Provides care for those students with health issues. Recommendation Rejected. Tabled for Further Study

Transcription

1 APPENDIX H Item: Nurses Contract Dept.: Student Support Background/Historical Context: Renewal of contract Recommendation: Approve Rationale for Recommendation: Provides care for those students with health issues Board Action: Recommendation Accepted Recommendation Rejected Tabled for Further Study Other

2 CONTRACT New Hanover County Schools 6410 Carolina Beach Rd. Wilmington, NC AND New Hanover County Health Department 2029 S. 17 th Street Wilmington, NC This contract will begin on July 10, 2014 and end on June 30, 2015 between New Hanover County Schools and New Hanover County Health Department. Both parties do mutually agree to the following: A. New Hanover County Schools will: 1. Pay $2,143, ($214, per month for 10 months) for services. 2. Provide an appropriately equipped room for the nurse when she is working at her designated school. B. New Hanover County Health Department will: 1. Develop and maintain First Aid guidelines and nursing protocols to be used in all schools. 2. Provide 4 full-time nurses for 10 months assigned to 4 High Schools. 3. Provide telephone coverage for Mosley Performance Center; Wilmington Early College Program; Lake Forest; and Isaac Bear Early College for 10 months. 4. Provide 7 full-time nurses (40 hours/week) for 10 months assigned to 7 middle schools. 5. Provide 13 full-time nurses (40 hours/week) for 10 months assigned to 13 elementary schools. 6. Provide 3 full-time nurses (40 hours/week) for 10 months assigned to 5 elementary schools and 1 middle school. 7. Provide 6 nurses (32 hours/week) assigned to 6 elementary schools. 8. Provide 1 part-time nurse (20 hours/week) assigned to the 2 Pre-K s. 9. Provide 1 part-time nurse (20 hours/week) assigned to the Head Start Program. 10. Provide supplies for School Medical Services. 11. Provide services in accordance with the North Carolina Nurse Practice Act and the guidelines established by the New Hanover County Health Department, and the attached Memorandum of Agreement between the New Hanover County Health Department and New Hanover County Schools. 12. Provide nursing supervision through the Personal Health Services Division Manager and Public Health Nurse Supervisors. This contract cannot be amended, modified or altered except by agreement, in writing, by duly authorized officials for both parties. Either party may terminate this contract after giving a thirty-day notice, in writing, of intent to do so. This contract is contingent upon the approval of the Memorandum of Agreement by both parties. In witness whereof, the parties acting through their duly authorized officials have executed this contract. NHCS FINANCE OFFICER NEW HANOVER COUNTY HEALTH DEPT. DATE DATE This instrument has been audited in the Manner required by the School Budget And Fiscal Control Act $ 1,406, $ 700, NEW HANOVER COUNTY MANAGER DATE $ 37, NEW HANOVER COUNTY BOARD CHAIR DATE

3 Addendum to Contract The New Hanover County Schools and the New Hanover County Health Department agree to the following additional provisions for the contract for the provision of n ursing services for the school year (the "Contract"): 1. New Hanover County Health Department ("Health Department") shall comply with the Jessica Lunsford Act, NC House Bill933, Section 21, (G.S. 115C, Article 22, part 6, as amended). Health Department shall conduct checks, not less than annually, of its employees who provide contracted services to the New Hanover County Schools. The checks must include the North Carolina State Sex Offender and Public Protection Registration Programs, the North Carolina State Sexually Violent Predator Registration Program, and the National Sex Offender Registry. Health Department shall prohibit its employees and contractual personnel listed with any such programs or registry from having direct interaction with New Hanover County Schools Students during the performance of this Contract. Health Department shall also provide to the New Hanover County Schools a notarized statement certifying that none of its employees or contractual personnel, who have or will have direct interaction with students pursuant to this Contract, are listed with these programs or registry, within 30 days of the commencement of this Contract. 2. Health Department shall defend and indemnify the New Hanover County Schools, the New Hanover County Board of Education, its Board Members, employees and agents of and from any and all claims demands causes of action, damages, costs and expenses, arising out of the actions or omissions of the Health Department, its employees, contractual personnel and agents pursuant to this contract, except to the extent caused by the New Hanover County Schools, its employees or agents. 3. Health Department shall obtain and maintain throughout the term of this Contract Commercial General Liability insurance and Professional Liability insurance with liability coverage limits of at least one million dollars ($1,000,000.00), per policy, and shall provide satisfactory proof of such insurance as requested by the New Hanover County Schools. 4. The parties agree that the nurses and other personnel provided by the Health Department pursuant to this Contract are employees of or contractual personnel of the Health Department and not of the New Hanover County Schools. The New Hanover County Schools shall not be responsible for supervision the nurses or other personnel provided by the Health Department. The New Hanover County Schools shall not be liable for the actions, inactions, negligence, professional malpractice or malfeasance of the nurses or other personnel provided by the Health Department pursuant to this Contract. New Hanover County Health Department. Date: New Hanover County Schools Board Chair Date:

