Indiana Code. Title 20 = Education. Legislative Update Health Laws. Indiana Code /20/2014

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1 Legislative Update Health Laws Jolene Bracale Indiana Department of Education June 2014 Indiana Code Indiana Code Title 20 = Education 1

2 Indiana Code Article 34 = Student Health and Safety IC as of 2013 Chapters 1: AIDS Advisory Council 2: Drug-Free Schools Committee 3: Health and Safety Measures 4: Immunizations 5: Care of Students with Diabetes 6: Student Safety Reporting 7: Student Athletes: Concussions and Head Injuries Changed July : Vision Testing Changes July : Immunizations 7: Concussion New Chapters 4.5: Epinephrine 8: Sudden Cardiac Arrest IC Changes 2

3 IC as of July : Health and Safety Measures 4: Immunizations 4.5: Epinephrine 5: Care of Students with Diabetes 7: Student Athletes: Concussions and Head Injuries 8: Sudden Cardiac Arrest IC Health and Safety Measures Health of Children 3

4 IC Health and Safety Most of the laws in Chapter 3 did not change, only the vision requirements have changed recently. Thus, most of this section of the presentation will be a review of laws that have been in existence for several years. IC Health and Safety Exception for Student Health Made in writing from LHCP States detrimental to a student s health Typically relates to immunizations - form on the DOE Health website for Medical Exemption for an Immunization IC Health and Safety Joint Employment Two or more school corporations may jointly employ one physician, one health coordinator, or one or more nurses Schools may also employ the personnel jointly with a city or town 511 IAC states school corporations must employee at least one RN with a BSN to coordinate school health services 4

5 IC Health and Safety Students found to be ill, medical care, readmission, appeals School may send students home who are ill or have a communicable disease Student readmitted when no longer ill, physician certification (no longer ill or not transmissible), Christian Science practitioner certification If disagreement, up to the local health officer to determine IC Health and Safety Vision Testing - Tests conducted for near and far vision for: a) students in grades K or 1 b) students in grades 3, 5, and 8 c) students suspected of having a defect - Special MCT Vision Screening done by a licensed eye professional is required for grades K or 1 - Applies to accredited public, charter and private schools - Information required for new School Health Report (found on DOE Online) IC Health and Safety Hearing Testing - Tests conducted for: a) students in grades 1, 4, 7, and 10 b) student who transfers into the school c) students suspected of having a defect - Applies to accredited public, charter and private schools - Information required for new School Health Report (found on DOE Online) 5

6 IC Health and Safety Release of medication - Medication may be released to: a) Parent b) Individual who is 18 or over and has written permission from parent to receive medication c) Student who has written permission from parent to receive medication IC Health and Safety Eye protection devices - Student and teacher shall wear industrial quality eye protection when participating in activities involving hot metals, sawing and cutting solid material, welding, vehicle repair, caustic or explosive materials IC Health and Safety Fire drills; tornado drills; manmade occurrence disaster drills - Schools shall conduct: - Monthly fire drills - At least one tornado drill each semester - At least one manmade disaster drill each semester 6

7 IC as of July : Health and Safety Measures 4: Immunizations 4.5: Epinephrine 5: Care of Students with Diabetes 7: Student Athletes: Concussions and Head Injuries 8: Sudden Cardiac Arrest Questions? IC Immunizations 7

8 IC Immunizations Statement of immunization history; waiver; rules - Schools must have an immunization record for every student - Students must be allowed to enroll, but may not attend without proper immunizations - Requirements determined by the Indiana State Department of Health IC Immunizations Statement of immunization history; waiver; rules - Schools may give a 20-day extension beyond the first day of school for parents to supply completed immunization record - Students may attend if he/she meet one of the following: complete, in-process, medical exemption, or religious exemption - Information required for new School Health Report (found on DOE Online) Immunizations Chickenpox new 2013 = all students should have two chickenpox vaccines Hepatitis A new 2014 = all kindergarten students need two; must be 6 months apart Meningitis new 2014 = all seniors must have a booster if first MCV4 given before age 16; only one is required if first MCV4 is given after the age of 16 8

9 Questions? IC as of July : Health and Safety Measures 4: Immunizations 4.5: Epinephrine 5: Care of Students with Diabetes 7: Student Athletes: Concussions and Head Injuries 8: Sudden Cardiac Arrest IC Epinephrine 9

