Nurse Education Webinar Series Susan Hoffmann MSN, RN, NCSN March 20, 2019

Care Coordination Planning and Implementation Part 2: Emergency Care Plans and 504’s

Participants will be able to articulate the role and responsibilities of the school nurse in the 504 process. Participants will be able to develop emergency care plans for students with selected chronic health conditions including asthma, diabetes, seizures and life threatening food allergies. Objectives:

Definition of Care Coordination Care coordination: generic term for the integration of health and social care services for a particular person. Components of care coordination include working with an individual and his/her caregiver(s) to ensure that a high-level, integrated and personalized care plan is implemented.

Standard 5 A Coordination of Care Organizes Collaborates with students Student Self-care Identify alternative options for care Communication Advocates Documents the coordination of care Educates colleagues Incorporates the Individualized Healthcare Plan Coordinates creation and implementation of the Individualized Healthcare Plan Provides leadership American Nurses Association and National Association of School Nurses. (2017). School nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Authors

21st Century Framework: Care Coordination A student-centered process led by the school nurse based on: Standards of School Nursing. Collaboration with the student, their family, and members of the interdisciplinary team. Health and academic goals of the student. (ANA, NASN, 2011; NASN, 2013).

Polling Question #1 True or False A student with a disability who is meeting academic benchmarks would not be eligible for accommodations in schools.

25 % of all students have chronic health condition FEDERAL LAWS IDEA ensures a free, appropriate public education (FAPE) in the least restrictive environment (LRE) Section 504 (Rehabilitation Act of 1973) Prohibits discrimination on the basis of a handicap (civil rights legislation). Deals with providing reasonable accommodations for students with disabilities. The school nurse is responsible for developing a plan to meet the in school medical needs of students so that they can be healthy, safe and ready to learn Planning care is a Standard of School Nursing Practice

CARE COORDINATION – PLANNING Primary goal of care coordination for the individual student is for the student to self-manage their illness or disability at the highest possible level based on their developmental stage and ability.

Individual Education Plan (IEP) Student Eligibility Requires specialized instruction SN team member to include health services in the IEP Plan Characteristics Includes specialized instruction, services, accommodations, supplementary aids, and modifications required for a student with a qualifying disability to ensure access and benefit from their individualized education program. Allocates both direct and indirect health services as “Related Services.” The IHP and EAP, when required, referenced as “on file in the health office.” Plan Purpose Ensures access and provides a program for educational benefit. Demonstrates compliance with education law (IDEA).

INDIVIDUAL HEALTHCARE Action Plan (IHAP) Student Eligibility: Special health care needs Purpose: Provides for effective and efficient delivery of services Promotes school success Reduces the liability of the school district. Process: All students requiring technical skills and services to meet their healthcare needs are seen by the school RN for assessment, planning and monitoring. Developed by the nurse for use by school personnel dealing with students requiring specialized nursing care INDIVIDUAL HEALTHCARE Action Plan (IHAP)

Individual Healthcare Plan (IHP) Guides Nursing Care Student Eligibility School nurse creates an IHP when a student has chronic or significant health needs that require ongoing direct or indirect care from the school nurse. Characteristics Created from assessment data and identifies nursing diagnoses, nursing interventions, and expected student outcomes. Stored as an electronic or hard copy file in the student’s health record. IHP information used to inform the 504 or IEP team regarding student health needs. Purpose Documents the nursing process and outlines health services provided at school. Demonstrates compliance with the state nurse practice act and the Standards of School Nursing practice. Individual Healthcare Plan (IHP) Guides Nursing Care

504 plans Prevent discrimination on the basis of a handicap Ensures reasonable accommodations

Student has a mental or physical impairment that adversely impacts a major life activity. Eligibility determined by 504 team 504 Plan Eligibility

Includes health accommodations, aids, and services to provide access to education The IHP and EAP, when required, should be referenced as “on file in the health office.” 504 Plan Characteristics

Provides access to education for students with disabilities. Demonstrates compliance with federal civil rights laws (Section 504) and ADA. 504 Plan purpose

Role of the School Nurse - advocate Identify students whose health needs may qualify for 504 or IEP Notify 504/Special Education Coordinator

Role of the school nurse – 504 Team Member Participate in eligibility determination Three essential elements: Physical or mental impairment that limits One or more major life activity To a substantial extent Educate team regarding medical needs Contribute to plan development

