Nathan Walters February 14, 1992 – May 18, 2001

1. Nathan Walters February 14, 1992 – May 18, 2001

2. Health Services Update Kathe Reed-McKay August 13th, 2009

3. Change in Nursing Assignments Shadle has a new Lead SN Welcome: Marianne Fischer, Lead SN Tonya Garman, Support RN

4. NEW IMMUNIZATION LAW:Pre-School Students • Pneumococcal Vaccine = PVC • Intervals are complicated like Hep B • Depends on child’s age + # of previous doses • Sasi has been programed

5. REQUIREMENTS DURING AN OUTBREAK ARE MORE STRINGENT THAN FOR SCHOOL ATTENDANCE CONTACT YOUR SCHOOL NURSE WHEN A CASE OF CHICKENPOX or MRSA IS REPORTED Remember that notification is needed for 5ths Disease, Chickenpox, Scabies + Bacterial Meningitis Use the Black notebook in every building: Resource Manual for Schools- SRHD

6. Immunization Data Start your immunization follow up early • Annual report: Submit On-line only • Due by Nov. 1st • Tech Services will again provide report

7. SPS Immunization Statistics • Personal exemption rates vary between schools: 0% - 15.2% • Non-compliance rates vary from between 1% - 48% • SPS still has the highest Personal Exemption and Non-compliance rates in the state • Soon: Compliance stats by schools to principals and office staff soon • Later in the fall- work together to help the schools that have high non-compliance rates.

8. CIS FORMS It is very important that sasi data matches the dates on CIS forms Adding dates per parent phone call: • Can be added to CIS by office staff (”per parent report on (date), your signature”) Adding dates from the state registry: • Must be added to CIS by the nurse.

9. CHILD PROFILE = State Registry • Many office staff now have access • Allows you to obtain dates you might not have • Reduce time spent in f/up • You can print out a CIS form with dates • Just enter the dates in sasi and attach CIS to the school CIS • CIS from registery = “medical document” • More health care providers entering data

10. Reminder: FOUR SASI SLOTS FOR VARICELLA #1 = First vaccination date #2 = Second vaccination date #3 = Parent Reported date of disease (Not acceptable for K this yr) #4 = DR verification of date of disease OR date of Blood Titre (Be sure to select “titre” from the exemptions pull down menu)

11. Reminder: IMMUNIZATION EXEMPTIONS • Use Conditional (“C”) in sasi for students in process of series • Do NOT use “Convenience” Personal Exemptions • Do NOT mention exemptions unless asked but provide form when asked • FYI: Current CIS=Rev. Jan 2006 Toss the old ones

12. ANY QUESTIONS SO FAR?

13. WEB RESOURCES Health Services Resources: http://www.spokaneschools.org Click on Parents or Staff and then Health Services You can link to this site from your Secretarial Resources Page

14. NEW ASTHMA AND ALLERGY PLANS Purpose: • Increased safety for students • Clearer “action” steps for staff • Less forms (med orders included in plan) Note: Keep copy in Med AND Care Plan notebook and use log forms w/plan Why: • Laws • Washington State Nursing Commission… concerns Goal: same plan used by all districts in Spokane County

15. “Pilot Projects” Workgroup developed new plans over a two year period New Asthma Plan: • 2008-09 in Central Valley and Riverside districts. • Plan improved Spring 09 New Allergy Plan: • 11 area districts will use 2009-10 • Plan will be improved, Spring 2010 BOTH PLANS MUST BE SIGNED BY BOTH PARENTS AND HEALTH CARE PROVIDER

16. CRITICAL POINT! BEWARE when a student has severe food allergies AND asthma • Might have a plan for each condition • Get both plans out • Breathing difficulties are associate with both conditions • OK to treat asthma but be ready to administer epi-pen and call 9-1-1 if symptoms don’t subside or get worse.

17. New Asthma Plan: “GO, CAUTION, STOP” GO ZONE: All is ok. • Participates fully in PE • Asthma is mostly stable • Uses “rescue” inhaler < 2x/wk CAUTION ZONE: Has symptoms Note: If student also has food allergy, get severe allergy plan too! • provide medication as ordered • Restrict activity • If student doesn’t recover, go to STOP ZONE • If student needs repeated dose, report to parent and school nurse

18. STOP ZONE: Emergency! • When any Stop Zone symptoms are noted or when in doubt, call 9-1-1 • Provide medication as ordered Note: Orders may include epi-pen for the Stop Zone. Don’t hesitate to use the epi-pen. It is not harmful for students to receive repeated doses of their “rescue” inhaler while waiting for EMS to arrive

19. New Allergy Plan • Bottom line: School staff are to administer the Epi-pen first and then call 9-1-1 • We do not give antihistamine and then “wait and watch” for more severe symptoms before giving epi-pen • Reason: Delayed administration of epi-pen can lead to a very poor outcome • At home parents can wait and watch, in school it’s not considered safe.