10 Emergency Medication IC Epinephrine IC Auto-Injectable Epinephrine School may fill a prescription for epinephrine from a licensed health care provider who has prescriptive authority School must store the epinephrine in a safe location in which only school personnel have access IC Epinephrine IC School nurse may administer epinephrine to a student, staff member or visitor in the school who is demonstrating signs of lifethreatening anaphylaxis and the individual does not have epinephrine at the school or the individual s prescription medication is not available 10

11 IC Epinephrine IC School employee may administer epinephrine to a student, staff member or visitor in the school (who is demonstrating signs of life-threatening anaphylaxis and the individual s prescription medication is not available) if the employee: Volunteers Receives training from a health care provider who is knowledgeable in recognizing the symptoms of anaphylaxis and the administration of epinephrine IC IC Epinephrine Allows health care provider to write a prescription, drug order, or protocol for epinephrine for the school or school district Allows a pharmacist to dispense epinephrine to a school or school district IC IC Epinephrine Gives liability protection to a school nurse or school employee who administers epinephrine in accordance with the manufacturer s guidelines Gives liability protection to a health care provider who writes a prescription, drug order, protocol or provides training to school personnel 11

12 IC Epinephrine IC There are several items to consider before schools should stock a dose of epinephrine. These items include a school policy regarding who can administer, under what circumstances, where the medication will be stored, purchasing the proper dosage and ensuring consistency by having the medication available in each school, who will do the training, and how the school should develop procedures to avoid allergic triggers through the writing and delegation of an individual health plan. IC Epinephrine Sample Standing Order is Posted on School Nurse Learning Connection Form to Complete if Epinephrine used in a School Posted on School Nurse Learning Connection CDC has published a document Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs Questions? 12

13 IC as of July : Health and Safety Measures 4: Immunizations 4.5: Epinephrine 5: Care of Students with Diabetes 7: Student Athletes: Concussions and Head Injuries 8: Sudden Cardiac Arrest IC Care of Students with Diabetes Diabetes 13

14 IC Care of Students with Diabetes IC Requirements of plan - Diabetes management and treatment plan (medical orders) must: - Identify health services needed at school - Evaluate ability of student to self-manage - Be signed by HCP and parent - Be submitted to the school nurse IC Care of Students with Diabetes IC Development of plan - Individual Health Plan must: - Be developed by the school nurse for each student with diabetes while the student is at school or participating in a school activity - Must incorporate the components of the management and treatment plan (MD orders) IC Care of Students with Diabetes IC Use of volunteer health aides - School principal s responsibility to seek school employees to serve as VHA s - VHA supervised by principal and school nurse - VHA must have access to school nurse 14

15 IC Care of Students with Diabetes IC Diabetes training program Two types of training 1. School nurse available on DOE Moodle, 8 modules, quizzes, certification 2. VHA PPP posted on DOE Health website; instructions and handouts posted on the School Nurse Learning Connection IC Care of Students with Diabetes IC Diabetes training program VHA Training by Riley CDE: - August 28, :00 am to 3:00 pm - Riley Hospital - Free - Call Lindsey at to register IC Care of Students with Diabetes IC Tasks, school nurses and volunteer health aides - School nurse first choice to perform tasks to assist student - VHA may be used if - Volunteer feels comfortable performing tasks - Parent signs agreement of authorization 15

16 IC Care of Students with Diabetes IC Authorized diabetes management and treatment activities - Allows for student self management at any time and any location - School nurse must establish emergency procedures for students that self manage IC Care of Students with Diabetes IC Information sheet required - Required for those supervising students during off-campus school related activities - Identifies emergencies, appropriate response and emergency contact information Questions? 16

17 IC as of July : Health and Safety Measures 4: Immunizations 4.5: Epinephrine 5: Care of Students with Diabetes 7: Student Athletes: Concussions and Head Injuries 8: Sudden Cardiac Arrest IC Student Athletes: Concussions Concussions 17

18 IC Student Athletes: Concussions IC Information and forms required before beginning practice for sport - School must give information sheet to high school student athlete and parents - Athlete and parent must sign form acknowledging receipt of information - Must be done before beginning practice for an interscholastic or intramural sport IC Student Athletes: Concussions IC Player suspected of sustaining concussion; removal from play; prohibition against returning to play - Athlete suspected of concussion must be removed from play - Cannot return to play until received a written clearance from LHCP trained in the evaluation and management of concussions IC Student Athletes: Concussions IC NEW ITEMS 1. Athlete must wait at least 24 hours before able to return to play 2. All football coaches must take a certification course 3. Applies to ANY football coach of a team whose members are under the age of 20 and who play on public property 18

