Helping Belton ISD Students Stay Safe & Healthy What Every BISD Staff Needs to Know About:

1. Helping Belton ISD Students Stay Safe & Healthy What Every BISD Staff Needs to Know About: • Medical Emergency Response Plan (MERP) • Emergency Plan for: • Asthma • Bleeding Disorder • Cardiac Condition • Diabetes • Seizures • Severe Allergies, Food Allergies SEVERE LOW BLOOD GLUCOSE Safe & Healthy Belton ISD Health Services 2012-2013

2. Helping Belton ISD Students Stay Safe & Healthy What Every BISD Staff Needs to Know About: • Medication Administration on Field/Athletic Trips • Oral Meds • Epipens • Inhalers • Bloodborne Pathogens Safe & Healthy Belton ISD Health Services 2012-2013

3. Safe & Healthy

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7. Emergency Plans

8. Asthma Emergency Plan Safe & Healthy

9. Bleeding Disorder Emergency Plan Safe & Healthy

10. Cardiac ConditionEmergency Plan Safe & Healthy

11. Diabetes Emergency Plan Safe & Healthy

12. Seizure Emergency Plan Safe & Healthy

13. Food Allergy

14. Food Allergy

15. Severe Allergy Emergency Plan Safe & Healthy

16. Teacher/Coach Responsibilities • Review the Emergency Plan for Severe Allergy plan with the school nurse, if available, and with the student and his/her parent/guardian. It may be helpful to review the following questions with the parent: • Can your child sit next to someone that is eating the allergen? • Can your child touch the allergen? • Would you like to provide a non-perishable safe lunch in case your child forgets lunch one day or cannot eat what is provided in the cafeteria that day? • Do you want to be notified every time we have food in the classroom? Food Allergy

17. Teacher/Coach Responsibilities • Develop emergency communication plan with the campus office and/or school nurse • Ensure that an adult accompanies a student suspected of having an allergic reaction or ask the nurse to come to the student • Keep the student’s plan accessible in the classroom and available for a substitute • Notify the school nurse at least 48 hours before a field trip so that emergency plan and EPIPEN administration procedures can be reviewed with one to two staff going on the field trip. • Educate classmates to avoid endangering, isolating, stigmatizing or harassing students with food allergies • Ensure other staff, students and their parents comply with any risk-reduction strategies. Food Allergy

18. Risk Reduction Strategies • No food sharing • No utensil sharing • Avoid serving food without appropriate ingredient labels • Hand washing before and after eating snacks/meals. Soap and water are best. • Avoid cross-contamination of food by wiping down eating surfaces before and after eating. • Designate allergen safe zones, such as designated tables/seating areas • Consider eliminating or limiting foods in the classroom, buses, after-school activities which may cause a life-threatening reaction to a student in a class • Avoid or use caution when using food for classroom activities, such as for crafts, science projects, holiday celebrations, etc. • Use non-food items as rewards instead of food • Avoid high-risk areas for field trips, i.e. corn fields, exposure to latex balloons or seafood, etc. Food Allergy

19. Field Trips Medications/Procedures/Supplies Emergency Care Plans Asthma Bleeding Disorder Cardiac Condition Diabetes Seizures Severe Allergies Other special conditions or procedures • Oral medications • Epipens • Inhalers • Diabetic supplies • Other equipment • Other emergency meds • Basic 1st Aid supplies Medication Administration on Field Trips

20. General Procedures for all Medications • Gather necessary supplies • Wash hands and place gloves • Prepare the correct dosage without touching the med if possible. If possible, the nurse will only send dosage needed for field trip • While preparing the medication, do not leave the med unattended or within reach of the student • Identify the student. Ask the student his/her name Medication Administration on Field Trips

21. General Procedures for all Medications • Explain the procedure to the student. If the student questions the right medication, stop and verify the medication against records or call nurse • You may want to ask the student: • What is the name of your med? • What color is your med? • How much do you take? • Provide confidentiality and privacy for the student as much as possible • Position the student properly for the medication administration according to the correct route Medication Administration on Field Trips

