Helping Belton ISD Students Stay Safe & Healthy

Helping Belton ISD Students Stay Safe & Healthy
What Every BISD Staff Needs to Know About: Medical Emergency Response Plan (MERP) Emergency Plan for: Asthma Bleeding Disorder Cardiac Condition Diabetes Seizures Severe Allergies, Food Allergies SEVERE LOW BLOOD GLUCOSE The ultimate goal of this training is help all Belton ISD students succeed, and we believe this can happen if our staff work as a team to keep health and safety as top priorities. This training assumes some have had the basic knowledge and skills obtained through a course like the AHA first aid and CPR training. Here we will give you specific district guidelines and procedures on: responding to medical emergencies, which also include becoming familiar with standard emergency plan protocol for chronic health conditions like: asthma, bleeding disorders, cardiac conditions, including cardiac arrest, diabetes, seizures, or a severe allergy like a life-threatening food allergy. Safe & Healthy Belton ISD Health Services

Helping Belton ISD Students Stay Safe & Healthy
What Every BISD Staff Needs to Know About: Medication Administration on Field/Athletic Trips Oral Meds Epipens Inhalers Bloodborne Pathogens Responding to these emergencies may include administering medications, so we will review not only how to give those emergency meds, but also how to administer medications to students while away on school events. Finally, we will review blood borne pathogen procedures so that you can stay safe while you are providing care to students. Some of you may work with older students that require only assistance with their health needs, but others may work with younger students where you have to do everything. All staff should collaborate with parents and school nurses to develop plans that are comprehensive and clear. We’ve ask that you attend this training rather than doing it online to not only have a nurse available for your questions, but to also facilitate documentation. Your initials on the sign-in sheet will ensure we credit you for this course on Eduphoria. We will provide this training on-line for those that were not able to attend. This training will also be given at each campus during staff development week in August. Keep in mind that this training provides knowledge, but does not test skills. If you need training for being a Diabetes Care Assistant or for administering medications, additional training is required to provide not only the knowledge you need but you also will need to demonstrate certain skills required for that assignment. School nurses will provide this training as the needs arise with our students. Safe & Healthy Belton ISD Health Services

Our goal when responding to medical emergencies is to get specially trained emergency help quick. First of all, before you help, make sure the scene is safe- you can’t help if you get hurt. Belton ISD’s Medical Emergency response plan states that you are to call 911 if you witness any of these medical emergencies: unconsciousness, breathing emergency like foreign object in the throat or severe shortness of breath, adult chest pain that radiates to the jaw or down one arm or cardiac arrest. Probably best to wait for more trained staff for students with chest pain unless student is exhibiting signs of severe difficulty breathing and is pale. Any severe bleeding that cannot be stopped , such as when a limb is amputated. Severe neck, back or neck injuries, diabetic or anaphylactic emergencies or 1st time seizures or seizures lasting more than 5 minutes. When in doubt, call. After you call 911- we ask that you call out or have someone else go get the nearest CPR trained staff. They will be designated on each campus map with a red cross. Also have someone go get the AED. They are designated on the map by the AED sign.. Next we ask that the school nurse and buddy nurse are called. The buddy nurse may not respond on site, but is helpful for her to be aware to be prepared in case more help is needed until EMS arrives. Call the principal and the health services coordinator to receive assistance with administrative aspects of an emergency, which include communicating with parents and documenting the incident. You are reminded to always stay with the student and to not attempt to move or transport them. Safe & Healthy

We need your help to develop our MERP maps by having you place your name on the map if you are currently certified in CPR/AEDs Safe & Healthy

 One way you can know if your students have a health condition requiring an emergency plan is to check on Skyward. The information may be located on any student profile page by clicking on the red H to the right of the page. Safe & Healthy

 You may also see health alerts on the student’s emergency info page.If you are aware a student has a life-threatening condition and the information is not in Skyward, please communicate with their school nurse. This includes if you have students carrying inhalers or EPIPENs. Safe & Healthy

Emergency Plans All standard emergency plans not only have how to identify and respond in that type of emergency, but they should also include the student’s emergency contact information, names of trained caregivers , including the student’s nurse, and any additional instructions by the student’s physician, such as medications to give and when to call 911. To view these emergency plans go the BISD Health Services Website and click on the link STAFF TRAINING>

Asthma Emergency Plan Safe & Healthy
Standard emergency plan protocol for students with asthma looks like this: If an asthma emergency occurs and you don’t have a plan at least follow the in the grey area. Part of your training today will include how to administer an inhaler. Safe & Healthy

