Transcript Slide 1

Changing the Way We Do Business:
Working SMARTER not HARDER?
Rebecca King RN, CSN, MSN, MEd
School Nurse Liaison
WVDE-Office of Healthy Schools
Hats Off To…
Objective #1:
• Participants will be
knowledgeable of the
vision for school health
service initiatives at a
national, state and local
level.
WV Department of Education
WV State Board of Education
(Promulgate educational rule for PreK-12,
adult vocational, institutional education facilities
and the school for the deaf and blind)
State
Superintendent
of Schools
WVDE Offices
Deputy
Superin
tendent
RESA
OEPA
Coordinated-School Public
Health Partnership
The West Virginia Story…
Coordinated School-Public Health Structure
2011
RESA-RSWS Focus
• Work Plan
– Local Wellness
– Bullying (S3 high schools)
– Substance Abuse (SBIRT)
– Suicide Prevention (ASPEN)
– Teen Pregnancy (HEAP, PREP grants)
– Physical Activity (Let’s Move)
– Nutrition (current WVDE-OCN
initiatives)
– Tobacco Prevention (Quit Kits)
What’s on the books?
• SN ratio of 1:1500 K-7 (W.Va. Code §18-5-22)
• WVBE Policy 2422.7-Standards for Basic and
Specialized Health Care Procedures in the
School Setting
• WVBE Policy 2422.8-Medication
Administration (Prescribed and OTC)
• WVBE Policy 2423-Communicable Disease
Control (HIV & Comm. Dx Inservices)
What’s on the books?
• WVBE Policy 5200Certification…Authorization, Permit, Full
Certification, Short or Long-Term Substitute
and PPST
• Asthma laws-W.Va. Code §18-5-22b
• Diabetes laws- W.Va. Code §18-2K-1
• High Acuity Funding-W.Va. Code §18-5-22
Top 5 Medical Diagnoses/Procedures
2010/11 School Nurse Needs Assessment
Medical Diagnoses
In-School Specialized
Health Care Procedures
Asthma
Inhalers for Asthma
Behavioral Disorders
Emergency Medications
Anaphylactic Reaction
Long-Term Medications
Obesity
Special Diets per Federal Form
Mental Disorders (Depression,
Bipolar, Schizophrenic, Suicidal)
Seizure Management
Close 5th places…..
Ear, Nose and Throat/
Migraine or Severe
Headache/Seizures
Diabetes Type II
2010/11
Student Medical Diagnoses
Diabetes Type I
16145
Seizures
18000
16000
11491
14000
Anaphylactic
Reaction
12000
10000
4213
8000
6000
4000
2000
0
238
852
2147
Behavioral
Disorders/ADD/
ADHD/OCD/Anxi
ety
Asthma
School Health
Efficiency
•
Multidisciplinary Team (SN, LPN,
Aides, Health Clerk/Secretary)
•
Utilization HealthCheck
examination for new school
enterers…No mass school
screenings
•
Evidence-based practices and
policies (BMI, Scoliosis,
Screenings, Lice, Prevention
Programs, etc.)
•
SBHC with full array medical,
dental and mental
Model
• YOUR County
WVDE-Healthy Schools at
http://wvde.state.wv.us/healthyschools/quicklinks.html.
National
School Nurses to Student Ratio
1:750 Well child
1:225 Chronic conditions
1:125 Complex conditions
1:1 as needed for multiple disabilities
What does the Student to
School Nurse ratio
look like on paper?
1340 + 150 + 10 + 2 =
750 225 125 1
1.66 + .66 + .08 + 2 = 5.28 nurses
Multidisciplinary Approach
1340 + 150 + 10 + 2 =
750
225 125 1
1.66 + .66 + .08 + 2 = 2 RNs
1 P/T LPN
1 clerk
NASN Research Priority
• Identify school nurse delivery models
(school nurse caseloads, credentials,
experience, etc.) necessary for quality
nursing care
• School nurses must identify and
measure outcomes expected as a result
of quality school nursing care
School nurse sensitive
outcomes
• Identify factors that measure the
impact of nursing care over and above
other factors
• Outcomes “sensitive” enough to
distinguish between the effects of
family and community and the effects
of the quality and the quantity school
nursing interventions on child, family
and school community outcomes
Health Care Reform
• WV children with increased insurance
coverage
• Expansion of Primary Care Center
services and funding
(currently serving 1 in 5 West Virginians)
– School-Based Health Services
• Dental
• Mental Health
• Family Planning
Helping us move to full-service communities/schools
Objective #2:
• Participants will be
familiar with evidencebased practice
recommendations in
school health and
challenged to fully
utilize them in daily
practice.