22. After giving medication: • Document as soon as possible on the appropriate form • Store medication in a secure place. Most medication needs to be stored in a cool, dry place. Some medication needs refrigeration • Clean, return, and/or dispose of equipment as necessary • Wash hands • Report all medication incidents or errors to the nurse and principal Medication Administration on Field Trips

23. Oral Medication • Pour prescribed dose into medication cup without touching the pill/tablet/capsule • If liquid, shake according to label instructions and use standard measuring device • Pour at eye level from side of bottle opposite the label, measuring dosage at the correct line • Give with a full glass of water unless otherwise indicated Medication Administration on Field Trips

24. What to do if… • Student refuses: document and report to nurse, parent, and/or principal • Student vomits after medication administration: Record time and whether medication was in vomit. Report to nurse, parent, and/or principal • Student can’t swallow: sit in upright position, give one med at a time, give adequate water, place medication on back of tongue, give med slowly. Watch for choking. Give with other food or crushed if directed by physician or pharmacist Medication Administration on Field Trips

25. Asthma Inhaler Administration • Gather supplies • Wash hands and place gloves • Shake inhaler up and down to prime inhaler • Remove mouthpiece cover • Have student breathe out and release air from lungs • Hold inhaler straight up, place mouthpiece (or spacer mouthpiece) in mouth, close lips tightly around it • As inhaling, press down on top of inhaler and release a dose of medication into lungs • Hold breath for 10 seconds • Wait one minute then repeat • Clean mouthpiece before replacing cover Medication Administration on Field Trips

26. Epipen Injection • Hold the Epipen firmly with the tip pointing downward • Hold cylinder in your fist with your thumb toward the tip of the tip. Do not touch the tip • Remove the gray safety cap • Place the tip on the outside are of the thigh at a right angle to the leg ( It can be injected through clothing) Medication Administration on Field Trips

27. Epipen Injection • Raise your hand way from the child’s leg, and with a quick motion, bring it firmly to the child’s outer thigh. By pressing the pen firmly against the thigh, a spring-activated mechanism will cause a needle to inject the epinephrine. Keep the device firmly in this position for 10 seconds • Remove the Epipen and massage the area for 10 seconds. Check the tip to see if the needle is showing, if it is not, you must follow the above step again Medication Administration On Field Trips

28. Helping Belton ISD Students & Staff Stay Safe & Healthy What Every BISD Staff Needs to Know About: Blood borne Pathogens Belton ISD Health Services 2012-2013 BBP

29. BBP: INFORMATION ACCESS Belton ISD BBP Exposure Control Plan • Annual Training • Web Access: Staff Training Tab of School Health Service Page • Written Access: BBP Exposure Control Plan @ the school health office of each campus or department in the district BBP

30. Why do I need this training? Your job duties may put you at risk of exposure to blood or other potentially infectious material (OPIM) • Breaking up fights • Assisting with nose bleeds, cuts • Assisting diabetic student • Working with combative students including those who bite and break the skin • Providing swallowing therapy BBP

31. What are Bloodborne Pathogens? • Viruses, bacteria, and other microorganisms that are carried in the bloodstream and can cause serious diseases • The most common BBP are: • Human Immunodeficiency Virus (HIV) • Hepatitis B Virus (HBV) • Hepatitis C Virus (HCV) BBP

32. cirrhosis AIDS HIVHepatitis CHepatitis B Liver failure death Liver cancer BBP

33. How do BBPs enter your body? Direct contact with blood or OPIM of an infected person through: • Open cuts, wounds, skin abrasions • Blood splashing into your eyes, nose, or mouth BLOOD + ENTER BODY BBP

34. Belton ISD provides the HBV Vaccine to: • Staff working in special-ed self-contained classrooms • Staff working in the school health clinics Staff whose school duties placed them at risk to frrquently come in contact with blood or other potentially infectious material • Free of charge • Series of three shots • Notify the BeltonISD School Health Coordinator immediately if you have not received the vaccine

35. Best Work Practices • Universal Precautions: All human blood may be infectious. Universally treat everyone the same. • Wear gloves when coming in contact with the blood of anyone and other personal protective equipment when applilcable • Wash Hands: Soap & water • Use Sharps Containers- available in all health clinics • Clean up blood & body fluid: ask for the right help! • Report any exposure incidents

