What’s New Legally

Regarding School Health?

Cynthia Mears, DO, FAAP

Linda Gibbons, RN, MSN, IL/NCSN

Disclosure

• The presenters have nothing to disclosure,

and would like to thank Heather Begley.

MD for her senior project slides and

contribution of EMR forms with

collaborator, Sarah Sobotka, MD

Objectives • Identify their responsibility for the use of EPI

pens and new state laws regarding their use

• Explain the new laws and requirements for

return to play for concussion management

• Describe the role of DM aidesfor the care of DM

in school

• Define the new federal school food guidelines

• Identify changes in IL immunization

requirements for school entry

• Identify the physician’s role in developing 504

plans

Epi Pens

• Background

– Child with known peanut allergy passed away,

parent is physician

• Ordered Chinese food with “no peanuts”

• Allergic reaction – no one recognized

• No Epi given – although was prescribed

• No Epi provided to school

PA 97-0361: Emergency

Epinephrine Act

Questions to consider:

• What personnel? What type of training?

• Adverse reactions to Epi pens?

• What if it’s not an allergic reaction?

• How are schools going to obtain pens?

• Who will pay for pens?

Emergency Epinephrine Act Results:

•Partners: ISMS, IASN

•Worked with sponsor to develop:

– Schools can stock Epi pens

– Anyone can give to child with a diagnosed allergy

– Only School nurses can give to those without

•“Provides that a school district or nonpublic school may authorize the

provision of an epinephrine auto-injector to a student or any authorized

personnel to administer an epinephrine auto-injector to a student, that

meets the prescription on file. Provides that a school district or

nonpublic school may authorize a school nurse do certain acts

pertaining to the provision or administration of an epinephrine auto-

injector to a student. Contains certain exemptions from liability, except

for willful and wanton conduct, for acts that result in injury arising from

the use of an epinephrine auto injector. Amends the Illinois Food, Drug

and Cosmetic Act to make a corresponding change.“

Implementation • Schools need standing orders for Epi pens

• Attorney General’s office

– ISMIE = physicians are not liable adverse reactions for students who have received Epi pens

“Exemption From Liability” (From AG office) – Under Public Act 97-0361, a physician who provides a

standing protocol or prescribes a supply of emergency epinephrine to a school is to incur no liability, except for willful and wanton conduct, for any injury arising out of the use of an epinephrine auto-injector.

– Therefore, if a student is injured or harmed due to the administration of epinephrine that a physician has prescribed to a school under this Act, the physician will not be held responsible for the injury unless he or she issued the prescription with a conscious disregard for safety.

Anaphylactic Reality

• Not your patients

• Why test the law? Everybody gets sued

• Overwhelmed school nurses

• Lack of education in schools on health issues and use of pens

• NO complete data on number of students with allergies

• No understanding of signs and symptoms by school personnel

Asthma

• CPS now has Asthma policy, as do most

schools

• http://www.dhs.state.il.us/page.aspx?item

=20996

• http://policy.cps.k12.il.us/download.aspx?I

D=259

Highlights CPS Asthma Policy

• Self Administration of Kids with Asthma

• Identification of students with Asthma

Asthma Action plan • Medications, detailed medical hx, description of

triggers and history of episodes and 504 Plan.

• Emergency response

• Training of school personnel as in-service.

• Bullying

Concussion Management PA 97-0204

• National movement to have physicians

clear children before play

• New research shows effect of MILD

concussions on developing brain and

injury

• Coaches and PE teachers required to

receive education

Removal from Play

• A student athlete who is suspected of

sustaining a concussion or head injury in a

practice or game shall be removed from

participation or competition at that time.

Return to Play

• A student athlete who has been removed

from an interscholastic contest for a

possible concussion or head injury can not

return to that contest unless cleared to do

so by a physician licensed to practice

medicine in all its branches in Illinois or a

certified athletic trainer, who practices

under the direction of a physician.

Return to play - future

• If not cleared to return to that contest, a

student athlete can not return to play or

practice until the student athlete has

provided his or her school with written

clearance from a physician licensed to

practice medicine in all its branches in

Illinois or a certified athletic trainer working

in conjunction with a physician licensed to

practice medicine in all its branches in

Illinois.

Assessments

• IMPACT -

– Computer based program

• SCAT – Sports Concussion Assessment

Tool

– App “http://www.scat2.org

• CDC - much free information and

handouts

Concussion Reality

• Under reported by kids and parents

• Initial events are not reported

• Not reported by team mates or coaches

– No incentives to do so

• No penalties in the law for clearance

• Physicians should report concussions on

school health form

Senate Bill 3410

• Requires policy provide that a student

athlete who has been removed from play

may not return to play

– until the student athlete is evaluated by a

licensed health care provider trained in the

evaluation and management of

concussions and head injuries

– and the student athlete receives written

clearance to return to play from that health

care provider.

Diabetes Care Act PA 97-0559

• Requires education of all school staff

about diabetes

• Schools allowed to have a volunteer

Delegated Care Aide to assist children in

monitoring blood sugar and giving insulin

• Must be volunteers and must be trained

• School nurse is most appropriate person

to provide diabetes care and management

Role of Delegated Care Aide

1. Check blood glucose and record results;

2. Recognize and respond to the symptoms

of hypoglycemia according to the diabetes

care plan;

3. Recognize and respond to the symptoms

of hyperglycemia according to the diabetes

care plan;

Role of Delegated Care Aide

4. Estimate the number of carbohydrates in

a snack or lunch;

5. Administer insulin according to the

student's diabetes care plan and keep a

record of the amount administered; and

6. Respond in an emergency, including how

to administer glucagon and call 911.

