PENNSYLVANIA DEPARTMENT of HEALTH Division of School Health

1. SCHOOL HEALTH UPDATE 2009 PENNSYLVANIA DEPARTMENT of HEALTHDivision of School Health Beth Anne Bahn and Rosemary Danchick-Moyer State School Health Consultants March 22, 2009

2. DIVISION OF SCHOOL HEALTH • Jon Dale, Director • Beth Anne Bahn, State School Health Consultant • Rosemary Danchick-Moyer, State School Health Consultant • Administrative Officer • Bill Barbour, STEPS School Health Coordinator • Valerie Morgan, Administrative Support • Six Regional School Health Consultants

3. Diabetes Cardiovascular Injury Prevention Chronic Disease Tobacco Prevention Maternal Child Health Special Needs Health Care Public Health Educator School Health Consultant HIV STD Communicable Disease Environmental Health Sanitarians Tuberculosis Immunization EMS Program Specialist DISTRICT OFFICE PROGRAM STAFF

4. REGIONAL SCHOOL HEALTH CONSULTANTS NW - Linda Deeter 724-662-6068 ldeeter@state.pa.us NC - Andrea Dale 570-327-3400 adale@state.pa.us NE - Lois Elick 570-826-2062 lelick@state.pa.us SC - Linda Katherman 717-787-8092 lkatherman@state.pa.us SE - Sue Templin 610-378-4352 stemplin@state.pa.us SW - Vacant 724-830-2701

5. SCHOOL IMMUNIZATION REQUIREMENTS • Regulations expected to be final this summer • Too late for start in school year 2009 – 2010 • New regulations will go into effect for school year 2010 - 2011

6. SCHOOL IMMUNIZATION REQUIREMENTS For Attendance in All Grades • 4 doses tetanus (DTaP, DT, Td) • (1 dose on or after 4 years old) • 4 doses diphtheria (DTaP, DT, Td) • (1 dose on or after 4 years old) • 3 doses polio • 2 doses measles (MMR) • 2 doses mumps(MMR) • 1 dose rubella (MMR) • 3 doses hepatitis B • 2 doses of varicella vaccine or history of disease

7. SCHOOL IMMUNIZATION REQUIREMENTS For Entering 7th Grade • Same requirements as “Attendance in All Grades” • PLUS • 1 dose tetanus/diphtheria/acellular pertussis • (if 5 yrs. have lapsed since last tetanus immun.) • 1 dose meningococcal conjugate • Tdap & meningococcal – no provisional – 1 dose antigen

8. SCHOOL IMMUNIZATION REQUIREMENTS

9. SCHOOL IMMUNIZATION REQUIREMENTS • The changes were first published in the PA Bulletin on February 9, 2008 • Comments were extended in a notice published March 8, 2008. • Comments were published May 3, 2008 • Continuing through regulatory process • Final form regulations will be published in the PA Bulletin, www.pabulletin.com

10. STATEWIDE IMMUNIZATION INFORMATION REGISTRY (SIIS) • Began in 1996 • Used primarily by hospitals, state health clinics • Now marketing to private providers • No cost to enter immunizations or view data • “View only” access for school nurses

11. STATEWIDE IMMUNIZATION INFORMATION REGISTRY (SIIS) • To enroll for view-only access: • Go towww.health.state.pa.us/pasiis • Click on Provider enrollment • Complete the application & fax or mail it to the Department

12. REVISION OF CH. 27 REGULATIONS • Strengthens language for contact investigations in schools • Immunization administration would be reportable via SIIS • Update school and child day care section • Will be published in PA Bulletin for comments

13. WHAT: Potassium Iodide (KI) tablets provided to schools who voluntarily request to participateWHY: KI protects thyroid from radiation during a release WHO: Schools located within a 10 mile radius (Emerg. Planning Zone)WHERE: 5 nuclear facilitiesHOW: Info/orientation and tablet pre-distributionWHEN: Fall of 2002 and planned for 2009 KI DISTRIBUTION PROGRAM FOR SCHOOLS

14. FIVE NUCLEAR FACILITIES Beaver Valley Power Station - Shippingport Borough (Serves parts of Beaver Co.) Limerick Generating Station - Limerick Twp. (Serves parts of Berks, Chester & Montgomery Cos.) Susquehanna Steam Electric Station - Salem Twp. (Serves parts of Columbia & Luzerne Cos.) Three Mile Island Nuclear Station - Londonderry Twp. (Serves parts of Dauphin, Lancaster & York Cos.) Peach Bottom Atomic Power Station - Peach Bottom Twp. (Serves parts of Lancaster & York Cos.)

