choices.
“A healthy child is a better learner” Author Unknown
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Sept. 2007 - Jan. 2008
Health Office Visits
Office Visits - Students 14,332
Illness
7,045
Medication Admin
4,585
Dismissals
646
Referral to Emergency
Health Services
10
911/Ambulance Calls
2
Injury Reports
33
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Health Screenings *
2006 - 2007
• Vision Screening – 2,474 – 71 Referrals
• Hearing – 2,294 – 107 Referrals
• Postural Screening – 895 – 36 Referrals
• Heights and Weights – 1,027
* Please note: These are in addition to Health Office visits
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Body Mass Index (BMI) Percentiles*
2006 - 2007
BMI Category
< 5th percentile
Grade
Grade 1
Grade 4
Grade 7
Grade 10
> 5th percentile
and
< 85th percentile
> 85th percentile
but
< 95th percentile
Underweight
Normal Range
At risk of
overweight
Overweight
Male
4
70
29
22
Female
3
53
15
13
Male
8
74
16
14
Female
1
80
26
16
Male
5
85
22
17
Female
6
97
23
16
Male
5
1
62
66
14
15
15
10
Gender
Female
> 95th percentile
* BMI percentiles are based on age and gender, using standards established by CDC.
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Impact of Obesity
Obesity puts children at risk for debilitating
or life threatening health problems such as
type 2 diabetes, heart disease, high blood
pressure, and stroke.
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Medications
Sept. 2007 - Jan. 2008
• Total Medication
Orders: 204
(approximately 7.5%
of students)
• Total Medications
Administered:
4,579
• Staff
Medications: 137
Analgesics
3,000
2,642
2,500
Insulin
2,000
Other
1,500
Psychotropics
1,000
Antibiotics
500
0
634
549
365
271
108
Asthma
Meds.
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Anticonvulsants
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Medical Conditions 2006-2007
300
284
250
200
150
132
100
66
50
59
19
14
11
8
Asthma
Allergies
EpiPens
ADHD
Autism
Cardiac
Seizures
Diabetes
0
This does not include other medical conditions such as mental health
(depression, bi-polar, anxiety), Down Syndrome, Celiac Disease, Migraines,
Orthopedic Problems, Cystic Fibrosis, Cancer, Genetic Disorders, and others.
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Nursing Procedures
Sept. 2007 - Jan. 2008
3,251 Nursing Procedures Total
• Blood Glucose Testing – 1,029
• Insulin Pump Care - 212
• Respiratory Procedures – 263
• Blood Pressure Monitoring – 40
• Wound Care - 695
• Orthopedic Procedures – 110
• Head Checks for Pediculosis – 265
• Other - 637
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Dismissals Sept. 2007 - Jan. 2008
14,000
12,947
12,000
10,000
8,000
Return to Class
Dismissed
6,000
4,000
2,000
648
0
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Communications
Sept. 2007 - Jan. 2008
• 1,752 Parent Phone Conferences
• 1,105 Meetings/Conferences With Staff
•
144 Communication with Community
Agencies
• 102 Referrals to Primary Care Physician
•
5 Other Referrals
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Staff Health
Sept. 2007 - Jan. 2008
• 117 Visits For Illness Assessments
• 137 Medications
• 55 Visits For First Aid
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Education Laws and Regulations
603 CMR 7.11
Professional Support Personnel Licenses
School Nurse (Levels:All)
(a) Initial License.
1.
Valid license to practice as a Registered Nurse in
Massachusetts.
2.
A bachelor’s or masters degree in nursing.
3.
A minimum of 2 full years of employment as a
Registered Nurse in child health, community health, or
other relevant clinical nursing.
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Laws and Regulations (continued)
4. Completion of an orientation program based on the
requirements for delivery of school health services as
defined by the Department of Public Health.
5. Passing score on the Communication and Literacy Skills
test.
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Laws and Regulations (continued)
(b) Professional License
1. Possession of an Initial License.
2. 3 years of employment as a school nurse.
3. Completion of one of the following:
a. Achievement and maintenance of certification or
licensure from a nationally recognized association
as a school nurse, community health nurse, or
pediatric/family/school nurse practitioner.
b. A master’s degree program that may include
credits earned in master’s degree program for the
Initial license in community health, health
education, nursing, or public health.
