Transcript 2011 School Health Update - PAPSA-Web

SCHOOL HEALTH UPDATE 2011
Beth Anne Bahn
Acting Director
Division of School Health
Bureau of Community Health
Systems
April 14, 2011
DIVISION OF SCHOOL HEALTH
• Beth Anne Bahn, Acting Director
• Vacant, State School Health Consultant
• Mary Taylor, Administrative Officer
• Administrative Support
• Six Regional School Health Consultants
REGIONAL SCHOOL HEALTH CONSULTANTS
NW – Donna Leffler
724-662-6068
[email protected]
NC – Deb Frey
570-327-3400
[email protected]
NE – Kristen Cheslick
570-826-2062
[email protected]
SC - Linda Katherman 717-787-8092
[email protected]
SE – Sheri Mountz
[email protected]
610-378-4352
SW – Joseph Donahue 724-830-2701
[email protected]
ACT 104 of 2010 (HB101)
• Allows CRNP/PA to complete
physicals for:
Teacher Certification
School Staff
Mandated Student Examinations
ACT 104 of 2010
• Epinephrine Auto-injectors
School policy on possession and use of
asthma inhalers need to include Epipens
Demonstrate competency
Specify conditions could lose privilege
Require updated prescription and parental
approval annually
ACT 104 of 2010
• Food Allergy Reaction Management
Part of Wellness Policy
Development of Guidelines
Co-chair of committee with PDE, Division of
Food and Nutrition Services
Pattern after Diabetes Guidelines
Stakeholder meeting April 21
IMMUNIZATION REGULATIONS
• Published in PA Bulletin May 29,
2010
http://www.pabulletin.com/secure/data/
vol40/40-22/984.html
• Effective August 1, 2011 for the
2011-2012 school term
IMMUNIZATION REGULATIONS
For New School Enterers in Kindergarten or First Grade
NOW:
• 4 doses tetanus (DTaP, DT,
Td) (1 dose on or after 4 years
old)
• 4 doses diphtheria (DTaP, DT,
Td) (1 dose on or after 4
years old)
• 3 doses polio
• 2 doses measles (MMR)
• 1 dose mumps (MMR)
• 1 dose rubella (MMR)
• 3 doses hepatitis B
• varicella immunity
(vaccine or history of disease)
NEW:
• 4 doses tetanus (DTaP, DT, Td)
(1 dose on or after 4th birthday)
• 4 doses diphtheria (DTaP, DT, Td)
(1 dose on or after 4th birthday)
• 3 doses polio
• 2 doses measles (MMR)
• 2 dose mumps (MMR)
• 1 dose rubella (MMR)
• 3 doses hepatitis B
• 2 doses varicella or immunity
(vaccine or history of disease)
IMMUNIZATION REGULATIONS
For Attendance In All Grades
NOW:
• 3 doses tetanus
(DTaP, DT, Td)
• 3 doses diphtheria
(DTaP, DT, Td)
• 3 doses polio
• 2 doses measles
(MMR)
• 1 dose mumps
(MMR)
• 1 dose rubella
(MMR)
NEW:
• 4 doses tetanus (DTaP, DT,
Td) (1 dose on or after 4th
birthday)
• 4 doses diphtheria (DTaP, DT,
Td) (1 dose on or after 4th
birthday)
• 3 doses polio
• 2 doses measles (MMR)
• 2 doses mumps (MMR)
• 1 dose rubella (MMR)
• 3 doses hepatitis B
• 2 doses varicella or
immunity (vaccine or
history of disease)
IMMUNIZATION REGULATIONS
For Entering 7th Grade
NOW:
• 3 doses tetanus (DTaP, DT, Td)
• 3 doses diphtheria (DTaP, DT,
Td)
• 3 doses polio
• 2 doses measles (MMR)
• 1 dose mumps
(MMR)
• 1 dose rubella
(MMR)
• 3 doses hepatitis B
• varicella immunity
(vaccine or history of disease)
NEW:
• 4 doses tetanus (DTaP, DT, Td)
(1 dose on or after 4th birthday)
• 4 doses diphtheria (DTaP, DT, Td)
(1 dose on or after 4th birthday)
• 1 dose tetanus/ diphtheria/
acellular pertussis (Tdap)
• 3 doses polio
• 2 doses measles (MMR)
• 2 doses mumps (MMR)
• 1 dose rubella
(MMR)
• 3 doses hepatitis B
• 2 doses varicella or immunity
(vaccine or history of disease)
• 1 dose meningococcal
conjugate
School Immunization Requirements for school attendance for all
grades according to PA school law.