504 Eligibility Does NOT require adverse education impact that necessitates special education

All school staff who interact regularly with the student know how to recognize hypo and hyperglycemia and respond appropriately. Staff members trained to check blood glucose levels and administer insulin and glucagon. Capable students are allowed to self-manage Needed assistance is provided in the classroom to increase safety and decrease missed class time. Full participation in all sports, extracurricular activities, and field trips, with the necessary diabetes care assistance and/or supervision provided. Permission to eat whenever and wherever necessary, including eating lunch at an appropriate time with enough time to finish eating. Permission to take extra trips to the bathroom or water fountain. Permission for extra absences for medical appointments and sick days without penalty. Alternate arrangements for classroom time missed for medical appointments, because of periods of high or low blood glucose, or illness related to diabetes. TID Sample 504 Provisions

Sample 504 plan for Type 1 Diabetes http://main.diabetes.org/dorg/PDFs/Advocacy/Safe_at_School/504- plan.docx

Sample 504 plan for asthma http://cac.websitetesturl.com/wp-content/uploads/2014/12/504-Parent- Updated-4.pdf

Sample 504 plan for Allergies https://onespotallergy.com/wp-content/uploads/2012/09/504- Service-Agreement-Public-Copy.pdf

Sample 504 plan for Seizures http://www.epilepsynorcal.org/wp- content/uploads/2015/07/Sample_504.pdf

Emergency action Plans (Emergency Care Plans)

Emergency Action Plan (EAP/ECP) Eligibility Potential for specific actions by school staff to intervene for a student in the event of healthcare emergency or situation.

Emergency Action Plan (EAP/ECP) characteristics School nurse uses IHP information and medical orders to determine the treatment protocol for school staff to follow. Distributed to school staff who are responsible for the student. Emergency Action Plan (EAP/ECP) characteristics

Emergency Action Plan (EAP/ECP) purpose Provides other school staff with criteria to identify emergencies and directions to assist the student. Demonstrates compliance with standards of school nursing practice. Used by school staff when responding to a health emergency Emergency Action Plan (EAP/ECP) purpose

ASTHMA Emergency Plans https://www.lung.org/assets/documents/asthma/asthma-action-plan-for-home.pdf

Diabetes Emergency Plans https://www.niddk.nih.gov/-/media/Files/Health-Information/Communication- Programs/NDEP/health-care- professionals/Hypoglycemia_Emergency_Care_Plan_Word_Version_FOR_POSTING_5-10- 17.docx?la=en

Seizure Emergency action Plans https://www.epilepsy.com/sites/core/files/atoms/files/seizure-action- plan-pdf_0.pdf

Anaphylaxis Emergency Plans https://www.aap.org/en- us/Documents/AAP_Allergy_and_Anaphylaxis_Emergency_Plan.pdf

Case scenario Discussion A student was unresponsive on a band trip over the weekend. The band director called 911 and the student was taken by ambulance. This is not the first time this has occurred with this student. This has been ongoing since 5th grade. The student had complained of chest pain. She told me that she was diagnosed with muscle spasms in the ER. She is scheduled to go on an overnight trip in April. Can the school legally require a doctor's release and guidelines for medical care for this student before she may travel on overnight trips? Mom does not always have a phone and is very difficult to reach. There is concern that there is an aspect of attention seeking with this particular student. Also, if the student is taken by ambulance, is the school legally obligated to have someone accompany the student? What plans would you develop?

references Alfona, A., Forbes, M. and Fisher, L. (2017) Education Law for Children with Disabilities: The Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act of 1973 (Section 504) In Resha, C. and Taliaferro, V. (Eds), Legal Resource for School Health Services, (pp. 141-151), Nashville, TN: School Nurse.com. Sampson, C.H., Will, S. I. (2017). IHP Basics and Using IHPs with Other Educational, Health and Home Care Agency Plans. In S. I. Will, M. W. Arnold, & D. S. Zaiger (Eds.), Individualized healthcare plans for the school nurse (pp. 9–10). Forest Lake, MN: Sunrise River Press. Zirkel, P. (2017) The School Nurse’s Role in the Identification Process for a 504 Plan. In Resha, C. and Taliaferro, V. (Eds), Legal Resource for School Health Services, (pp. 152-153), Nashville, TN: School Nurse.com.

Questions? suehoffm@gmail.com