Diabetes Reality

• Few volunteers – Cannot force any school staff

• CPS now has policy – Offering financial incentive for volunteers

• Poor training – many don’t know what to do

• Reaching out to food service staff

• No “rules” for the bill

• No funding for implementation – bill sponsor promised there would be no cost for implementation

• Many schools have no school nurse to consult with aide

• Doctors are not making 504 to start the process (must have plan submitted to schools)

• No feedback to providers on care provided in school

Aide Training

• Must be done by a licensed healthcare

provider (MD, DO, PA, APN) or a certified

diabetic educator

• Must be individualized to student in accord

with individual health care plan

• School nurses cannot provide this training

according to IL Nurse Practice Act

• Whom do they consult when problems

occur?

How to get involved in the schools?

• Wellness Policies – Required by federal law for schools to develop plans that

discusses nutrition and physical activity

– Healthy Hunger-Free Kids Act requires more transparency, expands stakeholders and expands scope of policy

– School Meal Standards

• Requires daily serviings of fruit and vegetables

• Substantially increases serving of whole grain-rich foods

• Requires only non-fat and low fat milk

• Limits calories content of meals based on the age of students

• Complete information for 504 and IEP plans

• Empower parents to insist that school provide 504 plan when needed

• Work with School Nurses

School Nurses

• IL CSN preparation mirrors that

recommended in AAP policy statement.

• Every CPS school has a CSN attached to

it who can be reached by phone even

when in a different building

• Most students with chronic health problem

deserve a 504 plan to identify

accommodations in school

504 Plan Eligibility

• Any condition that interferes with any of

life’s functions – learning, sleeping, eating

• Schools are required to provide

accommodations to allow student to

access his/her education

• Does not require a specific disability like

the special education (IEP) requires

Who writes 504 plan

• Can be requested by school, parent,

physician

• Written by school nurse, teacher, parent,

and at least one school administrator

• Often written by nurse, parent, and

principal

• Identifies impairment and

accommodations necessary

Form – As Simple As

• Demographic info

• Identify impairment

• Attendees at meeting

• List of accommodations

• When accommodations needed

• Based on school assessments and

medical management plan or MD orders

Examples of impairments

ASTHMA Accommodations:

• Check peak flow before P.E. class

• Prophylactic use of rescue inhaler 20

minutes before P.E. class

• Have inhaler with student when out on

playing field

• Asthma Action Plan on file

EMR Forms

for Asthma

504 Plans

Examples of impairments

DIABETES Accommodations:

• Check blood sugar before major exams

• Permission to check blood sugar in class

• Permission to carry snacks on person

• Check blood sugar before P.E. class

• Inservice teaching staff about diabetes

• Develop Emergency Action Plan

Examples of impairments

SEIZURES Accommodations

• Schedule classes with a buddy who

recognizes impending seizure

• Inservice classroom staff concerning

seizures

• Flexible deadlines for assignments after

seizure activity

• Develop Emergency Action Plan

Examples of impairments

ADHD Accommodations

•Monitor student’s weight weekly

•Classmate takes notes with carbon paper to

share

•Color code books and notebook

•Assignment check out and signature from

school and home daily

•Separate set of text books at home

ADHD Cont’d

• Behavior monitors quarterly to check

effectiveness of medication

• Report to office for daily medication

• Sit in front of room or area with least

distraction

• Teach student about condition and

medications

Generic 504 for EMR

Immunization Rules

• Written by IDPH and implemented by

ISBE

• Beginning with school year 2011-12, any

child entering sixth grade shall show proof

(see Section 665.250(b) of receiving one

dose of Tdap (defined as tetanus,

diphtheria, acellular pertussis) vaccine

regardless of the interval since the last

DTaP, DT or Td dose.

Immunization Rules

• Students entering grades seven through

12 who have not already received Tdap

are required to receive 1 Tdap dose

regardless of the interval since the last

DTaP, DT or Td dose.

• Only 6th and 9th graders are reportable in

2012-13 school year.

Pending Changes

• Immunization Advisory Committee has

proposed additional rule changes.

• Implementation will be in school year after

rule becomes effective rather than

immediately.

• Schools can barely enforce required

immunizations

• Recommended immunizations can be

discussed and promoted

School Forms

• Most are online for easy access

• Medication orders

• Asthma Action Plans

• Diabetes Management Plans

• Life-threatening Allergy Plans

• Individual Emergency Action Plans

• Child Health Examination Form

• Sports Physical Forms

References

• Frequently asked questions about Section 504 and the education of children with disabilities. Protecting students with disabilities. http://www2.ed.gov/about/offices/list/ocr/504faq.html

• Johnson, K. H. & Guthrie, S. (2012). Harnessing the power of student health data. NASN School Nurse. 27 (1) 27-33.

• Sheetz, A.H. (2012). How may the school nurse use data effectively? NASN School Nurse. 27 (1), 42-46.

• Wootan, M.G. (2012). The Healthy, Hunger-Free Kids Act: One year later. NASN School Nurse. 27 (1) 18-19.

ICAAP resources

• http://illinoisaap.org/about/committees/committe

e-on-school-health/coshresources/

• Interested in joining the school health

committee?

• Call Julie Shaffner, MS, MPH

• jshaffner@illinoisaap.com

• 312.733.1026 ext. 214