WHY EBIs…so students can get
safe, quality standardized care
Prioritize
• Immunizations, Immunizations,
Immunizations
• HealthCheck, Parent and Provider
Education, HealthCheck, Common
language, HealthCheck, Medical
home concept
• Evidence-based Practice and
Programs
Talk the Talk and
Walk the Walk
• Know the data and the
research, STOP the routines
and start utilizing the facts to
make school health
programming and procedure
decisions!
BMI…
• USPSTF recommends Medical
provider screening for 6 -18 year old
with comprehensive weight
management program. Inclusive of
counseling, diet, physical activity and
behavioral interventions which are
beyond our scope as nurses.
BMI…
• CDC (2007) recommends surveillance
only not census or population-based
screening by school personnel.
• Health and physical education
including modeling school meals and
physical activity for schools.
• Medical home management.
Acanthosis nigricans (AN)
Markers…
• CDC is aware that some groups are
interested in AN screening of children in
school settings to identify those at high risk
to develop type 2 diabetes. Although some
studies have observed that half the children
with type 2 diabetes had AN, insufficient
evidence exists for us to conclude that
having AN will lead to type 2 diabetes.
Therefore, at this time, CDC scientists
strongly discourage AN screening of children
in school or community settings.
Acanthosis nigricans (AN)
Markers…
• While AN is a reliable and independent marker of
hyperinsulinemia, the extent to which AN predicts the
development of type 2 diabetes is unclear. In this study, none
of the 233 students screened had hyperglycemia.
• CDC scientists are not aware of any systematic guidelines for
clinical detection of AN or a uniform AN case definition. The
repeatability, reliability, and validity of AN screening, relative
to expert diagnosis (gold standard), is unknown. This makes
it impossible to meaningfully interpret AN screening results.
Therefore, the utility of using AN as a screening tool for
diabetes prevalence or as a predictor of developing diabetes
is currently unknown.
Acanthosis nigricans (AN)
Markers…
• Those adolescents who have AN can be stigmatized by the
screening process and subsequent identification. We are also
concerned that if AN status becomes a part of adolescents'
medical records, it might jeopardize their future insurance
benefits.
• Most importantly, there are now no known interventions or
protocols to treat those who have AN. There is some evidence
that those with AN might benefit from physical activity.
Because improved physical activity benefits everyone in
school or communities, it makes sense to encourage physical
activity for all children, regardless of AN status.
• Medical home screening.
Acanthosis nigricans (AN)
Markers…
• Given the absence of a uniform case
definition and intervention protocols for
those with AN and considering the risk of
stigmatization for those with AN, CDC
scientists believe that it is not ethical or
cost-effective to mass screen children for
AN. CDC recommends that state diabetes
control programs consider an alternative
primary prevention approach and use
available resources to improve physical
activity and nutrition in schools and
communities.
Scoliosis Screenings...
• Affects only 2-3% of entire US Population.
Do the math.
• USPSTF did not find GOOD evidence to
support this screening for early detection.
• Accuracy of current screening test
(forward bending or scoliometer) is
VARIABLE.
• Only a small amount (minute) of the
nationally 2-3 % cases actually have health
benefits more cases are not clinically
significant.
Scoliosis Screenings...
• USPSTF found idiopathic scoliosis
detected through screening leads to
MODERATE HARM…concluding that
harms of screening out weigh the
potential benefits.
Dental Screening…
• By West Virginia Dental Laws, this is
outside of the scope of a nurse.
• We do individual “oral health
assessments” based on an individual
complaint NOT massive screenings.
