Auburn Public Schools
DATA REPORT SCHOOL HEALTH
SERVICES PROGRAM
2013-14 School Year
Anne Elsaid, RN, BA, BSN, NCSN
Margaret Collins RN, BSN, MPH
Luong Duong, RN, BSN
Cheryl King, RN, BSN, NCSN,
Glenna Sullivan, RN, ASN, NCSN
Jo Truong, RN, BSN,
Dorothy Vallaincourt, RN, BSN, NCSN
with contributions from
Carrie Cashman, LPN Auburn Pre School and Kerriann Stuart, RN 1:1
October 2014
1
Table of Contents HEALTH SERVICES REPORT 2013-14
Introduction
p.3
School Nurse Staffing
p. 3
School Health Services Activity
p. 4
1. Health Encounters and Disposition
p. 4
2. Injury Reports, Early Dismissals and Referrals for Health Services p.5
3. Medication Management
p. 6
4. Health Screenings
p. 7
5. Body Mass Index (BMI)
6. Medical Procedures/ Nursing Interventions
p. 7-8
p.9
7. Linkages to Health Care Providers
p.10
8. Oral Health, Health Education, Nursing Case Management
p.11
9. Students with Special Health Care Needs
p.11-13
 Types of Special Health Care Needs
 Cardiovascular Health/ Automated Electronic Defibrillator (AED)
 Medical Emergency Response Plans (MERP)
 Concussion Data -Auburn HS and MS
2
10. Substitute School Salary Info
p. 13
11. Nursing Highlights
p. 14
12. Essential School Health Services Grant
p.14-15
HEALTH SERVICES REPORT 2013-2014
Introduction
The Auburn Public Schools Health Services Department plays a critical role in supporting the District’s
goals, to improve student learning and achievement. The school nurses support this goal as they keep
students safe, healthy and ready to learn. The school nurses have a direct impact on student attendance.
Students who need nursing interventions and care are able to attend school and succeed. Students who
obtain an injury seek treatment from the school nurse, and they most often are able to return to class.
The APS nurses care for every student in the district. In addition, the school nurses provide preventive
care and health education for students, staff and parents. The APS nurses serve as a critical link
between the school, home, community resources, and primary health care providers.
In recent years, many changes have affected the demand for school health services. These influences
include: (1) research that clearly links health to educational achievement; (2) improvement in medical
technology (3) increase in the number of students with special health care needs; (4) an increase in the
severity of the medical diagnosis in these students; (5) restructuring of the health care delivery system;
(6) laws requiring inclusion of all students; (7) changes in family structure and patterns of parental
employment; (8) rise in social morbidities such as substance abuse, depression, and violence among
children; and (9) impact of diverse cultural and linguistic groups.
Attendance in the early grades is correlated with school achievement and dropout rates. School nurses
support attendance by providing needed health services in school. School nurses are significantly less
likely to dismiss a student than an unlicensed counterpart therefore keeping students in school and
ready to learn (Pennington & Delaney, 2008).
School Nurse Staffing
The APS Health Services’ program is currently staffed with 5 full time School Nurses and two School
Nurses who job share the AHS position , and a nurse who works with the Preschool students. In the
2013-14 school year there was an additional nurse who was a 1:1 RN. All nurses provide health care
services to students and staff in the Auburn Public Schools. Two nurses are co-nurse leaders for the
district, 2013-14 Anne Elsaid and Cheryl King and in 2014-15 Anne Elsaid and Margaret Collins.
Student needs required a nurse as a 1:1.
There are two School Physicians Kevin Delacey M.D and Erin McMaster MD. All MA school districts
are required to have a school physician. Dr. Delacey conducts fall and spring sports physicals at the
AHS and provides medical orders to the nurses. Both physicians are available to the nurses and the
District for consultation.The audiologist, Kym Meyer, MS CCC-A is a contract employee who supports
students with Section 504 plans and IEP’s who have a hearing impairment. The audiologist assists with
the development of education plans, trains teachers and staff, and coordinates the use of FM systems.
Nursing works closely with PT and OT services, guidance and school psychologists.
The Essential School Health Services Grant (ESHS) funds the APS nurses as a mentored school
district. The district grant is administered through the Douglas School Nurse Leader. The ESHS also
funds the Regional Nurse Consultant. The Regional Nurse Consultant works with Auburn and all other
Districts in the Central Mass Region. The ESHS grant Regional Consultant provides District support,
networking opportunities, and hosts three regional meetings annually to keep our district nurses up to
date with the MDPH guidelines.
