Auburn Public Schools DATA REPORT SCHOOL HEALTH SERVICES PROGRAM

Transcription

1 Auburn Public Schools DATA REPORT SCHOOL HEALTH SERVICES PROGRAM School Year Anne Elsaid, RN, BA, BSN, NCSN Margaret Collins RN, BSN, MPH Luong Duong, RN, BSN Cheryl King, RN, BSN, NCSN, Glenna Sullivan, RN, ASN, NCSN Jo Truong, RN, BSN, Dorothy Vallaincourt, RN, BSN, NCSN with contributions from Carrie Cashman, LPN Auburn Pre School and Kerriann Stuart, RN 1:1 October

2 Table of Contents HEALTH SERVICES REPORT Introduction p.3 School Nurse Staffing p. 3 School Health Services Activity p Health Encounters and Disposition p Injury Reports, Early Dismissals and Referrals for Health Services p.5 3. Medication Management p Health Screenings p Body Mass Index (BMI) p Medical Procedures/ Nursing Interventions p.9 7. Linkages to Health Care Providers p Oral Health, Health Education, Nursing Case Management p Students with Special Health Care Needs p Types of Special Health Care Needs Cardiovascular Health/ Automated Electronic Defibrillator (AED) Medical Emergency Response Plans (MERP) Concussion Data -Auburn HS and MS 10. Substitute School Salary Info p Nursing Highlights p Essential School Health Services Grant p

3 3 HEALTH SERVICES REPORT Introduction The Auburn Public Schools Health Services Department plays a critical role in supporting the District s goals, to improve student learning and achievement. The school nurses support this goal as they keep students safe, healthy and ready to learn. The school nurses have a direct impact on student attendance. Students who need nursing interventions and care are able to attend school and succeed. Students who obtain an injury seek treatment from the school nurse, and they most often are able to return to class. The APS nurses care for every student in the district. In addition, the school nurses provide preventive care and health education for students, staff and parents. The APS nurses serve as a critical link between the school, home, community resources, and primary health care providers. In recent years, many changes have affected the demand for school health services. These influences include: (1) research that clearly links health to educational achievement; (2) improvement in medical technology (3) increase in the number of students with special health care needs; (4) an increase in the severity of the medical diagnosis in these students; (5) restructuring of the health care delivery system; (6) laws requiring inclusion of all students; (7) changes in family structure and patterns of parental employment; (8) rise in social morbidities such as substance abuse, depression, and violence among children; and (9) impact of diverse cultural and linguistic groups. Attendance in the early grades is correlated with school achievement and dropout rates. School nurses support attendance by providing needed health services in school. School nurses are significantly less likely to dismiss a student than an unlicensed counterpart therefore keeping students in school and ready to learn (Pennington & Delaney, 2008). School Nurse Staffing The APS Health Services program is currently staffed with 5 full time School Nurses and two School Nurses who job share the AHS position, and a nurse who works with the Preschool students. In the school year there was an additional nurse who was a 1:1 RN. All nurses provide health care services to students and staff in the Auburn Public Schools. Two nurses are co-nurse leaders for the district, Anne Elsaid and Cheryl King and in Anne Elsaid and Margaret Collins. Student needs required a nurse as a 1:1. There are two School Physicians Kevin Delacey M.D and Erin McMaster MD. All MA school districts are required to have a school physician. Dr. Delacey conducts fall and spring sports physicals at the AHS and provides medical orders to the nurses. Both physicians are available to the nurses and the District for consultation.the audiologist, Kym Meyer, MS CCC-A is a contract employee who supports students with Section 504 plans and IEP s who have a hearing impairment. The audiologist assists with the development of education plans, trains teachers and staff, and coordinates the use of FM systems. Nursing works closely with PT and OT services, guidance and school psychologists. The Essential School Health Services Grant (ESHS) funds the APS nurses as a mentored school district. The district grant is administered through the Douglas School Nurse Leader. The ESHS also funds the Regional Nurse Consultant. The Regional Nurse Consultant works with Auburn and all other Districts in the Central Mass Region. The ESHS grant Regional Consultant provides District support, networking opportunities, and hosts three regional meetings annually to keep our district nurses up to date with the MDPH guidelines.