15. DEPARTMENT OF HEALTH WILL: • Identify all schools within each Emergency Planning Zone (EPZ) • Provide procedures to request participation in the program • Develop and provide orientation sessions to school health & administrative staff • Provide guidance on how to incorporate KI distribution plans into existing all-hazard plans • Develop sample resource materials • Distribute supply of KI tablets to schools

16. SCHOOLS WILL: • Request participation in the plan • Request the number of doses of KI that will be needed for students & staff • Identify staff (administration & health) to receive orientation from DOH • Accept or amend the KI plan for its school and incorporate into all-hazard plan • Develop plan for receipt, storage and distribution of KI

17. SCHOOL DISTRICTS PROVIDING SERVICES FOR PRIVATE/NON-PUBLIC SCHOOLS • 28 PA Code § 23.51, Children to be provided nursing services • A child in private, parochial & public schools shall be provided with school nurse services in the school which the child attends. • 28 PA Code § 23.52, Administration • The school nurse services shall be provided through the public school system & the administration of this service shall be the responsibility of the public school administrator in consultation, as needed, with the private or parochial school administrator.

18. SCHOOL DISTRICTS PROVIDING SERVICES FOR PRIVATE/NON-PUBLIC SCHOOLS • Provide school nurse services • Review of health care needs including IHPs & emergency plans as needed

19. SCHOOL DISTRICTS REPORTING DATA FOR PRIVATE/NON-PUBLIC SCHOOLS • If the school district is providing school health services to private/non-public • ADMs included on Annual Health Report • Also include data for: • Health exams, screens & select services • Chronic diseases • Serious School Injuries • Medication Administration

20. Important Law • 24 P.S. § 11-1101Purdon's Pennsylvania Statutes and Consolidated Statutes •  Title 24 P.S. Education   •  Chapter 1. Public School Code of 1949   •  Article XI. Professional Employes   •  (A) Definitions (Refs & Annos)  • § 11-1101. Definitions

21. Important Law The term "professional employe" shall include those who are certificated as teachers, supervisors, supervising principals, principals, assistant principals, vice-principals, directors of vocational education, dental hygienists, visiting teachers, home and school visitors, school counselors, child nutrition program specialists, school librarians, school secretaries the selection of whom is on the basis of merit as determined by eligibility lists and school nurses.

22. TRANSFER FOR HEALTH RECORDS • 24 P.S. §14-1409, Confidentiality, transference & removal of health records • “… the district or school wherein the child is newly enrolled shall request and the district or school where the child previously attended shall surrender the health record of the child.” • “…shall not destroy a child’s health record for a period of at least two years after the child ceases to be enrolled,…”

23. MAINTENANCE OF HEALTH RECORDS • 28 Pa Code, § 23.55, Maintenance of health records • “Health records shall be maintained for each child. These records shall be kept in the school building where the child attends school and shall be available to the school nurse at all times. Records shall be transferred with the child when he moves from one school to another or from one district to another.”

24. MEDICATION ISSUES • Do school nurses need a doctor’s order to administer over-the-counter medications to students? • 49 PA Code § 21.14. Administration of drugs • “(a)  A licensed registered nurse may administer a drug ordered for a patient in the dosage and manner prescribed.” • Who can administer? • Nurses can, when a licensed provider, authorized to prescribe, has written an order.

25. MEDICATION ISSUES Securing medications? Is it necessary? • “The Controlled Substance, Drug, Device and Cosmetic Act” Act of 1972, P.L. 233, No. 64 • Definition of practitioner’s includes nurses • Section 11. Professional Prescription, Administration, and Dispensing. • Section 12. Records of Distribution of Controlled Substances

26. MEDICATION ISSUES • 28 PA Code § 25.61. General provisions •  ”(a)  Persons maintaining stocks or having controlled substances in production areas or on hand for distribution shall provide effective controls and procedures to guard against theft and diversion of the substances.”

27. MEDICATION ISSUES • 28 Pa Code § 25.63. Security controls for practitioners and research personnel • “(b)  Controlled substances listed in Schedules II, III, IV and V shall be stored in substantially constructed, securely locked cabinets.”

28. MEDICATION ISSUES • All medication in schools are personal property for which the school nurse is responsible • Recommendation: ALL medications should be stored in locked space • Should have a method of accounting for access to these medications

29. DELEGATION In PA, professional nurse law does not provide for delegation of nursing functions to unlicensed individuals

30. DELEGATION • Emergency administration of an Epipen by a trained individual does not require professional nursing skill • The nurse may train an unlicensed person in how to respond using an Epipen This Is Not Delegation

31. CERTIFICATION STAFFING & POLICY GUIDELINES (CSPG) • Located at PA Dept. of Education website, www.pde.state.pa.us • In search box, type in CSPG # • 80 - School Nurse • 95 – Principal • 101 - Paraprofessional

32. CSPG 95 - PRINCIPAL • Certification Assignment: • An educator holding a valid PA certificate as a K12 Principal is qualified to perform the following: • Supervision and direction of certified and non-certified staff persons required for school operation exclusive of directing health services controlled by the Nurse Practice Act.