3
School Health Services Activity
The primary goal of the Health Services Department is to provide high quality nursing care to students
to keep students healthy and ready to learn. The school nurses document the student and staff health
visits throughout the year by the type of visit, and scope of school nursing activity. These activities are
divided into nine categories of data:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Health Encounters and Dispositions
Injury Reports, Early Dismissals, and Referrals for Emergency Health Services
Medication Management
Health Screenings
Medical Procedures
Linkages to Health Care and Insurance Providers
Oral Health
Health Education, Tobacco Prevention, and Support Groups
Nursing Case Management
1. Health Encounters and Disposition
An encounter is defined as any contact with a student during which the school nurse provides
counseling, treatment, or aid of any kind. Mandatory screenings (vision, hearing and postural) are not
counted as encounters. Screenings are tracked and reported separately. *nurses also support the staff in each
school
A total of 34,556 student health encounters were documented between August 28, 2013 and
June 26, 2014.
● Illness Assessment, Injury/first aid, and Scheduled Medication administration and treatments
are the most common reasons for visits to the school nurse
 Every encounter includes nursing assessment and health education.
 An illness encounter may include illness assessment, acute illness, chronic health condition,
etc.
● Mental/Behavioral Health Support includes any encounter requiring active listening,
anticipatory guidance, stress management, behavior modification/program support or
evaluation of altered mental status.
●
Number of Student Encounters
August 31, 2013-June 26, 2014
Type of Encounter
Number of Students
Illness Assessment
11,332
Injury First Aid
5,498
Mental/ Behavioral Health Support
955
Other/ Miscellaneous
3,750
Total 21,535 (does not include medication administrations and treatments)
An important role of school nursing practice is to provide health services to students who are sick,
injured, or who are experiencing a health emergency. After assessment and treatment by a school nurse,
the majority (95.8%) of students visiting the nurse’s office with an illness or injury complaint returned
to the classroom to continue their studies. (The return to class rate is higher than the state average of
91% in 2012-2013.) Students who are treated by the school nurse can be returned to the classroom with
4
minimal interruption of their educational activities; working parents do not have to take time off, and
the cost of treatment in a doctor’s office is avoided.
Percentages of students seen for visits (unduplicated students and those not seen for mandated
screenings)
Auburn High School
Auburn Middle School
Julia Bancroft
Packachoag
Bryn Mawr School
Mary D Stone
492/644= 76 %
451/593=76 %
270/284= 95 %
247/267= 96 %
266/266= 100%
244/244= 100%
8/31/ 2013- 6/26/ 2014
Student Disposition After Illness/Injury Assessment
Number
Percent
Returned to Class
Dismissals
*Other
Total
33,135
1,352
69
34,556
95.8
4.0
0.20
100%
“Other “ disposition:stayed in health room, referred to Counselor’s office, sent home to return later that day.
When students had to be dismissed, it was usually the result of illness (95.6%) rather than injury (4.6%)
2. Injury Reports, Early Dismissals and Referrals for Emergency Health Services
For injuries of a more serious nature, APS school nurses filed accident/injury reports
******Number of Student and Staff Injury Reports
August 31, 2013- June 26,2014
Student
Staff
Intent
Unintentional
Number Percent
21
Intentional
Unknown intent
Total
Number
134
Percent
10
1
1
0
145
22
School nurses referred students to urgent health care services a total of 32 times, twice for staff.
● * 9-1-1 or ambulance services were called 7 times for students, 2 times for staff
● Parents/guardians or emergency contacts were called to transport the student to health services
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3. Medication Management
The school nurse’s role in managing the medication administration program for the district is broad in
scope. The school nurses:
 Administer medications to students and monitor effectiveness.
 Manage limited delegation for the administration of selected medications to appropriately
trained teachers for field trips and special events, such as an in district field trip (the APS
District is registered with the MDPH to implement delegation with specific parameters).
 Training staff in the administration of an Epi Pen (epinephrine) in the event of an anaphylactic
reaction. Anaphylaxis is a potentially life threatening emergency that requires the prompt
administration of epinephrine. This requires registration with the MDPH to do so.