4 School Health Services Activity The primary goal of the Health Services Department is to provide high quality nursing care to students to keep students healthy and ready to learn. The school nurses document the student and staff health visits throughout the year by the type of visit, and scope of school nursing activity. These activities are divided into nine categories of data: 1. Health Encounters and Dispositions 2. Injury Reports, Early Dismissals, and Referrals for Emergency Health Services 3. Medication Management 4. Health Screenings 5. Medical Procedures 6. Linkages to Health Care and Insurance Providers 7. Oral Health 8. Health Education, Tobacco Prevention, and Support Groups 9. Nursing Case Management 1. Health Encounters and Disposition An encounter is defined as any contact with a student during which the school nurse provides counseling, treatment, or aid of any kind. Mandatory screenings (vision, hearing and postural) are not counted as encounters. Screenings are tracked and reported separately. *nurses also support the staff in each school A total of 34,556 student health encounters were documented between August 28, 2013 and June 26, Illness Assessment, Injury/first aid, and Scheduled Medication administration and treatments are the most common reasons for visits to the school nurse Every encounter includes nursing assessment and health education. An illness encounter may include illness assessment, acute illness, chronic health condition, etc. Mental/Behavioral Health Support includes any encounter requiring active listening, anticipatory guidance, stress management, behavior modification/program support or evaluation of altered mental status. 4 Number of Student Encounters August 31, 2013-June 26, 2014 Type of Encounter Number of Students Illness Assessment 11,332 Injury First Aid 5,498 Mental/ Behavioral Health Support 955 Other/ Miscellaneous 3,750 Total 21,535 (does not include medication administrations and treatments) An important role of school nursing practice is to provide health services to students who are sick, injured, or who are experiencing a health emergency. After assessment and treatment by a school nurse, the majority (95.8%) of students visiting the nurse s office with an illness or injury complaint returned to the classroom to continue their studies. (The return to class rate is higher than the state average of 91% in ) Students who are treated by the school nurse can be returned to the classroom with

5 minimal interruption of their educational activities; working parents do not have to take time off, and the cost of treatment in a doctor s office is avoided. Percentages of students seen for visits (unduplicated students and those not seen for mandated screenings) Auburn High School 492/644= 76 % Auburn Middle School 451/593=76 % Julia Bancroft 270/284= 95 % Packachoag 247/267= 96 % Bryn Mawr School 266/266= 100% Mary D Stone 244/244= 100% 8/31/ /26/ 2014 Student Disposition After Illness/Injury Assessment Number Percent Returned to Class 33, Dismissals 1, *Other Total 34, % Other disposition:stayed in health room, referred to Counselor s office, sent home to return later that day. When students had to be dismissed, it was usually the result of illness (95.6%) rather than injury (4.6%) 2. Injury Reports, Early Dismissals and Referrals for Emergency Health Services For injuries of a more serious nature, APS school nurses filed accident/injury reports ******Number of Student and Staff Injury Reports August 31, June 26,2014 Student Staff Intent Number Percent Number Percent Unintentional Intentional 10 1 Unknown intent 1 0 Total School nurses referred students to urgent health care services a total of 32 times, twice for staff. * or ambulance services were called 7 times for students, 2 times for staff Parents/guardians or emergency contacts were called to transport the student to health services 5