4 MEMORANDUM OF AGREEMENT BETWEEN THE NEW HANOVER COUNTY HEALTH DEPARTMENT AND THE NEW HANOVER COUNTY SCHOOL SYSTEM David E. Rice Health Director New Hanover County Health Department Superintendent or Designee New Hanover County School System Date Date 1

5 The attached School Health Services Program document has been written to provide understanding, give direction and establish specific responsibilities for the School Health Services Program between New Hanover County Health Department and New Hanover County School System. The New Hanover County Health Department employs and supervises the Public Health Nurses (PHNs) who serve the New Hanover County Schools. The PHNs, when providing these services for the schools, shall be considered agents of the Health Department. The School Health Supervisors supervise the PHNs and coordinate the Health Department School Health Program between the school system and the Health Department. The PHNs will provide nursing services according to school permission regulations and the North Carolina Nurse Practice Act to grades Pre-K through 12 during instructional hours. Mary C. Mosley Performance Learning Center, Lake Forest Academy, Transitional Program for Young Adults, Wilmington Early College, and Isaac Bear Early College will be provided with nursing telephone coverage. PHNs will report to their assigned schools daily unless other schedules are developed with the principals, the PHN is on leave, in meetings, or workshops. In the absence of the PHN, another nurse will be available by phone for consultation. The services provided by the nurses are in accordance with the North Carolina Nurse Practice Act and the New Hanover County Health Department School Health Program Policies and Procedures. The school will provide a suitable room for the nurse that allows for privacy, confidentiality, hand washing facilities in compliance with OSHA guidelines, computer equipment, telephone, locked cabinets for medication, supplies, and records, and a cot/recovery couch for nursing observation of students. Both the school system and the New Hanover County Health Department will conduct ongoing evaluations of our cooperative efforts. 2

6 I. SERVICE DELIVERY SCHOOL HEALTH SERVICES PROGRAM SCHOOL YEAR A. SCREENING AND OBSERVATION: Health-O-Rama for mass screening activities is planned by School Health, Speech, Dental Health, and School Administration personnel. Health-O-Rama schedules and dates will be coordinated and mutually agreed upon with school principals. Mass screening activities will include vision, hearing, and dental for selected grades. Objective: To identify specific health problems that may be a barrier to the student s performance and attendance in school. Method: General Observation and Mass Screening 1. General Observation a. Teachers will observe for signs/symptoms of illness, injury, or deviation from normal behavior which may require medical intervention. Students with suspected health problems may be referred directly to the nurse. b. Nurses will distribute Health Observation Guidelines to teachers and school personnel. Nurses will assess, refer, follow-up, and assist in securing of care as needed throughout the school year. 2. Mass Vision Screening a. Nurses and trained volunteers will perform vision screening for all students in grades 1, 3, and 6 as recommended by the American Academy of Pediatrics using the Snellen Eye Test Chart each school year. Nurses will manage all students who do not meet passing guidelines by performing rescreens, referring for vision care, providing financial resource assistance, and following-up as needed. b. Teachers may refer any grade level student with suspected vision problems to the nurse for vision screening anytime during the school year. c. Schools will provide a suitable location for vision screening to take place. Data managers will enter all mass vision screening results into the New Hanover County School System s student data base. 3. Mass Dental Screening a. Dental Health personnel will perform dental screenings for all students in grades K and 5 each school year, and other students by request. Dental personnel will make appropriate referrals, and provide follow-up as needed. b. Nurses will assist with financial resource needs, and follow-up on students as needed. c. Schools will provide a suitable location for dental screenings to take place. Data managers will enter all mass dental screening results into the New Hanover County School System s student data base. 4. Mass Hearing Screening a. Speech/Hearing personnel will perform hearing screenings for all students in grades 1, 3, and 6 each school year. Speech Therapist will manage all students whose screening results fail to meet passing guidelines, or are questionable by making appropriate referrals, and follow-up. 3