 Stock Epi Pens are ordered annually by the nursing co-leaders for emergency purposes. The
current cost per twin pack is $369.00 The Epipens4schools program provides public and
private schools with Epi Pens 0.3 mg and Epi Pens 0.15 mg twin packs for each school within
the district. In 2013 and 2014, this program has saved the APS district over $8,000. The
Auburn school nurses have an order from our school physician to administer this life saving
medication for an emergent anaphylactic reaction for students and staff.
 Ensure the proper training and supervision of the designated staff and documentation of the
training.
 Maintain a record-keeping system for the medication administration in the School Nurse
Assistance Program (SNAP) software, the APS’s electronic medical record. APS has seven
locations with SNAP set up, no current contract with ProMed software, can access the
software without access to immunization updates, other updates and software assistance.
** Among prescription medications that the nurses administered on a scheduled basis, psychotropic
medications were the most common, while among prescriptions taken on an “as-needed” (PRN) basis,
Asthma medications were the most common.**
Number of Student Prescriptions Doses Administered by School Nurses
August 31, 2013- June 26, 2014
Medication Schedule
Medication Class
Scheduled
Analgesics
Antibiotics
Anticonvulsants
Antihypertensive
Antihistamines
Asthma Med
Epinephrine
Insulin
Psychoptic
Other Pres/ OTC
Totals
0
95
0
442
91
493
0
2,071
2,525
1,699
7,416
6
PRN
297
0
0
0
9
700
0
80
26
90
1,202
Total
297
95
0
0
100
1,193
0
2,151
2,551
1,789
8,618
4. Health Screenings
Public schools in Massachusetts are required by MGL C71, s57 and MDPH regulations to conduct
postural, hearing, vision, and height/weight screening for students. The school nurses are responsible
for screening students and making referrals for an evaluation by the student’s primary care provider or
a specialist. The BMI referrals are mailed to the parents/guardians to ensure receipt.
Yearly Student Health Screenings and Referrals
August 31, 2013- June 26, 2014
Total Screenings
Number
Re-screen
Referrals
Type of Screening
Hearing
Vision
Height/ Weight
Postural
911
1225
710
983
29
105
221
27
28
100
221
27
* A completed referral is one in which an appointment for follow-up care has been made and the student was evaluated by provider or
specialist
Hearing screenings are conducted on K-3 annually and grades 7 and 9 annually.
Vision screenings are done on K-5 annually and grades 7 and 10 annually.
Height and Weight with BMI calculation is done in grades 1, 4, 7 and 10 annually.
Postural Screenings are conducted in grades 5, 6,7, 8 and 9.
5. Body Mass Index (BMI) Screenings
The Centers for Disease Control and Prevention recommends the use of Body Mass Index (BMI)
measurement to screen for obesity in children. BMI is a number calculated from height and weight, and
is considered a reliable indicator of body fat in most people. For children and teens, BMI is age and sex
specific. The measure is plotted on BMI growth charts to reveal the child's percentile ranking, which
indicates the relative position of the child's BMI among children of the same age and gender.
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BMI Report August 31, 2013 - June 26, 2014
Grade
Gender
<5th percentile
5th percentile
<85th
85th percentile
but <95th
>95th percentile
1
male
0
72
14
11
female
0
68
4
7
male
4
65
6
17
female
1
62
17
11
male
1
62
20
18
female
5
59
15
15
male
0
43
7
16
female
0
58
17
15
total
11
489
100
110
percentage
1%
69%
14%
16%
4
7
10
8
6. Medical Procedures/Nursing Interventions
The number of students in need of medical technology has increased in recent years in Auburn and
across the US. This presents multiple challenges for school administrators, parents/guardians, school
nurses, teachers, and students. Many students need a qualified school nurse to attend school.