33. CSPG 101 - PARAPROFESSIONAL • Utilization of Paraprofessional Staff • #7. Paraprofessionals serving as health room aides or other non-professional school district employees shall not be directed to engage in health-related activities reserved exclusively for licensed professionals and controlled by the Nurse Practice Act or other medically related laws.

34. HOMESCHOOLED STUDENTS • PA Public School Code of 1949, § 1327.1 states these students must have: • Evidence of Immunizations in accordance with Article XIV 1303 (a) • Evidence of Health & Medical services required for students of the child’s age or grade level per Article XIV

35. HOMESCHOOLED STUDENTS • According to PDE’s Basic Education Circular (BEC) on Home Education Programs, students must receive the same health tests as public school students • According to the affidavit form available as part of the BEC, the affidavit is to include attached evidence of immunizations, physical & dental exams & mandated screens

36. PDE BASIC EDUCATION CIRCULAR (BEC) Enrollment of students • Date of Issue:  January 22, 2009 • Documents which may be requested but not as a condition of enrollment: • Picture identification, • Health or physical examination records, • Academic records, • Attendance records, • Individualized Education Program, and other special education records Although schools may ask for any of this information, they may not require it as a condition of enrolling or admitting a child & they may not delay a child’s enrollment or attendance until these documents are provided.

37. CHILD PROTECTION LAW • Child Abuse Reporting LawAct 179 of 2006 • School Nurses are mandated reporters • Who to call: Childline (1-800-932-0313) and local Child Protective Services • Child may be interviewed at school without parent notification • Documentation of suspected abuse

38. HIPAA/FERPA GUIDELINES • FERPA is a Federal law that protects the privacy of students’ “education records”  • The HIPAA Privacy Rule requires covered entities to protect individuals’ health records and other identifiable health information and gives patients rights over their health information

39. HIPAA/FERPA GUIDELINES • NEW HHS/ED Joint Guidance on the Application of FERPA and HIPAA to Student Health Records • November 2008 • http://www.hhs.gov/ocr/privacy/index.html

40. PE & DENTAL MODIFICATIONS • Districts may request modifications to accept mandated physical and dental exams up to one year prior to the year they are required • School Board must vote to make the modification; then the district sends a letter to DOH, Division of School Health, providing notice of the board decision

41. ALL-HAZARD PLANNING FOR SCHOOLS • Title 35, all public-funded schools shall develop and implement ER preparedness plans… • Subcommittee of PA Safe School Statewide Advisory Committee • PEMA, Dept. of Education, Dept. of Health, Attorney General’s Office, State Police, representatives from IUs and school districts

42. ALL-HAZARD PLANNING FOR SCHOOLS • School-based Emergency Preparedness • AHRQ- Agency for Healthcare Research & Quality • http://www.ahrq.gov/prep/schoolprep/

43. CLARIFICATION ON ACT 48 REPORTING • Letter sent to Supt. Dec. 2008 • Activities/Programs must be at least 3 hours in length • PERMS won’t accept <3 hrs after Jan. 31, 2009 • Clarification letter being drafted • Recommend at least 3 hrs • PERMS will continue to accept 1 hr activities • Title must include content

44. RN CONTINUING EDUCATION REQUIREMENT • June 29, 2006 Act 58 of 2006 was signed into law • Requires 30 hours of CEs every 2 years • July 12, 2008 PA State Board of Nursing released regulations (49 Pa Code §§ 21.131 – 21.134) • School districts considered approved providers, under PDE

45. RN CONTINUING EDUCATION REQUIREMENT • Begins with those renewing their RN license in October of 2010 • CSNs may use their Act 48 hours • CRNPs may use their CRNP CEs • Additional information available at: www.dos.state.pa.us

46. RN CONTINUING EDUCATION REQUIREMENT • 49 PA Code § 21.131 Continuing education • (c) Board audits: proof of completion  • “(5) For school nurses, evidence that the nurse's certification by the Department of Education is current.”

47. RN CONTINUING EDUCATION REQUIREMENT • Submission of Continuing Education Information by School Nurses • CSNs verify on their biennial renewal application that they have complied with the continuing education requirements for certification by the school district. • If the CSN's renewal is selected for a compliance audit, the nurse would submit proof of current certification by the Department of Education

49. RN CONTINUING EDUCATION REQUIREMENT Effective Dates of CE Requirements Effective date of CE Requirements

50. RN CONTINUING EDUCAITON REQUIREMENT Effective Date of CE Requirements