6 3. Medication Management The school nurse s role in managing the medication administration program for the district is broad in scope. The school nurses: Administer medications to students and monitor effectiveness. Manage limited delegation for the administration of selected medications to appropriately trained teachers for field trips and special events, such as an in district field trip (the APS District is registered with the MDPH to implement delegation with specific parameters). Training staff in the administration of an Epi Pen (epinephrine) in the event of an anaphylactic reaction. Anaphylaxis is a potentially life threatening emergency that requires the prompt administration of epinephrine. This requires registration with the MDPH to do so. Stock Epi Pens are ordered annually by the nursing co-leaders for emergency purposes. The current cost per twin pack is $ The Epipens4schools program provides public and private schools with Epi Pens 0.3 mg and Epi Pens 0.15 mg twin packs for each school within the district. In 2013 and 2014, this program has saved the APS district over $8,000. The Auburn school nurses have an order from our school physician to administer this life saving medication for an emergent anaphylactic reaction for students and staff. Ensure the proper training and supervision of the designated staff and documentation of the training. Maintain a record-keeping system for the medication administration in the School Nurse Assistance Program (SNAP) software, the APS s electronic medical record. APS has seven locations with SNAP set up, no current contract with ProMed software, can access the software without access to immunization updates, other updates and software assistance. ** Among prescription medications that the nurses administered on a scheduled basis, psychotropic medications were the most common, while among prescriptions taken on an as-needed (PRN) basis, Asthma medications were the most common.** Number of Student Prescriptions Doses Administered by School Nurses August 31, June 26, 2014 Medication Schedule Medication Class Scheduled PRN Total Analgesics Antibiotics Anticonvulsants Antihypertensive Antihistamines Asthma Med ,193 Epinephrine Insulin 2, ,151 Psychoptic 2, ,551 Other Pres/ OTC 1, ,789 Totals 7,416 1,202 8,618 6

7 4. Health Screenings Public schools in Massachusetts are required by MGL C71, s57 and MDPH regulations to conduct postural, hearing, vision, and height/weight screening for students. The school nurses are responsible for screening students and making referrals for an evaluation by the student s primary care provider or a specialist. The BMI referrals are mailed to the parents/guardians to ensure receipt. Type of Screening Yearly Student Health Screenings and Referrals August 31, June 26, 2014 Total Screenings Number Re-screen Referrals Hearing Vision Height/ Weight Postural * A completed referral is one in which an appointment for follow-up care has been made and the student was evaluated by provider or specialist Hearing screenings are conducted on K-3 annually and grades 7 and 9 annually. Vision screenings are done on K-5 annually and grades 7 and 10 annually. Height and Weight with BMI calculation is done in grades 1, 4, 7 and 10 annually. Postural Screenings are conducted in grades 5, 6,7, 8 and Body Mass Index (BMI) Screenings The Centers for Disease Control and Prevention recommends the use of Body Mass Index (BMI) measurement to screen for obesity in children. BMI is a number calculated from height and weight, and is considered a reliable indicator of body fat in most people. For children and teens, BMI is age and sex specific. The measure is plotted on BMI growth charts to reveal the child's percentile ranking, which indicates the relative position of the child's BMI among children of the same age and gender. 7

8 BMI Report August 31, June 26, 2014 Grade Gender <5th percentile 5th percentile <85th 85th percentile but <95th >95th percentile 1 male female male female male female male female total percentage 1% 69% 14% 16% 8

9 6. Medical Procedures/Nursing Interventions The number of students in need of medical technology has increased in recent years in Auburn and across the US. This presents multiple challenges for school administrators, parents/guardians, school nurses, teachers, and students. Many students need a qualified school nurse to attend school. Type of Procedures Students Staff Auscultate Lungs Blood Glucose Testing 5,513 0 Blood Pressure Monitoring Carbohydrate/ Insulin Calculation 2,123 0 Catheter Care 0 0 Central Line Care 0 0 Check Ketones Insulin Pump Care IV Infusion Care 0 0 Nebulizer Treatment Orthopedic/ prosthetic device adjustment 66 0 Ostomy Care 0 0 Oxygen Adminisration 44 0 Oxygen Saturation Check Physical Therapy 4 0 Suspected Head Injury Suctioning 32 0 Tracheostomy Care 33 0 Naso Gastric Tube Care/ Feeding Usage Ear, Nose, Throat Assessment 1,588 4 Skin Assessment 2,501 7 Nutrition Assessment/ Treatment Muscular Skeletal Assessment