Does the
student have
the following
immunization
requirements
for attendance
in all grades?
•4 doses of tetanus
•4 doses of diphtheria
•3 doses of polio
•2 doses of measles
•2 dose of mumps
•1 dose of rubella
•3 doses of hepatitis B
•2 doses of varicella (chickenpox) or
history of disease
NO
Place on provisional status and review every 60
days for 8 months.
•May exclude from school if non-compliance
continues past provisional period.
In Compliance
•1 dose MCV
•1 dose of Tdap (if 5 years
have elapsed since last
tetanus immunization)
Y
E
S
In Compliance
NO
Deny admission
until one dose
of each antigen
listed to the left
is received.
Y
E
S
Y
E
S
NOTE: If the
student is
attending 7th
grade, do they
also have?
Does the
student have at
least one dose
of DT, OPV/IPV,
MMR, HepB
and Varicella?
NO
Place on provisional status and
review every 60 days for 8 months.
•May exclude from school if noncompliance continues past
provisional period.
Foreign exchange students or foreign students
visiting PA schools need at least one-dose of each
antigen to attend or visit PA schools, then they will
be placed on provisional status.
IMMUNIZATION REGULATIONS
IMMUNIZATION REGULATIONS
•Grace Period
•Vaccine dose administered within
the 4-day period prior to the
minimum age for the vaccination
or prior to the end of the minimum
interval between doses
•Considered a valid dose
Example: MMR
Example: hepatitis B
IMMUNIZATION REGULATIONS
• Children <5 years old, 28 Pa. Code §
27.77 (ACIP recommendations)
• Children 5 years and older, follow
School Health regulations, 28 PA
Code, Chapter 23, Subchapter C
IMMUNIZATION FAQs
• Can a parent ask for moral
exemption after student has had
several doses of vaccine?
Case by case basis
Determined by school administration
Needs to be in writing
Can sign back of immunization card
Not required to be renewed annually
IMMUNIZATION FAQs
• Doctor office not providing immunizations,
citing HIPAA
Share joint guidance HIPAA/FERPA
Include parent release on school forms
Encourage use of PA-SIIS
• Can school policy require students to have
immunizations on the 1st day of school, no
provisional?
Have to follow DOH regulations
SCHOOL IMMUNIZATION CATCH-UP
PROGRAM (SICU)
• Provide Hepatitis B, MCV4, Tdap, and
Varicella
Students unable to obtain through their
medical homes
• School districts plan, develop, and
implement programs
Consultation from local Health Department.
Protocols available from the Division of
Immunizations
• Vaccine is provided at no cost to school
districts for VFC eligible students
IMMUNIZATION RESOURCES
• Resources available on What’s New with
School Health,
www.health.state.pa.us/schoolhealth
Slide presentation from March 15, 2011
webinar, “Update to School Immunization
Regulations”
Division of Immunizations website
Law and regulations regarding immunizations
Updated Immunization Manual (when available)
Information on ordering immunization cards and
new rack cards
IMMUNIZATION RESOURCES
• PDE, Basic Education Circular (BEC), Education
for Homeless Students
• Joint Guidance on HIPAA and FERPA
• PA State Immunization Information System (PASIIS)
• CDC Childhood and Adolescent Immunization
Scheduler
Assist in determining immunization compliance
Provides an "instant picture of immunity.“
REFUGEE HEALTH
• DOH and DPW
• Provider Network
• Timely comprehensive health assessment
for each arriving refugee
Identify communicable diseases
Identify and treat health conditions or
health-related issues
• http://www.portal.state.pa.us/portal/server.pt/co
mmunity/refugee_health/19001
TB TESTING OF STUDENTS
• PA Public School Code
Section 14-1402 (a) & (f)
• 28 PA Code
Section 23.9
• Modification
Encouraged since 1997
TB TESTING OF STAFF
• PA Public School Code
Section 14 – 1416 & 14 – 1418
• 28 PA Code
Section 23.44
• Law doesn’t allow for modification of
TB testing for staff
• Does allow for alternative testing
methods
TB TESTING OF STAFF
• Volunteers
Must comply with TB testing
requirement if:
In direct contact with students for 10 or
more hours per week
MEDICALLY IMPAIRED DRIVER LAW
• Effective October 9, 2010
• CRNP and PA
When conducting physical exams for driver’s permits or
in determining whether person has a disorder affecting
ability to drive safely
Report to PennDOT within 10 days
Any patient 15 years of age or older diagnosed with
condition that could impair ability to safely operate
motor vehicle.
