DELEGATION GUIDELINES FOR SCHOOL NURSES. October 2015

Transcription

1 DELEGATION GUIDELINES FOR SCHOOL NURSES October 2015

2 Presenters Jolene Bracale, MSN, RN Registered Nurse for 30 years Critical Care for 10 years School Nurse for 15 years Program Coordinator for Student Health Services at the Indiana Department of Education for 4 years Blayne Miley, JD Indiana State Nurses Association, Director of Policy & Advocacy Indiana State University, Adjunct Professor teaching Health Policy Leadership to DNP students

3 INDIANA CENTER FOR NURSING ACCESS TO CARE ADDITIONAL SUBCOMMITTEE MEMBERS Barbara Kelly, MSN, FNP-BC, RN Lindsey Minchella, MSN, RN, NCSN, FNASN Deb Robarge, BSN, RN, NCSN Cecelia Smith, MSN, ANP-BC, RN Carolyn Snyder, MS, BSN, RN

4 BACKGROUND INFORMATION

5 Data The Universal Language Source:

6 School Nurse Data Collected in May 2013 Voluntary Participation Represents 49.7% of Indiana Students Data Received from all Regions of the State, all Types of Schools, all Grade Levels

7 Geographic Distribution of Data by Region 21 % 37 % 42 % North Central South

8 School Nurse Data 3% School Nurses are 9% primarily employed by school corporations (88%) and local hospitals (9%) 88% School Corp. Local Hospital Other

9 Top Three Roles of School Nurses Caring for the Ill or Injured Managing Students with Chronic Health Conditions Discussing Health Issues with Parents

10 Treatments Performed by School Nurses Catheterization Central Venous Line Care Administration of Emergency Medications Epinephrine, Glucagon, and Diastat Insulin Administration Nebulizer Treatment Shunt Care Tracheotomy Care/Cleaning Tube Feeding

11 Other School Nurse Roles Vision Screening Hearing Screening Immunization Verification Writing Individual Health Plans for Students Training for Health Aids, Teachers, Secretaries, Bus Drivers, Food Service, Custodians Educating and Counseling Students

12 STUDENT DATA

13 Types of Medicines for Students in Indiana Schools Total Medicine 12.5% = 141,159 Emergency Medicine 6.1% Long-Term Medicine 3.3% Short-Term Medicine 3.1%

14 Emergency Medication Given at Least Once During the School Year Out of 558,571 students reported on in this survey (49.7% of school population) Epinephrine = 45 Diastat = 37 Glucagon = 24

15 Chronic Diseases School Nurses were asked about 32 Different Chronic Diseases: 35.86% of Indiana Students had at least one of these 32 diseases = 402,385 Students in Indiana have at least one chronic health condition

16 Approximate Number of Students with Chronic Diseases (80,000 97,000) Asthma Environmental Allergies ADD

17 Approximate Number of Students with Chronic Diseases (9,000 25,000) Mental Health Disorders Migraines Severe Food Allergies Gastrointestinal Disorders Number of Students Seizures 9807

18 Approximate Number of Students with Chronic Diseases (4,000 8,000) Orthopedic Disability Cardiac Conditions/Hypertension Hearing Disorders Number of Students Visually Impaired 5400 Substance Abuse 4829

19 Approximate Number of Students with Chronic Diseases (2,400 4,000) Diabetes-Type Renal Condition Cerebral Palsy Number of Students Chromosomal Conditions 2519 Neurologic Condition (traumatic brain injury) 2437

20 Approximate Number of Students with Chronic Diseases (900 2,300) Metabolic Conditions (hypo/hyperthyroidism) 2336 Blood Disorders/Bleeding Disorder 1497 Number of Students Diabetes-Type Rheumatic Arthritis or other Rheumatic Condition 974

21 Approximate Number of Students with Chronic Diseases ( ) Sickle Cell Trait/Anemia Eating Disorder (bulimia/anorexia) Cancer Number of Students Addison's Disease 701 Fetal Alcohol Syndrome 643

22 Approximate Number of Students with Chronic Diseases ( ) Spina Bifida 641 Cystic Fibrosis 321 Number of Students Multiple Sclerosis 117

23 Chronic Disease Management Requires Writing Individual Health Plans and Delegating Nursing Tasks to Others Nurses in Schools Need Guidance

24 SCHOOL ISSUES IMPACTING SCHOOL NURSING

25 School Budgets Legislative Funding Formula has caused many schools to cut costs that are not directly related to education Support Services are being deleted or outsourced Non-qualified personnel are assuming health roles

26 Need for Guidance School administrators and many health personnel are not aware of scope of practice laws, especially as it applies to the education setting As we just saw, many students in need of health care are enrolled in our schools School personnel need to be educated and nurses need to have guidance regarding how to articulate the need for qualified personnel and the need to deliver safe health care to students

27 DELEGATION DOCUMENT

28 Subcommittee Members Lindsey Minchella, Carolyn Snyder Deb Robarge Barbara Kelly CeCelia Smith Jolene Bracale Blayne Miley

29 Guidelines to Delegation for Indiana School Nurses CONTENTS Section 1 - State of Indiana Regulations Section 2 - Principles of Delegation for the School Nurse Section 3 - Delegation Tools Section 4 - References

30 Section 1: Regulations Definitions School Nurse Registered Nurse Licensed Practical Nurse Standards of Practice for RN, LPN from Indiana Administrative Code Violations RN s & LPN s subject to discipline by Board of Nursing Unlicensed personnel practicing nursing as an RN or LPN commit a class B misdemeanor Statutory requirements for students with diabetes

31 Section 2: Principles of Delegation Delegation: who, what, when, why, how Who is an Unlicensed Assistive Person Documentation Steps in the delegation process Training v. delegation v. assignment Withdrawing delegation

32 Section 3: Delegation Tools Delegation Decision Tree 14 Prerequisites for Delegation Delegation Task Table Skills Checklist for Staff Training Medication Administration Checklist Training Verification Form for School Personnel to Administer Medication

33 Section 3: Delegation Tools

34 Section 3: Delegation Tools

35 Section 3: Delegation Tools

36 Section 3: Delegation Tools

37 Next Steps Organizational Endorsements Document will be distributed to all stakeholders in the school healthcare setting

38 Conclusion Thank You Do You Have Any Questions? Source: