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Teresa DuChateau, DNP, RN, CPNP Teresa DuChateau, DNP, RN, CPNP Teresa DuChateau, DNP, RN, CPNP Teresa DuChateau, DNP, RN, CPNP Wisconsin Public Health Association

The learner will be able to:

� Identify gaps in the current school health services system in Wisconsin

� Identify policy and procedure resources that can improve the delivery of school health services

� 5 year project starting in 2011

� Funded by Healthier Wisconsin Partnership Program◦ A component of the Advancing a Healthier Wisconsin endowment at the Medical College of Wisconsin

� Two main goals:◦ Develop and disseminate a state-wide school health services assessment tool

◦ Develop resources, templates and education materials to address priorities based on state-wide assessment results

� District level

� Online tool

� 100 questions100 questions100 questions100 questions

� Sections:Policies &

Procedures:

Services:

Health Services Nursing Services

Communicable Diseases Medication Administration

Crisis/Safety Planning•CPR/AED

Pupils with Special

Healthcare Needs

Pupil Records Health Education Curriculum

Nursing Services

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� Assessment completed in March-April 2012� Assessment completed by 117 school districts (27%)� Results of assessment represent 44% of Wisconsin school children

� Invited to participate via email◦ 63% of assessments completed by email invitation to school nurse◦ 37% of assessments completed by email invitation to district administrator

� 68% of Wisconsin school districts ‘opened’ the assessment

� Average time to complete assessment: 5.5 hours (includes prep and online completion)

� 90% completed by school nurse and 52% by school administrator

� Average nurse:pupil ratio was 1:1623 or more

� 80% of school nurses employed by school district◦ 7% of responding school nurses employed by health departments

� 38% of districts have 1.0 FTE ◦ Average FTE was 2.2 48%

42%

57%

64%

0% 20% 40% 60% 80%

Quality Improvement

Evidence Based

Best Practice*

Mandatory items

Assessment

Response=115*some best practice results not incorporated

� IEP (Individualized Educational Plan) development and involvement of the RN

� Number of CPR/AED trained staff in each school

� AEDs in over 90% of schools

� 77% of RNs have BSN or Master’s Degree

� Over 75% of schools have a policy on asthmatic inhaler self-carry and allow the students to self-carry and administer metered dose inhaler or dry

powder inhaler

� 41% of districts have a policy and protocol manual for emergency nursing services provided during after school (extra curricular and sporting events)

� 48% of districts have a school nursing procedure manual

� 52% of districts have policy and procedure regarding medication errors

� 35% of districts amend policy based on medication errors

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� Emergency Nursing Services

� Medication Administration

� Concussion Management

� Sample policies and procedures are based on best practices

� Incorporate state and federal requirements

◦ *Current Wisconsin law

◦ ^Current federal law

� Administering Medications to Students Policy and Procedure

� Medication Disposal Procedure

� Medication Error Procedure

� Staff Administration of Glucagon Policy and Procedure

� Staff Administration of Non-Student Specific Epinephrine Policy

� Student Self-Administration of Emergency Medications

� Policy

� Administrative Rule ◦ School Responsibilities

◦ Nursing Responsibilities

◦ Special Circumstances

◦ Field Trips

� Procedure

� Policy

� Administrative Rule◦ Role of School District Administrator

◦ Role of the Medical Director

◦ Role of the School Nurse

� Delegated Nursing Services

� Other School Health Services

� Policy

� Administrative Rule◦ Education

◦ Classroom Accommodations: “Return to Learn”

◦ Management of Head Injury Occurring During the School Day and School Sponsored Events (Before and After School/Fieldtrip)

◦ Management of Head Injury Occurring During a School Sponsored Sporting Event

◦ Pre-Athletic Season Baseline Testing

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Outlined in the following sections:

� Staffing

� Preparedness

� Policy

� Medication

� Training and Education

� Food Management

� Classroom Management

https://survey.qualtrics.com/SE/?SID=SV_dmrNo0aeSXScQWp

Online continuing education training for unlicensed assistive personnel◦ Hand hygiene

