School Nurse Practice Updates

1. School Nurse Practice Updates NCESD School Nurse Workshop 9/26/19 Cathy Meuret, MAEd, BSN, RN

2. Immunizations

3. RCW 28A.210.090 Immunization Program - Exemptions

4. RCW 28A.210.090 Change: (1)(c)…A philosophical or personal objection may not be used to exempt a child from the measles, mumps, and rubella vaccine.

5. Immunization Status Report Changes • Changing deadline to December 1, 2019 this year only. • Schools actively using the Immunization Information System (IIS) School Module are not required to report. DOH can pull the data from the School Module data tables.

6. Changes and Enhancements • Collects the same information for 3 groups: kindergarten students, 6th grade students, and all students in K - 12th grades. • Uses a custom form sent to each school. If the form is not received by October 1, email OICPSchool@doh.wa.gov • Collects the immunization status and type of exemption for each required immunization. • Counts any student that is “Out of Compliance” for any one or more of the disease immunization requirements as “Out of Compliance in the Overall Status” totals even if they are exempt, conditional, or up-to-date with any other requirements.

7. 2019 Reporting Information for schools and preschools who do not use the School Module is on the DOH Immunization webpages: • K-12thGrade Schools: https://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/SchoolStatusReporting • Preschool and Child Care: https://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/ChildCareStatusReporting

8. Two Methods for Non-School Module Districts • Survey Monkey Pilot • A spreadsheet with instructions will be emailed to nurses by October 15. Nurses who don’t receive the spreadsheet should emailOICPSchool@doh.wa.gov • Go to the Survey Monkey link (available October 15). • Enter the required information; click submit button to send. • .xlsx Spreadsheet File • Enter the required information onto the spreadsheet mailed to the nurse. Nurses who don’t receive the spreadsheet should email OICPSchool@doh.wa.gov • Email the completed spreadsheet back to: OICPSchools@doh.wa.gov

9. Back to School & Immunizations • Before a child may attend school, the parent must provide a DOH-approved CIS form and, if applicable, a COE. • “Conditional status” is a temporary condition defined by law. • Questions on immunization reporting and requirements can be sent to: oicpschools@doh.wa.gov

11. Opioid Reversal Medication

12. RCW 28A.210.290Opioid overdose reversal medication—Standing order • A high school may obtain and maintain opioid overdose reversal medication with a standing order per RCW 69.41.095. • The reversal medication may be donated.

13. RCW 28A.210.290 A school nurse, health care professional, or trained school staff may distribute or administer school-owned opioid reversal medication. Opioid overdose reversal medication may be administered may be administered on school property – a school building, playground, bus, field trip, or on sanctioned excursions.

14. RCW 28A.210.290 A school nurse or designated, trained school personnel may carry an appropriate supply of the reversal medication off school property for field trips/school sanctioned trips.

15. RCW 28A.210.290 • Training • Requirements • Personnel that should be trained • Limited Liability

16. RCW 28A.210.395 • Opioid overdose reversal medication— policy guidelines and treatment • OSPI, DOH and WSSDA Responsibilities • Guidelines Content

17. RCW 28A.210.395 Training by school and other entities. Example content: http://stopoverdose.org/section/take-the-online-training/

18. RCW 28A.210.395 By March 2020, WSSDA will update or create a model policy. Districts/Schools > 2000 students require a policy in place by beginning of 2020 - 21 school year. OSPI/WSSDA must maintain the model policy on their websites at no cost to schools.

19. RCW 28A.210.395 OSPI to develop and administer a grant program to assist public schools for funding to purchase opioid reversal medications and provide staff training.

20. NCESD School Nurse Corps Assistance NCESD SNC received a grant from North Central Accountable Community of Health to assist school districts with training, training equipment, travel and other expenses associated with Narcan program development.

21. Resources • Senate Bill 5380 - Final Bill Report http:/ /lawfilesext.leg.wa.gov/biennium/2019-20/Pdf/Bill%20Reports/Senate/5380-S%20SBR%20FBR%2019.pdf • 2018 Healthy Youth Survey: Data Brief: Prescription Drugs and Opiates https://www.doh.wa.gov/Portals/1/Documents/8350/160-NonDOH-DB-Opiates.pdf • NASN Naloxone in Schools Toolkit https://www.pathlms.com/nasn/courses/3353 • Free Narcan Nasal Spray High School Program http://www.corxconsortium.org/wp-content/uploads/Adapt-Narcan-High-Schools_3_14.pdf

22. Medical Marijuana in Schools

23. RCW 28A.210.325Medical use of marijuana-infused products—Administration by parent or guardian—School districts to develop policies

24. A school district must permit a student who meets requirements to consume marijuana-infused products for medical purposes.

