Transcript DPAS II Component 5

Frequent Flyers
Nancy Nadel
Sharon-rose Gargula
Nadel and Gargula 2012
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The student will decrease unscheduled
non-acute care visits to the nurse.
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Unscheduled
Non emergency
Unnecessary
No significant complaint
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Chapped lips
Invisible injuries
Stomach aches just
before lunch
Paper cut
Frequent visits out
of the same class
for vague
complaints
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Picking scab off
healing cuts
Personal female
care
Symptoms that just
started 1 minute
ago
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Scheduled medication
Scheduled treatment
Asthma attack
Chronic Illness care (diabetes, seizures)
Fever
Vomiting
Chest Pain
Injury requiring first aid
Significant mental health crisis
Nadel and Gargula 2012
Choose a group of
students (between
10-150) that are at
risk for frequent
visits
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Hint- the larger the
group the better
the outcome will
be
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Use eschool or DSC
to determine who
will be at risk
Past frequent flyer
New student to the
building who has
found their way to
you
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50% of the selected cohort will show
improvement over a defined period of time
with a minimum of 4 weeks.
If your cohort is 20, then a minimum of 10
students will have a decrease in their
unscheduled office visits by at least one visit
during the second time frame you have
chosen to measure.
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Any visit to the
nurse
Include time of visit
and length of visit
Chief complaints
Is it vague or
specific?
Is it medically
necessary?
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Discuss with the
student what the
ultimate goal is for
this visit (rest, pain
free, go home)
Where is the
student coming
from or where is
the student
supposed to be
going?
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History, including
onset of complaint
Care provided at
home
If an injury, where
did it happen?
Are parents aware of
the illness/injury?
How is this
interfering with
outside activities?
Physical assessment
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Staff conference:
what is the teacher
seeing in the
classroom?
How often is the
student leaving the
classroom?
Is the teacher aware
that the student has
come to the health
suite?
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Choose 2 equal points in time
 Min 4 weeks max is school year
 Example Nov 1st-30th and April 1st-30th or 1st MP and
3MP
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Compare the number of visits for the cohort
(identified students)
Improvement can be by a single visit!
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Identify the real reason for the visit.
Look for patterns such as a common time
Is there a substitute teacher?
Is it the same teacher who is making
excessive referrals?
Ensure medication availability and compliance
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Educate the student about acceptable reasons
for visiting the nurse
Identify a motivator for staying in class which
might include a reward system
Develop an IHP
Teach student self care and facilitate a means
for this to happen
Consider scheduling a time for an office visit,
just to check in
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Is there a plan for the
substitute teacher
and what to do with
students who are
frequent flyers?
Educate teachers on
proper referrals decision tree
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Make teacher aware
of excessive referrals
Attend PLC’s
Utilize support staff,
IST, guidance
counselor
Speak with
administration about
support for teachers
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Communicating
concerns, genuine
caring for student’s
well being
Obtain a health
history.
Set common goals
with parent.
Conference with
parents/teacher &
nurse
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Encourage parents
to follow-up with
PCP to rule out any
physical cause for
the student
complaint.
Mental health
issues if untreated
can cause physical
symptoms
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Students showing
improvement
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Total number of
students
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Acceptable growth
rate is 50% - unless
you chose
something else in
agreement with
your administrator
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School nursing started with the premise that
healthy children should be in the classroom
and sick students should be at home.
By decreasing the frequency of non emergent
visits we are supporting our teachers and
helping students become successful.
The documentation for this indicator can lead
to data for other indicators
We can combine this indicator with other
indicators.
Nadel and Gargula 2012
Nadel and Gargula 2012