7 b. Schools will provide a suitable location for hearing screenings to take place. Data managers will enter all mass hearing screening results into the New Hanover County School System s student data base. B. HEALTH ASSESSMENT Objective: To identify health problems that may interfere with the student s performance, academics, and attendance at school. Method: Record Review and Referral 1. Record Review and Referral a. Distribute Kindergarten Health Assessment forms to parents at Kindergarten registration and upon request (must be on file within 30 days of school entry). b. Distribute health history forms at the beginning of the school year to all students, including students transferring into the school system. All forms that include deviations from normal health will be given to the nurse for review. a. Review all Kindergarten Health Assessment forms within the first 30 days of school, and initiate appropriate referral and follow-up for identified health concerns. b. Review health history forms with deviations from normal health and initiate appropriate referral and follow-up for identified health concerns. 2. Conferences with Teachers and Parents a. Teachers will meet with the school nurse to evaluate health status and plan for referral and/or follow-up as needed. a. Review health records/potential health problems with teachers on a need to know basis. b. Assist parents and school personnel with referrals to appropriate resources for further evaluation of potential health problems. c. Provide health education and health promotion to individual classrooms, individual students, and school personnel as appropriate. C. IMMUNIZATIONS Objective: Assist schools to achieve compliance with North Carolina GS 130A-152 through 157. Method: Record, Review, and Exclusion a. Ensure that all students entering school initially in grades Pre-K through 12, including students who transfer into grades K-12, present original and/or verified record of completed state mandated immunizations within 30 days of school entry. b. Will review all immunization records of students entering the school system, inform parents of requirements, and request immunization records. c. Record immunizations in the school system student data base and retain a copy of the original record to be maintained in cumulative folder. d. Give incomplete or questionable immunization records to the nurse for review and notify parent/guardian of deficiency. 4

8 e. Inform parent/guardian of consequences of incomplete or no immunization record. f. Exclude any student from school who does not present a complete immunization record within 30 days of school entry in accordance with G.S. 130A-155. g. Notify nurse in writing when student is excluded from school in order for nurse to provide follow-up. a. Provide guidance and training to school support staff who review all immunization records of students entering school. b. Assist in review of incomplete or questionable immunization records. c. Advise principal of students not in compliance, and any special problems/circumstances. d. Assist parents/guardians in obtaining required immunizations, and immunization records. e. Utilize the North Carolina Immunization Registry. D. STUDENTS WITH SPECIAL HEALTH CARE NEEDS Objective: Identification and management of health problems that may negatively impact academic success and/or school attendance. Method: Counseling and Consultation a. Include the nurse as consultant and member in school meetings for students with medical concerns for nursing intervention as appropriate. b. Provide access to records of exceptional children as appropriate. a. Serve as a consultant and member (when medical problem exists) in school meetings for students with medical concerns. Provide counseling and consultation on specific health problems to parents and school personnel. b. Review the student health records as appropriate, assist in obtaining appropriate screenings, medical care, and refer for further evaluation as needed. Review and interpret findings with school personnel on a need to know basis, consult with parents, and discuss planned follow-up. c. Assist parents of students needing special care to secure health care and/or financial services. d. Registered Nurse will develop an Emergency Action Plan for students with a chronic disease, significant health problem, and/or a life threatening medical condition. Nurse will provide training, instruction, and consultation regarding care, special procedures, and give information to appropriate school staff on a need to know basis. Nurse will document trainings. E. MANAGEMENT OF HEALTH PROBLEMS Objective: Method: To assist in management of health problems that may interfere with the child s performance or attendance in school. Policy Development, Training and Emergency Action Plan Development 5