Type of Procedures
9
Students
Staff
Auscultate Lungs
976
2
Blood Glucose Testing
5,513
0
Blood Pressure Monitoring
170
66
Carbohydrate/ Insulin Calculation
2,123
0
Catheter Care
0
0
Central Line Care
0
0
Check Ketones
457
0
Insulin Pump Care
285
0
IV Infusion Care
0
0
Nebulizer Treatment
108
0
Orthopedic/ prosthetic device
adjustment
66
0
Ostomy Care
0
0
Oxygen Adminisration
44
0
Oxygen Saturation Check
507
2
Physical Therapy
4
0
Suspected Head Injury
812
6
Suctioning
32
0
Tracheostomy Care
33
0
Naso Gastric Tube Care/ Feeding
Usage
960
0
Ear, Nose, Throat Assessment
1,588
4
Skin Assessment
2,501
7
Nutrition Assessment/ Treatment
497
0
Muscular Skeletal Assessment
815
17
Eye Assessment/Care
603
4
Inhaler Technique Teaching
402
0
7. Linkages to Health Care Providers
The school nurses identified students without a primary care provider and referred the
parents/guardians to appropriate health care services. A referral is reported whenever an actual
appointment has been set up with a provider or agency. The school nurses also referred many students
to their existing primary care providers for early intervention and care. During the 2012-2013 school
year:
Referrals to new primary care providers
Referrals to existing primary care providers
Dental care
Behavioral/mental health
Other
Health insurance
3
198
13
12
8
3
8. Oral Health
The APS nurses recognize that dental health is closely linked to overall health. Cavities are the single
most common infection in children. The APS nurses in the elementary grades provide a weekly
Fluoride Mouth Rinse program to our students. A large percentage of students participate in this
program to reduce cavities. The need is there because our water is from Worcester and the water is not
fluoridated.
Total numbers of students receiving Fluoride Mouth Rinse:
10
Bryn Mawr
Packachoag
Mary D Stone
Julia Bancroft
120
182
111
158
Health Education
Every student health encounter is an educational opportunity. The nurses provide health teaching in
their daily nursing care. In addition the school nurses are often called upon to provide health education
and deliver presentations. The nurses provide information to students, staff, and community members
on topics such as nutrition, life-threatening allergies, and human growth and development. The nurses
work cooperatively with the classroom teachers and specialists to improve student health literacy. The
types of presentations given most frequently were life-threatening allergies, sun safety and cough
etiquette/ hand washing.
Health education was also promoted through the development and distribution of newsletters and
mailings. Health information was also made available to parents via the APS website, and individual
school websites.
Nursing Case Management
The APS school nurses spent a significant portion of their day performing case management duties that
included communication with families, school staff, and community health care providers regarding
student health issues. During the school year, school nurses documented:
health counseling and education communications with parents, which included phone calls,
parent visits, and individual letters -13,390
● communications with other school staff about student health issues- 2,399
● communications with other agencies and health providers about student health issues- 844
● group meetings-91
●
Individual Health Plans
Students with special health care needs require nursing case management, which starts with the
development of Individual Health Plans (IHPs). The IHP is developed by the school nurse in
conjunction with the student’s family, school staff, and relevant community health care providers. The
IHP is an individualized plan that details a student’s specific medical, nursing, emergency care, and
health education needs while in school. IHPs are reviewed and updated on a regular basis to ensure that
students receive the appropriate health care in school. During the school year 2013-14 the nurses
developed or updated 167 care plans
9. Students with Special Health Care Needs
1. Types of Special Health Care Needs
School nurses provide care for students with a wide variety of special health care needs. The diagnosis
was based on information provided to the APS nurses by the student's primary care provider, who
conducts a physical examination and submits a School Health Record once every 3 to 4 years. This
information is supplemented by parent reports (on emergency cards and health information forms)
submitted annually. Conditions not requiring nursing care in school may be less likely to be reported to
school nurses.
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School Year 2013-2014
Physical/ Developmental Conditions
Allergies: Bee sting allergies
Allergies: Food
Allergies: Latex
Autoimmune Disorders
Blood Dyscrasias
Cancer
Cardiac Conditions
Celiac Disease
Cystic Fibrosis
Diabetes Type 1
Diabetes Type 11
Inflammatory Bowel Disease
Migraine Headaches
Neurologic Conditions: Cerebral Palsy
Neurologic Conditions: Spina Bifida
Neurologic Conditions: Seizure Disorder
Neurologic Conditions: Degenerative Disorder
Neurologic Condition: Other
*Other Physical/ Developmental conditions
9
52
7
3
2
0
18
4
3
7
7
6
44
7
1
14
1
7
43
Behavioral / Emotional Conditions
ADHD/ADD
Anxiety
Depression
Encopresis
PTSD/ Trauma History
Other behavioral conditions
67
11
8
4
5
18
Total Number of students with special health care needs
This accounts for 14 % of the student population.