20. Somewhat controversial.. Some parents: • don’t understand why we can’t give antihistamine and “wait and watch” • Some parents understand the importance • Some parents think their child will be getting an epi-pen every time they come to the office

21. Controversial… • Some DR’s know that mild symptoms may not progress to a serious reaction and prefer giving antihistamine and “wait and watch”. Note: School staff do not have the medical expertise to always adequately assess the progression of a serious reaction. • Some DR’s understand the need for a more clear approach of treatment at school.

22. Minor vs. Serious Symptoms Minor symptoms Generally present as localized hives. Can be the first symptom but not always. Serious symptoms Generally involve multiple body systems: • Skin: (widespread hives) • Throat: tightness, hoarsness, cough • Lungs: SOB, coughing, wheezing • Gut: Nausea, stomach ache/cramps, vomiting • Heart: fainting, blue/gray skin color or pale • General: panic, sudden fatigue, chills, feeling of impending doom.

23. Your Role: If you suspect ingestion or child shows any symptoms of having a reaction: • FOLLOW THE PLAN • ADMINISTER EPI-PEN • STAY WITH STUDENT • CALL 9-1-1 • THEN CONTACT PARENT + SCHOOL NURSE It takes a team to respond

24. A little recent history…. • Several districts in western WA made the change to Epi-pen first and no wait and watch, last fall. • A challenging change but it smoothed out as the year progressed. • If you notice an old EAP comes to school… notify your school nurse. • Concerns from DR’s and Parent should be directed to the school nurse or HS Director. • Nurses report that epi-pens were not given more frequently than before

25. Critical Point! IF A STUDENT HAS BOTH ASTHMA AND SEVERE FOOD ALLERGY, THEY ARE AT HIGHER RISK FOR COMPLICATIONS AND DEATH

26. Exception to the rule… Some children with frequent, chronic skin conditions (i.e. eczema) may need separate medication orders for oral medication that is given before following the EAP for severe allergy. This is the rare exception and determined by the school nurse who assesses the situation with parent and health care provider.

27. Be Confident… Take Action • Be calm, take charge • Understand and follow Emergency Action Plans • Prompt administration of epi-pen will save a life • Never hesitate to call 9-1-1 • Always stay with a student who may be in crisis • Ask for help or clarification when needed. • Participate in training and practice drill opportunities ~~Nurses will be offering staff training throughout the year

28. QUESTIONS?? Questions will come up as school starts… Please contact your school nurse or myself for more info.

29. Head Lice Resources/Notebooks • Notebooks distributed last January • Nurses continue to offer training Purpose: • Align practice with current research • Reduce absences due to head lice • Provide consistency district-wide

30. NEW GUIDELINES DISTRIBUTED “MEDICAL EMERGENCY GUIDELINES + HEALTH INFORMATION” • Mailed to all bldgs this summer • To be placed in every room with the Crisis clipboard Includes: • Review of Common Health Conditions • 9-1-1 Considerations • Field Trip Checklist (Revised)

31. H1N1 UPDATE “Swine Flu” • Not sure how much impact this will have on the schools and our community. • Appears very contagious to children • Letters prepared for distribution to staff and parents- first week • Updates provided on the district’s website • Preparation and Communication is key

32. H1N1… what do we do in schools? The same recommendations for all of the community: • Stay home when your ill • Exclude students with flu like symptoms • Frequent hand washing • Cough and Sneeze in your sleeve • Don’t share food, drinks, utensils • Avoid close contact with ill persons • Follow health care providers instructions

33. HS Records Retention Review • Health room logs = keep in school office file for 8 years and then shred • Vision and Hearing Screening – keep school copy on file until replaced by new results the next yr (shred) • Medication or TX forms/logs- Send to me at the end of the yr and I keep for 8 yrs • Care plans are to be shredded when replaced with a new plan, plan no longer needed or when student moves

34. POTPOURI OF REMINDERS: • Remember to dispose of medications by placing both the med and forms in the ORANGE envelope. • Distribute “parent packets” at the time of registration (Severe Allergy and Diabetes) • Help us code Severe Food Allergies as “F” and less significant sensitivities with a “G”

35. Potpourri…. • Every time a student enrolls at your school, a new 1F15 B- “Health Record” form must be completed. • “Q” health code = Mental Health/Behavioral issues • Use district approved Cleaning and Disinfecting products

36. QUESTIONS? THANKS FOR ALL YOU DO ALL YEAR!!