9 1. Lice Infestation a. Teachers will refer students with suspected infestation of lice to the nurse or school personnel in absence of nurse. b. Manage screening, referral, and criteria for school re-entry in absence of nurse. a. Instruct school personnel on the epidemiology and detection of lice infestation. b. Instruct parents/guardians, and school personnel on the Lice Policy in New Hanover County Schools, detection of lice, and treatment. c. Provide follow-up according to the Lice Policy in New Hanover County Schools. 2. Emergency Administration of Epinephrine (EpiPen) a. Principal will designate staff persons responsible for receiving training in administration of Epinephrine (EpiPen) in an emergency situation. b. Students may carry, possess and self-administer Asthma and/or Anaphylactic medication with physician authorization and parent permission according to policy. c. Maintain a copy of the Emergency Action Plan/Medication Authorization within easy access to those designated personnel. a. Nurse will develop an Emergency Action Plan for identified students; provide instruction/training for designated school personnel in the administration of Epinephrine (EpiPen), and document training. b. Physician/Medical Consultant has given standing orders for administration of Benadryl and Epinephrine anaphylaxis management by Public Health Nurse Only. c. Physician/Medical Consultant has given standing orders for administration of Epinephrine for life threatening asthma exacerbations by Public Health Nurse Only. 3. Medical Emergencies/Emergency Response a. Principal will designate school staff personnel and the school nurse to serve on the First Response Team who has current certification in CPR and use of the AED. The school system will provide instruction to staff. b. Each school develops their own emergency response plan and provides staff training. AED s are monitored monthly by nurses and school personnel. c. Medical emergencies will be handled by the School Nurses or school personnel, referred to parent/guardian, and emergency facility as necessary. d. The school will maintain emergency information on each student. e. Maintain a system of accident reports on the school system s student data base. f. Maintain adequate health room facilities. g. Evaluate classrooms and school areas for safety features. h. Evaluate school facilities in terms of needs of special students. a. Nurse will maintain current certification in CPR/AED. b. Nurse will develop an Emergency Action Plan for students with identified lifethreatening medical conditions. The Emergency Action Plan and/or medication authorization will be given to school staff/team members on a need to know basis. 6

10 c. Nurses will provide in-service and training for school staff to comply with NC laws, and document training, and attendance. Principals will designate and ensure staff attendance. d. Nurses will assist parents/guardians and school staff in obtaining health care services needed for the student. e. Nurses will handle medical emergencies or delegate to school personnel in her absence. Will refer to parent/guardian and/or emergency facility as necessary. f. Nurses will serve on the First Response Team, Crisis, and Disaster Teams. g. Maintain adequate First Aid and health room supplies. h. Provide training to appropriate personnel and volunteers. i. The School Health Program will develop and revise policies, procedures, standing orders, and nursing protocols regarding illness and accident care on an ongoing basis. F. CONSULATION Objective: To provide health education and consultation to school personnel, students, and parents/guardians about school health, child health, and communicable disease. Method: Nurses will provide consultation, assistance, and training for school system Personnel. a. Participate in faculty meetings, when invited, to provide medical information as well as information on school health services, health department services, and communicable disease. b. Be available to participate in parent education sessions when requested and as time permits. c. Respond to referrals and questions, collaborating and referring as needed with community resources. d. Provide teachers with First Aid supplies. e. Consult with the Health Department s Communicable Disease Division as needed. f. Provide health education and counseling to students, individually or as a group, in coordination with School Social Workers and School Counselors. g. Serve on the Family Involvement Team (FIT) and on school committees as appropriate. h. Consultation provided for: Life threatening medical conditions; medical emergencies Medication administration Special medical procedures Chronic medical conditions to include but not limited to: Diabetes, Asthma, Allergies, Epilepsy Control and management of communicable/infectious diseases Special needs students to include but not limited to: special medical procedures, physical, psychological and socio-economic needs OSHA; Environmental hazards; Infection control guidelines Safety; Accident prevention; Animal control issues Tobacco Free Schools G. REFERRAL AND FOLLOW-UP Objective: To assist in securing care for health conditions that may interfere with the student s performance or attendance. 7

