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HCPSS / POLICIES

Policy 5100 Implementation Procedures - Health Services

Policy Document

Implementation Procedures

I. Definitions

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

  1. Agency Nurse – A non- Howard County Public School System(HCPSS) nurse that provides health room coverage in the absences of the designated school nurse.

  2. Overdose Response Program(ORP) – HCPSS procedures and protocols for the management of administering an overdose reversing medication to an individual experiencing or believed to be experiencing an overdose.

  3. 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.

  4. Substitute Nurse – An HCPSS nurse that provides health room coverage in the absence of the designated full time nurse.

  5. 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.

II. 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 II.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 health services employee on duty.

    6. Students who receive health care from 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 longterm 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. Employees and Visitors

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

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

    3. 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 employees.

    4. First aid care will be provided in accordance with current guidelines found in the National Safety Council Recommendations and the Health Services Requirements and Procedures Manual.

    5. 911 will be called immediately if the needs of the 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 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; daily logs and narrative reports will be completed.

III. 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 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 principal 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.

IV. Overdose Response Program (ORP)

  1. The health services coordinator/designee will ensure that an overdose reversing medication will be stored and accessible in each school.

  2. Adequate training will be provided regarding the recognition of overdose emergency situations and administration of overdose reversing medication.

  3. All school health personnel and other school employees will, as designated by the health services coordinator and school administrator, be trained in the overdose response program.

  4. All trained school employees are authorized to administer overdose-reversing medication to a student or other person located on school property who is reasonably believed to be experiencing an opioid overdose.

  5. HCPSS will ensure that each school will provide notification to parents regarding the ORP.

V. 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.

    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.

VI. 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 is 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 school 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 principals 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 administrators.

    4. Criteria for evaluation will include compliance with Health Services PerformanceStandards and achievement of goals, 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.

VII. Licensure, Certification, and Professional Development

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

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

  3. Professional development will be offered on a regular basis for required certification.

  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 school employees when a nursing task is delegated.

VIII. 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 assign a substitute nurse or agency nurse to a 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 health employees is not available. School nurses and principals are responsible for developing a plan for providing basic services in these situations.

IX. 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.

X. History

ADOPTED: December 10, 1992

REVIEWED:

MODIFIED:

  • February 12, 2015

  • September 19, 2017

  • November 7, 2019

REVISED:

  • June 28, 2007

  • April 15, 2010

  • February 10, 2011

EFFECTIVE: November 7, 2019