25. Upon request, the school district shall adopt a policy to authorize parent/ guardian to administer marijuana-infused products to a student for medical purposes while the student is on school grounds, on a school bus, or attending a school-sponsored event.

26. Policy Inclusions:Require the student be authorized to use marijuana-infused products for medical purposes. Verify DOH Authorization Form.

27. Policy Inclusions:Establish protocols for verifying the student is authorized to use marijuana for medical purposes.

28. Policy Inclusions:The parent or guardian acts as the designated provider for the student. Allow parent/guardian to administer marijuana-infused products for medical purposes to the student while on school grounds, school bus, and/or school-sponsored events.

29. Policy Inclusions:Identify locations on school grounds where marijuana-infused products may be administered. Prohibit the administration of medical marijuana to a student by smoking or other methods involving inhalation.

30. Liability: School officials, employees, volunteers or students and parents acting in accordance with district policy may not be arrested, prosecuted, or subject to criminal sanctions.

31. RCW 28A.300.473 (Policy Suspension)Medical use of marijuana-infused products—Suspension of policies that authorize student use on school grounds

32. OSPI and School District Policy Suspensions Federal government issues a communication suggesting federal funding will be withheld if WA State continues to implement RCW 28A.210.325 and 69.51A225. • OSPI requests a formal opinion by state attorney general on the federal communication; and • State attorney general provides a formal opinion that the federal communication has reasonably demonstrated that continued implementation of the RCWs jeopardizes future federal funding.

33. OSPI BULLETIN Medical Marijuana Administration to Students

34. Key Points: • Only a licensed health care practitioner can authorize a patient to receive medical marijuana products. • Authorization to use medical marijuana is not a prescription for marijuana.

35. Key Points: • Medial Marijuana Recognition Cards expire 6 months after issued (or earlier). • A current copy of recognition cards should be kept on file by the school.

36. Implications for Schools: • Only the parent/guardian with a valid student and designated provider card shall provide and administer marijuana-infused products for medical purposes. • Students are not permitted to self-carry marijuana products.

37. Implications for Schools: • Schools are not required and should not store marijuana-infused products. • School staff and nurses are not permitted to administer marijuana products not approved by the FDA.

38. Implications for Schools: • Schools should consult with parent/guardian regarding current, past, potential side effects. • Schools should follow protocols (or develop a new one) in case of adverse reactions or complications after a student receives a product.

39. Implications for Schools: • Designated staff should document, keep track of card expiration dates, and any potential or known side effects and parent signature or initials. • Staff should keep a daily written log of date and time the parent administers marijuana, and parent initials, and enter into student health record.

40. Implications for Schools: • School administrators should be aware of the impairing side effects of some medical marijuana-infused products and plan for how student can access school… schedules, arrival and departure from school, participation in school-sponsored out-of-state field trips.

41. Implications for Schools: • Nurses shall follow national (NASN) and state practice guidelines for medical marijuana and work with the parent/guardian to ensure care coordination occurs.

42. NCQAC Advisory OpinionAdministration of Cannabis/Marijuana Products in School Settings (K-12), Public and Private Schools

43. NCQAC Advisory Opinion • It is within the scope of the RN or LPN to administer FDA-approved prescription cannabis/marijuana derived products in schools. (Example: Epidiolex) • It is not within the scope of the RN or LPN to administer medically authorized marijuana-infused products in school settings, public and private, grades K-12.

44. NCQAC Advisory Opinion: • RCW 69.51A.010 states that an authorization to use medical marijuana is not considered a prescription. Nurses may not administer or delegate to UAP to administer authorized medical marijuana.

45. NCQAC Advisory Opinion: • The law does not include any provision for a PDA to administer authorized or prescribed marijuana products in the school setting. Only a parent/guardian can administer “authorized” marijuana-infused products.

46. NCQAC Advisory Opinion: • A nurse can only administer or delegate administration of those types of prescription or over-the-counter drugs specifically allowed under the school laws, Nurse Practice Act, or other state or federal laws.

47. NCQAC Advisory Opinion: • WAC 246-840-700 requires nurses to communicate changes in status. This includes written documentation. Nurses must document care given and response to the care.

48. NCQAC Advisory Opinion: • It is within the scope of practice of the trained and competent RN or LPN to administer FDA-approved prescriptive cannabidiol products (such as Epidiolex) to students in schools per RCW 28A.210.

49. NCQAC has determined: • It is not within the nursing scope of practice to administer or delegate to assistive personnel to administer authorized medical marijuana. • It is not within the nursing scope of practice to provide storage and handling of authorized medical marijuana products.

50. NCQAC has determined: • It is not within the scope of practice of a nurse or other district staff to act as a PDA to administer authorized medical marijuana. • The laws and rules do not prohibit a nurse from validating medical marijuana authorizations.