Bleeding Disorder Emergency Plan
Here is a standard emergency plan protocol for students with bleeding disorder and actions to take for minor or severe symptoms. Remember that if the school receives orders from the doctor additional instructions may be added to the plan. Safe & Healthy

Cardiac Condition Emergency Plan
Here is the standard emergency plan protocol for students with cardiac conditions. Sudden cardiac arrest requires quick response- we must initiate compressions and get the AED. Safe & Healthy

Diabetes Emergency Plan
Here is the standard emergency plan protocol for students with diabetes. Staff trained to be diabetic care assistants (UDCAS) will have a copy of the student’s emergency plan with more detailed instructions. UDCA training involves general knowledge and skills for caring for diabetic students as well as individual training on the student’s specific emergency plan. What you see is a Level II emergency plan, while an UDCA will have a Level III. Safe & Healthy

Seizure Emergency Plan
Here is a standard emergency plan protocol for students with seizures. If there are emergency medications as part of this plan, you will be given additional training. Safe & Healthy

Recent law now requires annual training for all Texas districts on life-threatening food allergies for the purpose of providing all school staff basic knowledge and skills to identify children with a possible allergic reaction to food, to begin implementation of the student’s emergency plan and to also implement strategies to reduce the risks for food allergy reactions. One out of every 25 Americans has a food allergy and it is estimated that between people die annually from food allergy reactions or anaphylaxis. Though there are other allergens like bee stings, eight foods account for 90% of all allergic reactions- they are peanuts, tree nuts, milk, eggs, wheat, fish and shellfish, and soy. Food Allergy

A severe allergic reaction, or anaphjylaxis, is rapid in onset and may cause death You may see swelling, hives, itchy red rash, trouble swallowing, shortness of breath, repeitive coughin, voice change, nausea & vomiting, diarrhea, abdominal cramping, and in severe cases, a drop of blood pressure and loss of consciousness. Asthmatic children more likely to experience an anaphylactic reaction to foods and be higher at risk for death Food Allergy

Severe Allergy Emergency Plan
Standard emergency plan protocol for students with severe allergies lists what typical minor and major symptoms would be. If the parents have not provided emergency medication for a severe allergic reaction, all we can do is call 911- and keep the student still and calm. Most physicians will prescribe oral medication like Benadryl for minor symptoms and an EPIPEN for a severe reaction, but take time to review the student’s emergency plan, because it may call for an EPIPEN even if the student accidently ingests the food allergen, even if there are no symptoms. Part of our training on medication administration will include instructions on how to administer an EPIPEN. Safe & Healthy

Teacher/Coach Responsibilities
Review the Emergency Plan for Severe Allergy plan with the school nurse, if available, and with the student and his/her parent/guardian. It may be helpful to review the following questions with the parent: Can your child sit next to someone that is eating the allergen? Can your child touch the allergen? Would you like to provide a non-perishable safe lunch in case your child forgets lunch one day or cannot eat what is provided in the cafeteria that day? Do you want to be notified every time we have food in the classroom? Teacher and coach should: Review the Emergency Plan for Severe Allergy plan with the school nurse, if available, and with the student and his/her parent/guardian. It may be helpful to review the following questions with the parent: Can your child sit next to someone that is eating the allergen? Can your child touch the allergen? Would you like to provide a non-perishable safe lunch in case your child forgets lunch one day or cannot eat what is provided in the cafeteria that day? Do you want to be notified every time we have food in the classroom? Food Allergy

Teacher/Coach Responsibilities
Develop emergency communication plan with the campus office and/or school nurse Ensure that an adult accompanies a student suspected of having an allergic reaction or ask the nurse to come to the student Keep the student’s plan accessible in the classroom and available for a substitute Notify the school nurse at least 48 hours before a field trip so that emergency plan and EPIPEN administration procedures can be reviewed with one to two staff going on the field trip. Educate classmates to avoid endangering, isolating, stigmatizing or harassing students with food allergies Ensure other staff, students and their parents comply with any risk-reduction strategies. Develop emergency communication plan with the campus office and/or school nurse Ensure that an adult accompanies a student suspected of having an allergic reaction or ask the nurse to come to the student Keep the student’s plan accessible in the classroom and available for a substitute Notify the school nurse at least 48 hours before a field trip so that emergency plan and EPIPEN administration procedures can be reviewed with one to two staff going on the field trip. Educate classmates to avoid endangering, isolating, stigmatizing or harassing students with food allergies Ensure other staff, students and their parents comply with any risk-reduction strategies Food Allergy

