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HCPSS / POLICIES

Policy 5100 Implementation Procedures - Health Services

Policy Document

Implementation Procedures

I. Provision of Health Care

  1. Students

    1. The health assistant or nurse will conduct an initial review of student health records. If students are identified as having special health needs, the procedures under Section I.A.9. below will be followed.

    2. Health services and services provided by the school-based wellness centers and TeleHealth Centers will be provided in accordance with current guidelines found in the Health Services Requirements and Procedures Manual.

    3. First aid and management of exposure incidents must be provided in accordance with guidelines in the Health Services Requirements and Procedures Manual, the Maryland State School Health Services Guidelines, and the Occupational Safety and Health Administration (OSHA) regulations.

    4. Students who are in need of health care during the school day should be sent to the health suite with a pass except in the case of an emergency.

    5. Students will have their health needs determined by the Howard County Public School System (HCPSS) health services employee on duty.

    6. Students who receive health care from HCPSS health services employees will have their admission to the health suite recorded on the daily log. Information regarding the care provided will be recorded on the individual student health records as appropriate.

    7. 911 will be called immediately if the needs of the student are determined to be sufficiently serious to require emergency medical services. Parents will be notified as soon as possible once the safety of the student is established. An administrator and the Office of Safety and Security will be notified of 911 calls as soon as possible.

      Maryland Medical Orders for Life Sustaining Treatment (MOLST) will be implemented for students as ordered in compliance with Maryland State Health Services Guidelines.

    8. Once care has been given, the student will be returned to class with a pass. If the student cannot return to class due to the nature or seriousness of the problem, the parent will be contacted to make arrangements for early dismissal.

    9. Special Health Needs: The school nurse or Cedar Lane nurse will complete a health appraisal for all students with special health needs in accordance with Maryland State School Health Standards requirements and Maryland Board of Nursing Standards of Care. Special health needs are temporary or long-term health problems arising from physical, emotional, or social factors or any combination of these factors. Students with special health needs may or may not be enrolled in a special education program. Identification may include referrals from parents, employees, and community professionals. Any student with complex health needs that cannot be met with current staffing and/or in the current school setting will be referred to the health services coordinator in order to develop a plan of care.

  2. HCPSS Employees and Visitors

    1. Care is only provided within the limits of existing resources and staffing.

    2. Nurses or health assistants will provide emergency first aid to HCPSS employees and visitors within the scope of their licensure/certification and employment.

    3. HCPSS employees with diagnosed medical conditions that could result in episodes requiring the provision of emergency medication or treatment may request a medical accommodation by contacting the Office of Safety and Security. Services approved as reasonable accommodations will be provided consistent with doctor’s orders and within the licensure of HCPSS employees.

    4. First aid care will be provided in accordance with current guidelines found in the Guidelines for Emergency Care in Maryland Schools and the Health Services Requirements and Procedures Manual.

    5. 911 will be called immediately if the needs of the HCPSS employee or visitor are determined to be sufficiently serious to require emergency medical services. An administrator and the Office of Safety and Security will be informed of 911 calls as soon as possible.

    6. When HCPSS employees and visitors receive health services, a record of the care provided will be maintained. Worker’s Compensation First Report of Injury or Illness and Employee Injury Reports will be completed as appropriate.

II. Mandated Programs

  1. The health services coordinator/designee will ensure that guidelines and procedures for the implementation of State-mandated programs and activities, including documentation of immunization compliance, are current. The health services coordinator/designee will collaborate with school-based administrators, the Howard County Health Department (HCHD), the Maryland State Department of Education (MSDE), and the Maryland Department of Health (MDH) when reviewing the guidelines and procedures.

  2. The school-based administrator and the health services coordinator/designee will work collaboratively to ensure that mandated programs are effectively implemented.

  3. Designated school health professionals in the Health Services Office will make required reports to the HCHD, the MSDE, and the MDH according to current guidelines and instruction.

III. State-Mandated Emergency Rescue Medications

  1. The health services coordinator/designee will ensure that stock emergency medication will be stored and accessible in each school.

  2. Adequate training will be provided to designated HCPSS employees regarding the use of stock emergency medications.

  3. All school health personnel will be trained in the administration of stock emergency medications.

  4. HCPSS will ensure that each school will provide notification to parents as required by law.

IV. Records

  1. Each enrolled student must have a student health record.

    1. If a student enrolls and does not have a health record, one must be developed.

    2. Students who are registered but not enrolled and who are receiving related services such as speech, occupational therapy, or physical therapy must have a health record, which includes, at a minimum, an immunization record.

    3. Students who are enrolled in the HCPSS and are engaging totally in education programs and services off campus are required to have a health record maintained at the student’s assigned school.

    4. Parents of students who are transferring from other HCPSS schools will have health records transferred to the receiving school at the time of transfer, using procedures described in Policy 9050 Student Records.

  2. Each student health record will include all State and locally mandated health records, forms, and certificates. Other forms and documents such as parent notes, reports to parents, medical reports, medication orders, etc., will be added to the record as they are generated or received.