19 IC Student Athletes: Concussions IC Information regarding the law, sample forms, information sheets, and a new FAQ Document are available on the DOE Health website and DOE Concussion Learning Connection. As courses are approved, they will promptly be posted on both of these sites as well. Questions? HB 1290 and HB 1202 = HEA Sections 19

20 HEA 1290 Section 1 IC Adds an athletic trainer to the list of a health care provider HEA 1290 Section 2 IC Adds the requirement that high school students must receive training in CPR and AED in health class - Includes a psychomotor skills component meaning hands on practice with manikins - Instructional program must be from the AHA, ARC or other nationally recognized organization HEA 1290 Section 2 IC Instruction can be done by teacher or volunteer not required to be a certified CPR trainer - Does not require student to be CPR certified - Waiver available for psychomotor component on the DOE Health website - FAQ Document has been posted on the DOE Health website 20

21 HEA 1290 Section 3 New Chapter in IC as of July : Health and Safety Measures 4: Immunizations 4.5: Epinephrine 5: Care of Students with Diabetes 7: Student Athletes: Concussions and Head Injuries 8: Sudden Cardiac Arrest IC Student Athletes: Sudden Cardiac Arrest 21

22 Sudden Cardiac Arrest HEA 1290 Section 3 IC Student Athletes: Sudden Cardiac Arrest - Refers to public and nonpublic accredited schools - Refers to intramural and competitive athletic contests and cheerleading - Begins July Educational forms similar to concussion inform and educate coaches, student athletes, and parents of athletes of the nature and risk of sudden cardiac arrest - Parent and athlete must sign a form acknowledging receipt HEA 1290 Section 3 IC Student Athletes: Sudden Cardiac Arrest - If a student athlete is suspected of experiencing a symptom of SCA, student is removed from play and parent is notified - May return to play upon verbal permission of parent - Written permission to RTP must be provided by parent within 24 hours 22

23 HEA 1290 Section 3 IC Student Athletes: Sudden Cardiac Arrest - Sample forms will be developed by DOE and posted on our website - Sample forms will be similar to Concussion forms - Schools able to develop/use own forms if desired HEA 1290 Section 4 IC Student Athletes: Sudden Cardiac Arrest - Refers to postsecondary educational institutions - All the same requirements - Educational forms to athlete - If symptoms suspected, RTP by athletic trainer or physician HEA 1290 Section 5 IC Adds athletic trainers to the list of individuals applying for a certificate or license - Requires athletic trainers to have a national criminal history background check 23

24 Questions? Massachusetts Study Massachusetts Study Study conducted by CDC and Massachusetts Program put full-time school nurses in schools and studied the cost-effectiveness Found that for every $1 spent, $2.20 was saved in medical bills, parent wages, and teacher time 24

25 Massachusetts Study Researchers found that teachers spent 20 fewer minutes each day dealing with student health issues once a school nurse was assigned to their building. Massachusetts Study Money Spent ($79 m) Nurse cost $79 million to provide health services Money Saved ($177.2 m) Same care provided at a medical facility would cost $20 million Parent productivity losses cost $28.1 million Teacher productivity losses cost $129.1 million Massachusetts Study Quotes from Researcher: Sheetz, the study s senior author said, I could not believe the amount of health care that was being done in schools and the critical nature of it. School nurses, Sheetz said, see 60 to 70 kids each day. They have to be ready to provide emergency care and mental health services and help manage chronic conditions like diabetes. Nurses are also charged with teaching other members of the school community about issues such as life-threatening food allergies. 25

26 Massachusetts Study This study demonstrates the health needs of students and Indiana legislation reflects these same needs: Diabetes Legislation Epinephrine Legislation Concussion and Sudden Cardiac Arrest Legislation School Health Report Questions? Other Important Notes 26

27 Smart Snacks in Schools New School Nurse Orientation July 29 and 30 More information and the registration section can be found at the following link: New USDA Rule for Schools for School Year Applies to all food and beverage sold to students (a la carte, vending machines, fundraisers) during the school day Does not apply to food and beverages brought to school for lunch, sold in after-school bake sales or fundraisers, or sold to adults only School Health Report Found on DOE Online Applies to all accredited schools Asks for vision screening, hearing screening, and immunization verification information Closes June 15, 2014 Instructions for a password, entering data, and an instructional video are available on the DOE Health website 27

28 Questions? Thank you for your time and best wishes for a great summer! 28