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Documentation
• All Health events must be documented by
the school nurse.
• Health Records are a critical component
for the documentation of health events.
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All medications
Immunization Status
Vision, Hearing, Scoliosis Screening Results
Health History
Physical Exams
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Documentation (continued)
• ALL students with a special health condition
(e.g. diabetes, asthma) MUST have a nursing
Care Plan – Massachusetts General Laws
(“M.G.L.”) 244 CMR 3.02
• Each medication order MUST have a written
medication administration plan per M.G.L.,
105 CMR 210.005
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What does the School Nurse do?
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Stocks and maintains health care office.
Episodic assessment and nursing care.
Writes Individual Health Care Plans (IHCP) for each student
with special needs, i.e. Life Threatening Food Allergy (LTA),
Diabetes, Cystic Fibrosis, Cancer, Asthma, etc.
Communicates with administration and staff about health needs.
Does screenings and makes referrals.
Acts as a resource.
Provides individual and group health education and promotion
to students, staff, and parents.
Communicates with physicians and community agencies on an
as needed basis to promote the health of students.
Documents care and events.
Much more…
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What does the Nurse Leader do?
• Plans and coordinates district-wide health services program.
• Communicates and collaborates with local board of health, school
physician, and Massachusetts Department of Public Health (MDPH).
• Collaborates with school personnel and supports team approach for
student physical, social, mental, and emotional health.
• Attends quarterly MDPH School Nurse Leader meetings
• Attends regional Nurse Leader Meetings.
• Does Monthly Activities Report for MDPH – electronic submission.
• Does Annual reports for MDPH.
• Participates in Continuous Quality Improvement Program (CQI).
Currently doing Vision CQI.
• Co-chairs Health Advisory Council, a diverse group from the schools
and the community that promotes wellness and healthy behaviors.
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Nurse Leader (continued)
• Chairs Healthy Schools Committee which evaluates and manages
school facilities for environmental, safety, and health issues.
• Assists in maintaining school health management system
(Healthmaster) which enables ongoing data analysis.
• Promotes the use of the new MDPH “School Health Manual”.
• Collaborates with Superintendent and others to develop health policies,
i.e. Life Threatening Allergy (LTA) and Emergency Preparedness.
• Maintains Automated External Defibrillators (AEDs) and provides
CPR/AED training opportunities.
• Supervises and manages school nurses. Holds monthly meetings.
• Orients, trains and supervises substitute nursing staff.
• Collaborates with school business manager in preparing school health
supplies budget and Essential School Health Services (ESHS) “Program
Budget Plan”.
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Nurse Leader (continued)
• Does yearly review of school nurse procedure manual.
• Promotes school nurse networking in community with private,
collaborative, and vocational schools.
• Ensures that these schools receive information from the MDPH
(weekly e-mails and alerts) as well as other health information.
• Member of groups promoting health and safety within the community,
i.e. the Hanover Alliance for the Prevention of Substance Abuse
(HAPSA) and the Regional Emergency Management Systems
(REMS) task force.
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Recommended Ratio
School Nurse to Student
In the 1998 Report to the Massachusetts Legislature,
“Options for Developing School Health Services in the
Commonwealth of Massachusetts”, the Department of
Public Health recommended the following:
• One fulltime equivalent (FTE) licensed school nurse for each
building (both public and nonpublic) with 250 to 500 students;
• An additional 0.1 FTE for each additional 50 students in
buildings with more than 500 students; and
• 0.1 FTE for each 25 students in buildings with fewer than 250
students.
When developing staffing plans, other factors to consider
include the number of children with special health care
needs, the number of buildings, and the distance and/or
travel time between buildings.
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Hanover Schools Enrollment
School
No. of Students
Center
380
Sylvester
253
Cedar
555
Hanover Middle
899
Hanover High
656
Total
2743
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Closing Summary
The goal of the Health Services is to support education
by keeping students healthy, in school and ready to learn.
Student health needs have grown increasingly complex
through the advancement of medical technology and
requires professional nursing staff for school attendance.
Student health complexities have increased the demand
for continuous documentation.
The need for nursing staff and a nurse leader is evidenced
by the volume and complexity of health office visits and
the volume and complexity of health issues encountered
in our schools today.
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