10 Eye Assessment/Care Inhaler Technique Teaching Linkages to Health Care Providers The school nurses identified students without a primary care provider and referred the parents/guardians to appropriate health care services. A referral is reported whenever an actual appointment has been set up with a provider or agency. The school nurses also referred many students to their existing primary care providers for early intervention and care. During the school year: Referrals to new primary care providers 3 Referrals to existing primary care providers 198 Dental care 13 Behavioral/mental health 12 Other 8 Health insurance 3 8. Oral Health The APS nurses recognize that dental health is closely linked to overall health. Cavities are the single most common infection in children. The APS nurses in the elementary grades provide a weekly Fluoride Mouth Rinse program to our students. A large percentage of students participate in this program to reduce cavities. The need is there because our water is from Worcester and the water is not fluoridated. Total numbers of students receiving Fluoride Mouth Rinse: Bryn Mawr 120 Packachoag 182 Mary D Stone 111 Julia Bancroft

11 Health Education Every student health encounter is an educational opportunity. The nurses provide health teaching in their daily nursing care. In addition the school nurses are often called upon to provide health education and deliver presentations. The nurses provide information to students, staff, and community members on topics such as nutrition, life-threatening allergies, and human growth and development. The nurses work cooperatively with the classroom teachers and specialists to improve student health literacy. The types of presentations given most frequently were life-threatening allergies, sun safety and cough etiquette/ hand washing. Health education was also promoted through the development and distribution of newsletters and mailings. Health information was also made available to parents via the APS website, and individual school websites. Nursing Case Management The APS school nurses spent a significant portion of their day performing case management duties that included communication with families, school staff, and community health care providers regarding student health issues. During the school year, school nurses documented: health counseling and education communications with parents, which included phone calls, parent visits, and individual letters -13,390 communications with other school staff about student health issues- 2,399 communications with other agencies and health providers about student health issues- 844 group meetings-91 Individual Health Plans Students with special health care needs require nursing case management, which starts with the development of Individual Health Plans (IHPs). The IHP is developed by the school nurse in conjunction with the student s family, school staff, and relevant community health care providers. The IHP is an individualized plan that details a student s specific medical, nursing, emergency care, and health education needs while in school. IHPs are reviewed and updated on a regular basis to ensure that students receive the appropriate health care in school. During the school year the nurses developed or updated 167 care plans 9. Students with Special Health Care Needs 1. Types of Special Health Care Needs School nurses provide care for students with a wide variety of special health care needs. The diagnosis was based on information provided to the APS nurses by the student's primary care provider, who conducts a physical examination and submits a School Health Record once every 3 to 4 years. This information is supplemented by parent reports (on emergency cards and health information forms) submitted annually. Conditions not requiring nursing care in school may be less likely to be reported to school nurses. 11

12 School Year Physical/ Developmental Conditions Allergies: Bee sting allergies 9 Allergies: Food 52 Allergies: Latex 7 Autoimmune Disorders 3 Blood Dyscrasias 2 Cancer 0 Cardiac Conditions 18 Celiac Disease 4 Cystic Fibrosis 3 Diabetes Type 1 7 Diabetes Type 11 7 Inflammatory Bowel Disease 6 Migraine Headaches 44 Neurologic Conditions: Cerebral Palsy 7 Neurologic Conditions: Spina Bifida 1 Neurologic Conditions: Seizure Disorder 14 Neurologic Conditions: Degenerative Disorder 1 Neurologic Condition: Other 7 *Other Physical/ Developmental conditions 43 Behavioral / Emotional Conditions ADHD/ADD 67 Anxiety 11 Depression 8 Encopresis 4 PTSD/ Trauma History 5 Other behavioral conditions 18 Total Number of students with special health care needs 348 This accounts for 14 % of the student population. Number of students with 504 plans on file Cardiovascular Health and Automated Electronic Defibrillators (AED s) An automated external defibrillator (AED) is a portable device used to restore normal heart rhythm to patients in cardiac arrest. If cardiac arrest is not treated within a few minutes, the condition is fatal. The APS have an AED in every elementary school, middle school, and 3 at the Auburn High School. The APS nurses check the AED s monthly. The Auburn Fire Department s EMS personnel also come to each school to check the equipment. Maintenance and checks are essential to a successful AED program. CPR/AED training is offered routinely to District staff members. 3. Medical Emergency Response Plans (MERP) The MA legislature passed An Act Relative to Medical Emergency Response in Schools, Acts of 2012 Chapter 77. The law was passed in response to a tragic death in Sutton MA of a 16 year old student, Michael Ellsessar, while playing football in The law requires schools to do a number of things to improve safety and preparedness in the event of a medical emergency. 4. Concussion Data from High School and Middle School 12

