Hanover Public SchoolsHealth Services

School Health Update

2007-2008

Prepared by

Jean Hight R.N., BSN

Nurse Leader

February 2008

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The primary mission of the Hanover Public Schools Health Services is to support educational achievement for all students. The Hanover School Nurses strive to accomplish this goal by providing quality holistic health care to all students. Through health education and promotion we encourage the establishment of healthy behaviors and healthy life choices.

“A healthy child is a better learner” Author Unknown

Mission Statement

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Sept. 2007 - Jan. 2008 Health Office Visits

Office Visits - Students 14,332

Illness 7,045

Medication Admin 4,585

Dismissals 646

Referral to Emergency Health Services 10

911/Ambulance Calls 2

Injury Reports 33

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Health Screenings *2006 - 2007

• Vision Screening – 2,474 – 71 Referrals

• Hearing – 2,294 – 107 Referrals

• Postural Screening – 895 – 36 Referrals

• Heights and Weights – 1,027

* Please note: These are in addition to Health Office visits

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Body Mass Index (BMI) Percentiles*2006 - 2007

BMI Category< 5th percentile > 5th percentile > 85th percentile > 95th percentile

and but< 85th percentile < 95th percentile

At risk ofGrade Gender Underweight Normal Range overweight Overweight

Grade 1 Male 4 70 29 22

Female 3 53 15 13

Grade 4 Male 8 74 16 14

Female 1 80 26 16

Grade 7 Male 5 85 22 17

Female 6 97 23 16

Grade 10 Male 5 62 14 15

Female 1 66 15 10

* BMI percentiles are based on age and gender, using standards established by CDC.

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Impact of Obesity

Obesity puts children at risk for debilitating or life threatening health problems such as type 2 diabetes, heart disease, high blood pressure, and stroke.

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Medications Sept. 2007 - Jan. 2008

• Total Medication Orders: 204 (approximately 7.5% of students)

• Total Medications Administered: 4,579

• Staff Medications: 137

2,642

634549365

271108

100

500

1,000

1,500

2,000

2,500

3,000 Analgesics

Insulin

Other

Psycho-tropics

Antibiotics

AsthmaMeds.

Anti-convulsants

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Medical Conditions 2006-2007

284

132

66 59

19 14 11 80

50

100

150

200

250

300

AsthmaAllergiesEpiPensADHDAutismCardiacSeizuresDiabetes

This does not include other medical conditions such as mental health (depression, bi-polar, anxiety), Down Syndrome, Celiac Disease, Migraines, Orthopedic Problems, Cystic Fibrosis, Cancer, Genetic Disorders, and others.

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Nursing Procedures Sept. 2007 - Jan. 2008

3,251 Nursing Procedures Total• Blood Glucose Testing – 1,029

• Insulin Pump Care - 212

• Respiratory Procedures – 263

• Blood Pressure Monitoring – 40

• Wound Care - 695

• Orthopedic Procedures – 110

• Head Checks for Pediculosis – 265

• Other - 637

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Dismissals Sept. 2007 - Jan. 2008

12,947

648

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Return to ClassDismissed

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Communications Sept. 2007 - Jan. 2008

• 1,752 Parent Phone Conferences

• 1,105 Meetings/Conferences With Staff

• 144 Communication with Community Agencies

• 102 Referrals to Primary Care Physician

• 5 Other Referrals

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Staff Health Sept. 2007 - Jan. 2008

• 117 Visits For Illness Assessments

• 137 Medications

• 55 Visits For First Aid

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Education Laws and Regulations

603 CMR 7.11Professional Support Personnel LicensesSchool Nurse (Levels:All)(a) Initial License.

1. Valid license to practice as a Registered Nurse in Massachusetts.

2. A bachelor’s or masters degree in nursing.

3. A minimum of 2 full years of employment as a Registered Nurse in child health, community health, or other relevant clinical nursing.

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Laws and Regulations (continued)

4. Completion of an orientation program based on the requirements for delivery of school health services as defined by the Department of Public Health.

5. Passing score on the Communication and Literacy Skills test.

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Laws and Regulations (continued)

(b) Professional License1. Possession of an Initial License.2. 3 years of employment as a school nurse.3. Completion of one of the following:

a. Achievement and maintenance of certification or licensure from a nationally recognized association as a school nurse, community health nurse, or pediatric/family/school nurse practitioner.

b. A master’s degree program that may include credits earned in master’s degree program for the Initial license in community health, health education, nursing, or public health.