Massive Screenings
• Are massive screening conducive to
accurate screenings?
• Do they detect a high population of
needs?
• Can you do a diagnosis, treat or
referral to a specialist?
• Is the medical home an unneeded
entity in a child’s life?
• Do you coordinate health services and
share health information with them?
Massive Screenings
• Outdated
• Lack of supportive research to show
need or true gaps in birth up to three
year old screenings and medical
home care.
• The concept of surveillance and
screening in a medical home is
continuity of care.
WHY?
• PreK is the new enterer with
approximately 15, 000 (71%)students
entering last year leaving only 6,000
new enterers in kindergarten.
• Follow PreK rule under
WVBE…HealthCheck and now
Superintendent’s Interpretation from
2007 which is rule for 6,000
kindergarten enterers.
• Prioritize your time stop rescreening!
Objective #3:
• Participants will be
provided with the
current status of school
nursing and school
health services in the
state of West Virginia
(changing of the guards,
current data and trends,
national certification
and continued
recruitment, working
toward full-service
schools, etc.).
Retirements
•
•
•
•
•
School Nurses
Principals
Health Services Directors
Superintendents
Offsite PreK collaboratives
WV Data
• Lack of preventive care.
• Adolescents without well-child visits
and immunizations.
• Poor oral hygiene and health.
• 17% increase in teen pregnancy
population.
• Below proficiency on HEAP scores
throughout the state.
• Leading in Asthma, Obesity, Hepatitis
B and C, prescription drug abuse, etc.
Developing a Collaborative Team
• Completing Electronic Data Entry
(Immunizations required on WVEIS, Ipad Grant
requires HealthCheck data, High Acuity funds
require HCP for certain specialized health
procedures, medication logs, sick bay). PreK
Child Accomplishment Summaries.
• Increasing the use of WV Statewide
Immunization Information System
(WVSIIS)…feeding into WVEIS.
Developing a Collaborative Team
• Capitalization of funding sources…what are
they?
• Training of staff to recognize early signs and
symptoms of communicable diseases,
provide fluoride rinse programs, health
promotion programs, enhancing health and
physical education, physical activity,
nutritional programs, relationships with
hospitals, programming to assist school
health, filling in the resource gaps, etc.
Developing a Collaborative
Team
• Ensuring children receive annual Well Child
visit and Dental exam for continued health
promotion and prevention practices
• Incorporation of nursing students (LPN to
NP and Doctorate in the school setting) and
others.
• Developing MOUs/Contracts for a county
medical director (Primary Care Centers,
School-Based Health Centers, Private) or
Medical Advisory Board
Developing a
Collaborative Team
• Ensuring children receive annual Well Child visit and
Dental exam for continued health promotion and
prevention practices.
• Developing and maintaining working relationships.
• Developing supports at the RESA
• Developing a seamless health and medical record with
the most influential people working together for the
best of each student.
Full Service School
• School which provides for the whole
child with integration of the eight
components of school health through
medical, behavioral and dental
services, parent supports and
services in the school, community
supports…Making your school
friendly with a whole child, family
and community focus.
Become Nationally Certified
• Ensures leadership skills, quality
care, efficiency, annual professional
development and evidence-based
practice.
How do we get there?
Strategies
• Know legislative rule, state rules and county
policy.
• Know your nursing practice act and the role
of LPN and UAPs.
• Support the Medical and Dental Home
concept to move West Virginia towards
preventive health.
• Validate immunization records and follow
provisional enrollments through to
completion.
• Make adolescent vaccinations and well-child
visits YOUR priority NOT an AFTER THOUGHT!
Strategies
• Follow and implement evidence-based
practice. Obtain a medical consultant or form
medical advisory board for your county’s
school health services program.
• Form collaborative teams/
relationships with public health.
• Form collaborative teams/initiatives with
medical, dental and behavioral health
providers/communities.
Together we serve the
WHOLE CHILD
THANK YOU!
Have a WONDERFUL
Thanksgiving!
Rebecca King
WVDE-Coordinator
School Health
and Coordinated School-Public Health
[email protected]
304.558.8830