  3. A separate individual health record will be maintained in the health suite for each student enrolled in every school.

  4. Access to health records is guided by the Family Educational Rights and Privacy Act of 1974 (FERPA) and Policy 9050.

  5. When students withdraw, transfer, or graduate, the health record will be managed in accordance with Policy 9050.

V. Supervision and Evaluation

  1. Health Assistants

    1. School nurses are responsible for supervising and evaluating health assistants in one or more schools.

    2. The frequency and duration of supervision activities are dependent upon Maryland Board of Nursing Criteria for Delegation.

    3. The process used by school nurses to monitor the performance of health assistants may include observation, review of records, and consultation with health services supervisors and school-based administrators.

    4. Criteria for evaluation will include and will comply with the evaluation tool designed for the purpose.

    5. A formal evaluation will be conducted annually.

    6. Principals/designees will provide written input to the annual evaluations using a form developed for that purpose. Principals will meet with health assistants to discuss their input and sign the forms.

    7. Health assistants and principals will receive copies of signed evaluations. Originals will be filed in their personnel file.

    8. School nurses will confer with health services supervisors regarding the development of action plans and for any evaluation with Needs Improvement or Unsatisfactory overall ratings.

  2. Nurses

    1. The health services coordinator/designee is responsible for supervising and evaluating school nurses and Cedar Lane nurses.

    2. The frequency and duration of supervisory visits will be determined according to specific needs.

    3. The process used to monitor the performance of nurses may include observation, review of records, and consultation with school-based administrators.

    4. Criteria for evaluation will include compliance with Health Services Performance Standards and will be established using an evaluation tool.

    5. Principals will provide written input to the annual evaluations using a form developed for that purpose. Principals will meet with nurses to discuss their input and sign the form.

    6. Nurses and principals will receive copies of signed evaluations. Originals will be filed in the personnel file.

VI. Licensure, Certification, and Professional Development

  1. Nurses and health assistants must maintain current licensure and/or certification according to Maryland Board of Nursing requirements.

  2. Health assistants must maintain current certification in first aid, Basic Life Support, Cardio Pulmonary Resuscitation (CPR), and the use of an Automated External Defibrillator (AED) from an approved program. Nurses must maintain current certification in Basic Life Support, CPR, and the use of an AED from an approved program.

  3. Professional development will be offered on a regular basis.

  4. Nursing tasks will only be delegated in accordance with the Maryland Board of Nursing Nurse Practice Act. Training will be provided by the nurse to a health assistant or other unlicensed HCPSS school-based employees when a nursing task is delegated.

VII. Health Room Coverage

  1. When a health assistant or school nurse is absent for a half day or more, every effort will be made to provide coverage for the health room. The school nurse will be notified and plans put into place to provide care for students with special health needs.

  2. In the absence of a school nurse, arrangements will be made for temporary supervision of affected health assistants by a float nurse or another school nurse.

  3. There may be times when health room coverage by HCPSS health services employees is not available. School nurses and principals are responsible for developing a plan for providing basic services in these situations.

VIII. Communication

  1. The Health Services Requirements and Procedures Manual will be available in each school in the health suite and on the school system website. This manual will provide specific information and direction for the provision of health care in the school setting. The manual will be revised and updated as necessary to be consistent with current standards of nursing and medical practice, and to reflect current State and federal requirements.

  2. Basic information regarding health services, including screening requirements and medication administration, will be published in the HCPSS Student & Parent Handbook and on the school system website.

IX. Definitions

Within the context of these implementation procedures, the following definitions apply:

  1. Float Nurse – A HCPSS nurse assigned by the Health Services Office in various locations to provide nursing coverage.

  2. School-Based Wellness Center (SBWC) – Health centers that are located in a school or on a school campus, which provide onsite comprehensive preventive and primary health services.

  3. State-Mandated Emergency Rescue Medications – HCPSS will stock emergency medication deemed necessary by State Law.

  4. Telehealth Centers – The use of information and communication technology as a two-way connection between a student and nurse at school and a doctor at another location for the provision of health care.

X. Monitoring

Policy 5100 implementation procedures will be overseen by the Division of Schools.

XI. History

ADOPTED: December 10, 1992

REVIEWED: December 13, 2018

MODIFIED:

  • February 12, 2015

  • September 19, 2017

  • November 7, 2019

  • June 12, 2025

REVISED:

  • June 28, 2007

  • April 15, 2010

  • February 10, 2011

EFFECTIVE: June 12, 2025

Policy History Key

  • Adopted-Original date the Board took action to approve a policy
  • Reviewed-The date the status of a policy was assessed by the Superintendent’s Standing Policy Group
  • Modified-The date the Board took action to alter a policy that based on the recommendation of the Superintendent/designee did not require a comprehensive examination
  • Revised-The date the Board took action on a that policy based on the recommendation of the Superintendent/designee needed a comprehensive examination
  • Effective-The date a policy is implemented throughout the HCPSS, typically July 1 following Board action.