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Documentation

• All Health events must be documented by the school nurse.

• Health Records are a critical component for the documentation of health events.– All medications– Immunization Status– Vision, Hearing, Scoliosis Screening Results– Health History– Physical Exams

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Documentation (continued)

• ALL students with a special health condition (e.g. diabetes, asthma) MUST have a nursing Care Plan – Massachusetts General Laws (“M.G.L.”) 244 CMR 3.02

• Each medication order MUST have a written medication administration plan per M.G.L., 105 CMR 210.005

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What does the School Nurse do?

• Stocks and maintains health care office.• Episodic assessment and nursing care.• Writes Individual Health Care Plans (IHCP) for each student

with special needs, i.e. Life Threatening Food Allergy (LTA), Diabetes, Cystic Fibrosis, Cancer, Asthma, etc.

• Communicates with administration and staff about health needs.• Does screenings and makes referrals.• Acts as a resource.• Provides individual and group health education and promotion

to students, staff, and parents.• Communicates with physicians and community agencies on an

as needed basis to promote the health of students.• Documents care and events. • Much more…

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What does the Nurse Leader do?

• Plans and coordinates district-wide health services program.

• Communicates and collaborates with local board of health, school physician, and Massachusetts Department of Public Health (MDPH).

• Collaborates with school personnel and supports team approach for student physical, social, mental, and emotional health.

• Attends quarterly MDPH School Nurse Leader meetings

• Attends regional Nurse Leader Meetings.

• Does Monthly Activities Report for MDPH – electronic submission.

• Does Annual reports for MDPH.

• Participates in Continuous Quality Improvement Program (CQI). Currently doing Vision CQI.

• Co-chairs Health Advisory Council, a diverse group from the schools and the community that promotes wellness and healthy behaviors.

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Nurse Leader (continued)

• Chairs Healthy Schools Committee which evaluates and manages school facilities for environmental, safety, and health issues.

• Assists in maintaining school health management system (Healthmaster) which enables ongoing data analysis.

• Promotes the use of the new MDPH “School Health Manual”.• Collaborates with Superintendent and others to develop health policies,

i.e. Life Threatening Allergy (LTA) and Emergency Preparedness.• Maintains Automated External Defibrillators (AEDs) and provides

CPR/AED training opportunities.• Supervises and manages school nurses. Holds monthly meetings.• Orients, trains and supervises substitute nursing staff.• Collaborates with school business manager in preparing school health

supplies budget and Essential School Health Services (ESHS) “Program Budget Plan”.

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Nurse Leader (continued)

• Does yearly review of school nurse procedure manual.

• Promotes school nurse networking in community with private, collaborative, and vocational schools.

• Ensures that these schools receive information from the MDPH (weekly e-mails and alerts) as well as other health information.

• Member of groups promoting health and safety within the community, i.e. the Hanover Alliance for the Prevention of Substance Abuse (HAPSA) and the Regional Emergency Management Systems (REMS) task force.

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Recommended RatioSchool Nurse to Student

In the 1998 Report to the Massachusetts Legislature, “Options for Developing School Health Services in the Commonwealth of Massachusetts”, the Department of Public Health recommended the following:

• One fulltime equivalent (FTE) licensed school nurse for each building (both public and nonpublic) with 250 to 500 students;

• An additional 0.1 FTE for each additional 50 students in buildings with more than 500 students; and

• 0.1 FTE for each 25 students in buildings with fewer than 250 students.

When developing staffing plans, other factors to consider include the number of children with special health care needs, the number of buildings, and the distance and/or travel time between buildings.

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Hanover Schools Enrollment

School No. of Students

Center 380

Sylvester 253

Cedar 555

Hanover Middle 899

Hanover High 656

Total 2743

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Closing Summary

The goal of the Health Services is to support education by keeping students healthy, in school and ready to learn.

Student health needs have grown increasingly complex through the advancement of medical technology and requires professional nursing staff for school attendance.

Student health complexities have increased the demand for continuous documentation.

The need for nursing staff and a nurse leader is evidenced by the volume and complexity of health office visits and the volume and complexity of health issues encountered in our schools today.