11 Method: Nurses or School Staff may notify parent/guardian in a confidential manner of any suspected health conditions by telephone, letter, or home visit. a. Notify parent/guardian of any student the nurse screens/assesses and determines that a referral is appropriate. At least three (3) attempts to contact parent/guardian will be made. These attempts and the outcome will be recorded in the school system s student data base. b. Assist parent/guardian in obtaining health care for the student as needed. This may include assistance in obtaining medical insurance or other financial resources. Referrals to the student s primary care provider, or referral to available community resources/medical providers. This may involve coordination with School Social Workers. I. RECORDS AND REPORTS Objective: To document health services utilizing the school system s student data base as appropriate and as required by Federal, State and local guidelines, to provide a mechanism for quality review and to maintain health information. Method: A health record will be maintained jointly by school and health personnel and maintained as part of the student s cumulative folder or confidential medical record in the school system s student data base. Recording and maintenance of these confidential records shall not violate Family Educational Rights and Privacy Act. a. The student s immunization status at the time of school enrollment, transfer, and on an ongoing basis as needed. b. Results of mass screenings. c. Provision of a secured, locked area in the school, where health services were rendered, for health related records to be filed yearly. a. Appropriate documentation of teacher/nurse referrals for health care. b. Documentation of referrals to providers of health care as appropriate. c. Follow-up, results of services rendered by referral source, and a plan for continuity of care if indicated. d. An authorization form for the administration of medication during school hours signed by the health care provider, parent/guardian, and school nurse. e. Documentation of nursing care provided, and any deviations from normal health. f. Documentation of parent/guardian conferences or contacts. g. Documentation of multi-disciplinary efforts to plan care. II. QUALITY ASSURANCE/PROGRAM EVALUATION Objective: To provide an annual review of the School Health Program for evaluation of identified needs, documentation of provided services, objectives obtained, and quality assurance. 8

12 Method: School Health Program revisions will be made according to identified needs and current Standards of Practice. Results of Quality Assurance and Program Evaluations are documented and reported to the Health Director, Personal Health Services Manager, Assistant Superintendent for Student Support Service, and the Public Health Nurses in New Hanover County Schools. School Health Program Responsibility: a. Submit a monthly school health reports to the School Health Supervisors to include numbers of the following: students and staff health room visits; medical referrals/secured care; contacts/consultations; vision screenings/referrals/secured care; medications administered; special procedures performed; student records assessed; emergency action plans developed; health education sessions/articles; home visits; and families/children assisted in the Healthy and Ready to Learn Initiative. b. Semi-annual health room quality assurance audit by school health Team Leaders and/or Supervisors. c. Health room visits by School Health Supervisors and Team Leaders approximately every 2-3 months and as needed. III. PROFESSIONAL DEVELOPMENT Objective: Method: To assume responsibility for continuing education, professional development and to contribute to professional growth. Enhancement of Professional Nursing knowledge and skills 1. Nurses maintain a current Registered Nurse license as required by the North Carolina Board of Nursing; provide nursing services in accordance with the North Carolina Nurse Practice Act and School Health and Policies and Procedures established by the New Hanover County Health Department. 2. Nurses maintain current certification in CPR/AED per NHCHD School Health policy and procedure. 3. Nurses will participate in continuing education programs to increase knowledge, competency and proficiency of nursing knowledge and skills. 4. Nurses evaluate recommendations for change based on evaluation, review, and the quality assurance process. The Health Department will comply with NC House Bill 933, Section 21, (G.S. 115C, Article 22, part 6 amended). Contractor shall conduct checks not less than annually of its employees who provide the contracted services to the New Hanover County Schools. The checks must include the State Sex Offender and Public Registration Program, The State Sexually Violent Predator Registration Program, and the National Sex Offender Registry. The Health Department shall prohibit any contractual personnel listed with any such programs or registry from having direct interaction with students, and the Health Department will provide New Hanover County Schools a notarized statement certifying that none of its employees who have direct interaction with students are listed with these programs or registry within 30 days of the commencement of this contract. 9