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DPAS II Component 5

DPAS II Component 5. Frequent Flyers Nancy Nadel Sharon-rose Gargula. What is this indicator asking?. The student will decrease unscheduled non-acute care visits to the nurse. What is a “Non- Acute” Visit?. Unscheduled Non emergency Unnecessary No significant complaint.

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DPAS II Component 5

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  1. DPAS II Component 5 Frequent Flyers Nancy Nadel Sharon-rose Gargula Nadel and Gargula 2012

  2. What is this indicator asking? • The student will decrease unscheduled non-acute care visits to the nurse. Nadel and Gargula 2012

  3. What is a “Non- Acute” Visit? • Unscheduled • Non emergency • Unnecessary • No significant complaint Nadel and Gargula 2012

  4. Examples of non-acute visits • Chapped lips • Invisible injuries • Stomach aches just before lunch • Paper cut • Frequent visits out of the same class for vague complaints • Picking scab off healing cuts • Personal female care • Symptoms that just started 1 minute ago Nadel and Gargula 2012

  5. Legitimate visits • Scheduled medication • Scheduled treatment • Asthma attack • Chronic Illness care (diabetes, seizures) • Fever • Vomiting • Chest Pain • Injury requiring first aid • Significant mental health crisis Nadel and Gargula 2012

  6. What is a cohort? Choose a group of students (between 10-150) that are at risk for frequent visits • Hint- the larger the group the better the outcome will be • Use eschool or DSC to determine who will be at risk • Past frequent flyer • New student to the building who has found their way to you Nadel and Gargula 2012

  7. What does a goal look like? • 50% of the selected cohort will show improvement over a defined period of time with a minimum of 4 weeks. • If your cohort is 20, then a minimum of 10 students will have a decrease in their unscheduled office visits by at least one visit during the second time frame you have chosen to measure. Nadel and Gargula 2012

  8. What Data to collect • Any visit to the nurse • Include time of visit and length of visit • Chief complaints • Is it vague or specific? • Is it medically necessary? • Discuss with the student what the ultimate goal is for this visit (rest, pain free, go home) • Where is the student coming from or where is the student supposed to be going? Nadel and Gargula 2012

  9. How data is collected • History, including onset of complaint • Care provided at home • If an injury, where did it happen? • Are parents aware of the illness/injury? • How is this interfering with outside activities? • Physical assessment • Staff conference: what is the teacher seeing in the classroom? • How often is the student leaving the classroom? • Is the teacher aware that the student has come to the health suite? Nadel and Gargula 2012

  10. Now what to do with this data • Choose 2 equal points in time • Min 4 weeks max is school year • Example Nov 1st-30th and April 1st-30th or 1st MP and 3MP • Compare the number of visits for the cohort (identified students) • Improvement can be by a single visit! Nadel and Gargula 2012

  11. Interventions for the student • Identify the real reason for the visit. • Look for patterns such as a common time • Is there a substitute teacher? • Is it the same teacher who is making excessive referrals? • Ensure medication availability and compliance Nadel and Gargula 2012

  12. Interventions for the student • Educate the student about acceptable reasons for visiting the nurse • Identify a motivator for staying in class which might include a reward system • Develop an IHP • Teach student self care and facilitate a means for this to happen • Consider scheduling a time for an office visit, just to check in Nadel and Gargula 2012

  13. Interventions for the teacher • Is there a plan for the substitute teacher and what to do with students who are frequent flyers? • Educate teachers on proper referrals - decision tree • Make teacher aware of excessive referrals • Attend PLC’s • Utilize support staff, IST, guidance counselor • Speak with administration about support for teachers Nadel and Gargula 2012

  14. Interventions for the Parents • Communicating concerns, genuine caring for student’s well being • Obtain a health history. • Set common goals with parent. • Conference with parents/teacher & nurse • Encourage parents to follow-up with PCP to rule out any physical cause for the student complaint. • Mental health issues if untreated can cause physical symptoms Nadel and Gargula 2012

  15. Comparison of Data • Students showing improvement • ___________________ • Total number of students • Acceptable growth rate is 50% - unless you chose something else in agreement with your administrator Nadel and Gargula 2012

  16. Why is this indicator important? • School nursing started with the premise that healthy children should be in the classroom and sick students should be at home. • By decreasing the frequency of non emergent visits we are supporting our teachers and helping students become successful. • The documentation for this indicator can lead to data for other indicators • We can combine this indicator with other indicators. Nadel and Gargula 2012

  17. Questions? Nadel and Gargula 2012

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