13 Auburn Middle School Grades 6,7,8 19 = Total number of reported head injury forms received of which 5 are middle school sports team related Auburn High School Grades 9,10,11, and = Total number of reported head injury forms received of which 20 are high school sports team related 5. Per Diem/Substitute School Nurses It has become increasingly challenging to recruit, train and retain per diem, or substitute, school nurses. We have created a Nurse Binder to increase consistency and to provide information for the substitutes and have started to train our nursing substitutes in our nursing software, SNAP. Program Development The APS nurses participated in program planning and development activities in coordination with other District professionals, in areas such as environmental health, policy development, crisis management, and emergency preparedness. In addition, nurses attended conferences and meetings that contributed to their professional development and that assist in obtaining and maintaining nursing licenses, DESE certification and National School Nurse (NCSN) certification status. 13

14 Some Health promotion and services for students, faculty and community that School Nurses were involved in during school year. *Attended Kindergarten orientation in August and conducted parent meetings about students needs and registration requirements * Assisted with Kindergarten registration meetings in the Spring- daytime and evening sessions *Conducted Blood Pressure clinics for staff *Coordinated Sun Safety program on Spree Day- presented awards for sun safety *Coordinated donation/gifts for needy families for holidays *Attended Literacy Night and provided health promotion materials to parents and students * Organized a Walking club before school * Taught Healthy Snack Program which incorporates nutrition and fitness * Taught Hand washing and cough etiquette lessons to prevent the spread of illness *Taught lessons on the new nutrition guidelines with My Plate to students * Involved in teaching Puberty Education classes * Taught Personal Hygiene classes *Taught Sun Safety and general Safety Lessons *Supported health needs during the Relay For Life event held at AHS *Nurses are involved in some School wide meetings and functions such as Safety Team meetings, EST meetings, Welcome Back events, Curriculum Nights, and chaperoning school dances Essential School Health Services Grant:One of the goals of the Regional system is to support and increase networking opportunities for the school nurse leaders in their regional areas. Auburn is part to of the Central Massachusetts region. Expansion of the consultant role to full time includes outreach to unfunded schools as well as charter, collaborative and vocational-technical schools in the region. At the Regional meetings there has been a continued focus on various aspects of the educator evaluation process. The meetings have also provided collaboration topics as the expanding role of 1:1 nurses in the school setting and Best Practice initiatives. 14

15 APPENDIX A Scope of Service Essential School Health Services Grant Program COMPONENTS Each program must meet or continue to meet the following seven components as described below: 1. School health service program infra-structure 2. Collaboration with the comprehensive, coordinated health education program, tobacco control program, etc. 3. Plan for linkage of students with primary care providers, dental providers, behavioral/mental health programs (as needed), community prevention programs, and health care insurance. 4. Development of a management information system. 5. Implementation of performance improvement (continuous quality improvement) and evaluation programs. 6. Services to private schools located in the applicant s community 7. Collaboration/consultation/networking among school nurses. For a more complete description of each of these components, we can provide a copy of the ESHS Grant and the Scope of Services. 15