Number of students with 504 plans on file
348
127
2. Cardiovascular Health and Automated Electronic Defibrillators (AED’s)
An automated external defibrillator (AED) is a portable device used to restore normal heart rhythm to
patients in cardiac arrest. If cardiac arrest is not treated within a few minutes, the condition is fatal.
The APS have an AED in every elementary school, middle school, and 3 at the Auburn High School.
The APS nurses check the AED’s monthly. The Auburn Fire Department’s EMS personnel also come
to each school to check the equipment. Maintenance and checks are essential to a successful AED
program. CPR/AED training is offered routinely to District staff members.
3. Medical Emergency Response Plans (MERP)
The MA legislature passed An Act Relative to Medical Emergency Response in Schools, Acts of 2012
Chapter 77. The law was passed in response to a tragic death in Sutton MA of a 16 year old student,
Michael Ellsessar, while playing football in 2010. The law requires schools to do a number of things to
improve safety and preparedness in the event of a medical emergency.
4. Concussion Data from High School and Middle School
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2013-2014
Auburn Middle School
Grades 6,7,8
19 = Total number of reported head injury forms received
of which 5 are middle school sports team related
Auburn High School
Grades 9,10,11, and 12
44 = Total number of reported head injury forms received
of which 20 are high school sports team related
5. Per Diem/Substitute School Nurses
It has become increasingly challenging to recruit, train and retain per diem, or substitute, school nurses.
We have created a Nurse Binder to increase consistency and to provide information for the substitutes
and have started to train our nursing substitutes in our nursing software, SNAP.
Program Development
The APS nurses participated in program planning and development activities in coordination with other
District professionals, in areas such as environmental health, policy development, crisis management,
and emergency preparedness. In addition, nurses attended conferences and meetings that contributed to
their professional development and that assist in obtaining and maintaining nursing licenses, DESE
certification and National School Nurse (NCSN) certification status.
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Some Health promotion and services for students, faculty and community that
School Nurses were involved in during 2013-2014 school year.
*Attended Kindergarten orientation in August and conducted parent meetings about students needs and
registration requirements
* Assisted with Kindergarten registration meetings in the Spring- daytime and evening sessions
*Conducted Blood Pressure clinics for staff
*Coordinated Sun Safety program on Spree Day- presented awards for sun safety
*Coordinated donation/gifts for needy families for holidays
*Attended Literacy Night and provided health promotion materials to parents and students
* Organized a Walking club before school
* Taught Healthy Snack Program which incorporates nutrition and fitness
* Taught Hand washing and cough etiquette lessons to prevent the spread of illness
*Taught lessons on the new nutrition guidelines with My Plate to students
* Involved in teaching Puberty Education classes
* Taught Personal Hygiene classes
*Taught Sun Safety and general Safety Lessons
*Supported health needs during the Relay For Life event held at AHS
*Nurses are involved in some School wide meetings and functions such as Safety Team meetings, EST
meetings, Welcome Back events, Curriculum Nights, and chaperoning school dances
Essential School Health Services Grant:One of the goals of the Regional system is to support and
increase networking opportunities for the school nurse leaders in their regional areas. Auburn is part to
of the Central Massachusetts region. Expansion of the consultant role to full time includes outreach to
unfunded schools as well as charter, collaborative and vocational-technical schools in the region. At the
Regional meetings there has been a continued focus on various aspects of the educator evaluation
process. The meetings have also provided collaboration topics as the expanding role of 1:1 nurses in the
school setting and Best Practice initiatives.
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APPENDIX A
Scope of Service
Essential School Health Services Grant Program
COMPONENTS
Each program must meet or continue to meet the following seven components as described
below:
1.
School health service program infra-structure
2.
Collaboration with the comprehensive, coordinated health education program,
tobacco control program, etc.
3.
Plan for linkage of students with primary care providers, dental providers,
behavioral/mental health programs (as needed), community prevention
programs, and health care insurance.
4.
Development of a management information system.
5.
Implementation of performance improvement (continuous quality
improvement) and evaluation programs.
6.
Services to private schools located in the applicant’s community
7.
Collaboration/consultation/networking among school nurses.
For a more complete description of each of these components, we can provide a copy of the ESHS
Grant and the Scope of Services.
15