Don’t need to report conditions expected to last less
than 90 days
MEDICALLY IMPAIRED DRIVER LAW
• Diabetes
Severe hypoglycemic reactions or
symptomatic hyperglycemia
Not qualified to drive
Unless continuous period of at least 6
months free from disqualifying episode
• Request on-line access
https://www.dot3.state.pa.us/contact_u
s/medicalEmail.jsp
MEDICALLY IMPAIRED DRIVER LAW
• Report to Primary Care Provider
Diabetics
Severe hypoglycemic reactions (requires outside
intervention or assistance of others) or produces confusion,
loss of attention or loss of consciousness
Symptomatic hyperglycemic (caused loss of consciousness
or an altered state of perception, including, but not limited
to, decreased reaction time, impaired vision or hearing, or
both) and confusion reactions
Seizure activity
Cardiovascular
Syncopal attack, loss of consciousness, vertigo, paralysis or
loss of qualifying visual fields
MEDICALLY IMPAIRED DRIVER LAW
http://www.dot3.state.pa.us/centers/medicalReportingCenter.shtml
AED
• Check Battery & pads for expiration
dats
Potentially greater liability than not
having an AED
• Grants/funding- Kiwanis, Lions,
Rotary, PTA, booster clubs
MEDICATION ISSUES
• Field Trips (pp. 18-19 medication
guidelines)
Can’t refuse student attendance on field
trip because nurse not available
(IDEA/504)
May not request waiver of liability from
parent (Berlin Brothers Valley SD)
Advance notice to nurse for planning
Limit # of field trips from building per
day
MEDICATION ISSUES
• Field Trips
Invite parent or parent designee
Utilize licensed nurse from sub list
Licensed parent volunteer
Need clearances
Approval as district volunteer
Provider permission to change dosage
time or skip a dose
MEDICATION ISSUES
• Out of state field trips
Check with Board of Nursing
Get in writing
• Delegation to student by parent
Student under school jurisdiction
Zero tolerance drug policies
• Self-administration by student
Emergency medications only
MEDICATION ISSUES
• Extracurricular activities
Same rules as field trips
• Early Intervention Programs
School District responsibility
Integral part of school program
Located in school district building
Medications, immunizations & emergency
care
Screenings for baseline (optional)
MEDICATION ISSUES
• Emergency Medications
PA Public School Code- self carry and
administer asthma inhalers/epinephrine
auto-injectors
May train unlicensed staff to assist with
their administration
Diastat, glucagon etc. require licensed
medical professional to administer
SPECIAL NEEDS STUDENTS
• Medical Plans of Care
Standard of Care- “If you didn’t write it,
you didn’t do it.”
Emergency Care Plan (ECP)
Individualized Health Care Plan (IHP)
Individualized Education Plan (IEP) with
medical component
504 Service Agreement
SPECIAL NEEDS STUDENTS
• Nurse should be part of team for IEP
and 504
Nurse who has student as part of their
caseload
Should not sign legal document if not
involved in development of plan
Reasonable accommodations for student
SPECIAL NEEDS STUDENTS
• Students with newly diagnosed or
unstable Type 1 Diabetes and an IEP
Medical provider can write as part of
Medical Management Plan
Nurse required in school building at all times
Federal funds to cover cost
SPECIAL NEEDS STUDENTS
• Factors to Consider
Individualized Transition Plan (ITP)
Transition Healthcare Checklist
Who can legally provide Care?