36. Questions or Comments?References & Resources Emergency: American Academy of Pediatrics (AAP). (2008) Disaster planning for schools. Pediatrics, 122 (4) pp. 895‐ 901. doi:10.1542/peds.2008‐2170 Cole, V., Henry, B., Tyson, D., Fitzgerald, R., Hopkins, R. (2007). In the face of danger: Comprehensive emergency preparedness and response for schools. Penn GSE Perspectives on Urban Education, Retrieved from http://urbanedjournal.org/archive/Vol.%205%20Iss.%202%20Order%20in%20Schools/Articles/Article_ 2_In%20the%20Face%20of%20Danger.html Doyle, J., & Loyacono, T. (2007). Disaster preparedness guidelines for school nurses. Silver Spring, MD: National Association of School Nurses. Fitzpatrick, B. (2006). Emergency management, crisis response and the school nurse’s role. In J. Selekman (Ed.) School nursing: A comprehensive text. (pp. 205‐ 233). Philadelphia: F.A. Davis Company. Diabetes Care, 34(Supp 1), S70‐S74. American Association of Diabetes Educators (AADE). (2008). Position statement: Management of children with diabetes in the school setting. The Diabetes Educator, 34(3), 439‐443. American Nurses Association /National Association of School Nurses (ANA/ NASN). (2011). Scope and standards of practice: School nursing, 2nd ed. Silver Spring, MD: Nursebooks.org. Food Allergy American Academy of Allergy, Asthma and Immunology Board of Directors (1998). Position Statement-Anaphylaxis in schools and other child-care settings. Journal of Allergy Clinical Immunology: 102(2), 173-175. Food Allergy Network (2001). Information about anaphylaxis: Commonly asked questions about anaphylaxis. www.foodallergy.org. Mudd, K. E. & Noone, S. A., (1995). Management of severe food allergy in the school setting. Journal of School Nursing: 11(3), 30-32 National Association of School Nurses (2000). Position Statement-Epinephrine use in life-threatening emergencies. Scarborough, ME: Author.

37. Questions or Comments?References & Resources Medication Belton Independent School District Board Policy (2012). FFAC Legal and Local: Wellness and Health Services: Medical Treatment: Administering Medication. Retrieved June 22, 2012 from http://pol.tasb.org/Policy/Code/164?filter=FFAC Belton Independent School District Board Policy (2012). FFAF Legal: Wellness and Health Services: Individualized Health Plan. Retrieved June 22, 2012 from http://pol.tasb.org/Policy/Search/164?filter=FFAF Texas Department of State Health Services (2011). Texas School Health Guidelines: School health Manual: Chapter 5, 208. Retrieved June 22, 2012 from http://www.dshs.state.tx.us/schoolhealth/pgtoc.shtm American Academy of Pediatrics. (2009). Policy statement guidance for the administration of medication in school. Pediatrics 124, 1244‐1251. American Nurses Association / National Council of State Boards of Nursing (ANA/NCSBN). (2006). Joint statement on delegation. Retrieved from https://www.ncsbn.org/Joint_statement.pdf American Nurses Association (ANA). (2005). Principles of delegation. Silver Springs, MD: Author. Canham, D.L., Bauer, L., Concepcion, M., Luong, J., Peters, J., & Wilde, C. (2007). An audit of medication administration: A glimpse into school health offices. Journal of School Nursing, 23, 21‐27. doi: 10.1177/10598405070230010401 Clay, D., Farris, K., McCarthy, A.M., Kelly, M.W., Howard, R. (2008). Family perceptions of medication administration at school: errors, risk factors and consequences. Journal of School Nursing, 24, 95‐102. doi: 10.1177/10598405080240020801 Gursky, B. S., & Ryser, B. J., (2007). A training program for unlicensed assistive personnel. Journal of School Nursing, 23, 92‐97. doi: 10.1177/10598405070230020601 BBP http://www.dir.ca.gov/dosh/dosh_publications/expplan2.pdf http://www.odh.ohio.gov/ASSETS/BF89785CAD2F478BB75134D8219D2A5F/bbpath.pdf http://www.setonresourcecenter.com/safety/written/pdf/bbpschools.pdf Contact info: Belton ISD Health Services charlotte.smith@bisd.net