◦ Child who may require oral care at school

◦ Children with feeding difficulties

◦ Correct body mechanics

◦ Transfers

� Transfer out of wheelchair

� Transfer to a wheelchair

� Transfer from mat to a wheelchair

� Two person transfer

◦ Types of transfer devices

� Portable total body lift

� Sit to stand device

◦ Using a walker

◦ Diapering

◦ Weighing a diaper

◦ Applying a skin barrier to perineal area

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AmputationDifficulty Breathing Behavioral Emergencies Bleeding Blisters Burns Cold SoreCuts, Scratches, & Scrapes Diarrhea DislocationEar/Eye Problems Fainting Fever Fractures & Sprains Headache Head Injuries Heat/Cold Emergencies Nose BleedPuncture Wounds Rashes Stomachaches Vomiting

Resource Pilot Sites

Rice Lake

Turtle Lake

Sparta

Abbotsford

Edgar

Portage

Green Lake

Waukesha

Racine

Hurley

Kohler

Prairie du Chien

Pulaski

Webster

� 15 school districts piloting 4 of the resources and tools

� The case study evaluation will focus on:◦ Usability of the specific tools and resources ◦ Process changes◦ Capacity building ◦ Policy changes related to implementation of the resources

� The case study evaluation will help to identify why features of a resource/tool implementation succeed at a particular location and has challenges within a different setting

� Implement at least 3 (three) tools/resources in Fall 2013 and 1 (one) additional resources in Fall 2014

� Provide current documents/materials related to those resources (e.g., written policies or procedures)

� Participate in baseline and follow up data collection through written surveys, interviews, and focus groups as outlined in the timeline above

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� Preparation time: 5 hours� Time to complete online: 1.5 hours

� Average number of staff who assisted in completion: 4

� 69% of users who completed evaluation strongly agree/agree the time spent on the assessment was well spent

� 71% would use assessment tool again in the future

� Majority recommend completing assessment every 2-3 years

� Divide tool into sections:◦ Mandatory

◦ Best Practice/Evidence Based and Quality Improvement

� Allow the school district to choose which section(s) of the assessment they would like to complete

� As resources are developed (or identified), provide direct links to resources on the assessment tool

Core Partners:Core Partners:Core Partners:Core Partners:

Yvonne Yvonne Yvonne Yvonne EideEideEideEideSouthern Regional Office, Wisconsin Division

of Public Health (DPH)

Kathy GrahamKathy GrahamKathy GrahamKathy GrahamWisconsin Association of Local Health Departments and Boards (WALHDAB)

Rachel GallagherRachel GallagherRachel GallagherRachel GallagherWisconsin Association of School Nurses

(WASN)

Gretchen SampsonGretchen SampsonGretchen SampsonGretchen SampsonWisconsin Public Health Association (WPHA)

Bette CarrBette CarrBette CarrBette CarrWisconsin Department of Public Instruction

(DPI)

Marie WolffMarie WolffMarie WolffMarie WolffMedical College of Wisconsin (DFCM)

Advisory Council: Advisory Council: Advisory Council: Advisory Council: Over 25 member advisory council representing

EducationHealth careAdvocacyPolicy

AcademiaSchool nursing

Parents

Nurse Practice Nurse Practice Nurse Practice Nurse Practice Council: Council: Council: Council:

Marcia CreasyMarcia CreasyMarcia CreasyMarcia Creasy

Retired School Nurse

Sharon Sharon Sharon Sharon DaunDaunDaunDaun

Sheboygan Schools

Rachel GallagherRachel GallagherRachel GallagherRachel Gallagher

Milwaukee Public Schools

Mary Mary Mary Mary Kay Kay Kay Kay KempkenKempkenKempkenKempken

Randall Schools

Mary Mary Mary Mary Kay Kay Kay Kay LogemannLogemannLogemannLogemann

Platteville Schools

Barb MaleyBarb MaleyBarb MaleyBarb Maley

Wisconsin Dells Schools

Kerri SchmidtKerri SchmidtKerri SchmidtKerri Schmidt

Rhinelander Schools

Joan SimpsonJoan SimpsonJoan SimpsonJoan Simpson

New Richmond Schools

Lynne Lynne Lynne Lynne SvetnickaSvetnickaSvetnickaSvetnicka

Madison Schools

Lori ZinckLori ZinckLori ZinckLori Zinck

Madison Schools

Teresa DuChateau, DNP, RN, CPNP

School Nurse Resource Coordinator

Wisconsin Public Health Associationteresa@badgerbay.co

414-875-7257