Dietary Accommodations
SPECIAL NEEDS STUDENTS
• ITP
Effort to standardize assessment of
student transportation needs
Resources and training available
Working with Bureau of Family Health
and PDE Bureau of Special Education
SPECIAL NEEDS STUDENTS
• Transition Healthcare Checklist
Required to start transition planning by age 14
School responsible for successful transition
Should include a health component
Most likely area for failure according to PATTAN
statistics
Checklist updated in 2010
Also available in Spanish
http://www.portal.state.pa.us/portal/server.pt?open
=514&objID=558090&mode=2
SPECIAL NEEDS STUDENTS
• Provision of Care
Care of Medically Fragile Child
http://www.aft.org/pdfs/healthcare/medicall
yfragilechild0409.pdf
Scope and Standards (ANA)
Code of Ethics (ANA)
PA laws and regulations
SPECIAL NEEDS STUDENTS
•Dietary Accommodations
•Special dietary needs medical form has been
updated
•http://www.portal.state.pa.us/portal/server.pt/community/national_scho
ol_lunch/7487/special_dietary_needs_in_school_nutrition_programs_resources/509222.
•Must be signed by physician
•Share medical form with Food Services
Director
•Collaboration with Food Services is critical for
appropriate provision of health and food services
CONTINUING EDUCATION
• Act 48
DSH will submit hrs reported for courses
from ANCC, ANA, AMA, AGD and PADHS
Fax certificates to 717-783-4790 or email to [email protected] along
with PDE ID
• Act 58
If CSN, Act 48 hours count for RN CE
LEARNING MANAGEMENT SYSTEM
(LMS)
• All School Personnel & Supplemental
Licensed Health Staff
• Offers on-line courses for school staff
Act 48 hours through the Division of School
Health
Act 58 hours through the Dept. of Health
• To become a registered user:
www.paprepared.net
PA ASTHMA PARTNERSHIP
• www.PAasthma.org
• Resources
• Partners Sharing Newsletter
• Funding Opportunities
• Research Articles
THE CENTER (CNAP)
• Formerly PA Advocates for Nutrition and
Physical Activity
• Now Center for Nutrition and Activity
Promotion at Penn State Hershey
Children’s Hospital
www.nrgbalance.org
nrgZone Enrollment
• March 14 – April 22, 2011
• www.nrgbalance.org/schools
Click on Healthy Schools Campaign
25- question assessment
• Online resources
• Monthly eNewsletter
• Annual events (ex. Apple Crunch)
PROPOSED CH. 12 REGULATIONS
• Establish baseline nutritional &
physical activity standards
• Adopted by State Board of Education
May 6, 2010
• Approved by Governor’s Office
November 6, 2010
• Currently in Attorney General’s Office
PROPOSED CH. 12 REGULATIONS
• Physical Activity
30 minutes daily
Moderate – to – vigorous
• Physical Education
150 minutes at elementary level
225 minutes at secondary level
To be removed in final version
PROPOSED CH. 12 REGULATIONS
• Encourages active commuting (bike
or walk) safely to & from school
• Establish & maintain coordinate
school health advisory committee
• Coordinated School Health plan
Student nutrition, health & physical
activity
Includes the wellness policy
PROPOSED CH. 12 REGULATIONS
• Nutrition Standards
Encourages school gardens or farms
Guidelines for classroom celebrations
Offer sample party menus
Comply with nutrition standards
Non-food rewards & celebrations
Fundraising
Comply with nutrition standards
Set standards for competitive foods &
beverages
SCHOOL HEALTH WEB PAGE
www.health.state.pa.us/schoolhealth
• Data/reports from Annual Report
Database
• Laws and Regulations
• Policies and Procedures
• Manuals, Guidelines and Forms
• Training opportunities, Grants and
Funding
• Information on Current and Future Health
Issues
• What’s New
HAPPY SCHOOL NURSE’S DAY
May 11, 2011