Risk Reduction Strategies
No food sharing No utensil sharing Avoid serving food without appropriate ingredient labels Hand washing before and after eating snacks/meals. Soap and water are best. Avoid cross-contamination of food by wiping down eating surfaces before and after eating. Designate allergen safe zones, such as designated tables/seating areas Consider eliminating or limiting foods in the classroom, buses, after-school activities which may cause a life-threatening reaction to a student in a class Avoid or use caution when using food for classroom activities, such as for crafts, science projects, holiday celebrations, etc. Use non-food items as rewards instead of food Avoid high-risk areas for field trips, i.e. corn fields, exposure to latex balloons or seafood, etc. Risk reduction strategies include: No food sharing No utensil sharing Avoid serving food without appropriate ingredient labels Hand washing before and after eating snacks/meals. Soap and water are best. Avoid cross-contamination of food by wiping down eating surfaces before and after eating. Designate allergen safe zones, such as designated tables/seating areas Consider eliminating or limiting foods in the classroom, buses, after-school activities which may cause a life-threatening reaction to a student in a class Avoid or use caution when using food for classroom activities, such as for crafts, science projects, holiday celebrations, etc. Use non-food items as rewards instead of food Avoid high-risk areas for field trips, i.e. corn fields, exposure to latex balloons or seafood, etc. Food Allergy

Medications/Procedures/Supplies
Field Trips Medications/Procedures/Supplies Emergency Care Plans Oral medications Epipens Inhalers Diabetic supplies Other equipment Other emergency meds Basic 1st Aid supplies Asthma Bleeding Disorder Cardiac Condition Diabetes Seizures Severe Allergies Other special conditions or procedures Make sure you are prepared before you go on field trips. As soon as field trips are approved, inform the school nurse of date, times, place, and students going.48 hours before, meet with school nurse and receive instructions on any student’s emergency plan and /or medications and practice the skills. Many meds do not need to be given on field trips, but some do. Board Policy FFAC outlines guidelines & procedures, but always remember to never provide medication to a student unless you have proper written authorization and the medication is in a properly labeled container. The day of the field trip go by and pick up a 1st Aid kit form the nurse and the medications. Each medication will be accompanied by written instructions and a space to document the time the med was given, if needed. Diabetics will be accompanied by an unlicensed diabetic care assistant (UDCA), but the school nurse needs to know in advance so instructions can be given to the assigned UDCA. Medication Administration on Field Trips

General Procedures for all Medications
Gather necessary supplies Wash hands and place gloves Prepare the correct dosage without touching the med if possible. If possible, the nurse will only send dosage needed for field trip While preparing the medication, do not leave the med unattended or within reach of the student Identify the student. Ask the student his/her name Gather necessary supplies Wash hands and place gloves Prepare the correct dosage without touching the med if possible While preparing the medication, do not leave the med unattended or within reach of the student Identify the student. Ask the student his/her name Medication Administration on Field Trips

General Procedures for all Medications
Explain the procedure to the student. If the student questions the right medication, stop and verify the medication against records or call nurse You may want to ask the student: What is the name of your med? What color is your med? How much do you take? Provide confidentiality and privacy for the student as much as possible Position the student properly for the medication administration according to the correct route Explain the procedure to the student. If the student questions the right medication, stop and verify the medication against records or call nurse You may want to ask the student: What is the name of your med? What color is your med? How much do you take? Provide confidentiality and privacy for the student as much as possible Position the student properly for the medication administration according to the correct route Medication Administration on Field Trips

After giving medication:
Document as soon as possible on the appropriate form Store medication in a secure place. Most medication needs to be stored in a cool, dry place. Some medication needs refrigeration Clean, return, and/or dispose of equipment as necessary Wash hands Report all medication incidents or errors to the nurse and principal After giving medication: Document as soon as possible on the appropriate form Store medication in a secure place. Most medication needs to be stored in a cool, dry place. Some medication needs refrigeration Clean, return, and/or dispose of equipment as necessary Wash hands Report all medication incidents or errors to the nurse and principal Medication Administration on Field Trips

Medication Administration on Field Trips
Oral Medication Pour prescribed dose into medication cup without touching the pill/tablet/capsule If liquid, shake according to label instructions and use standard measuring device Pour at eye level from side of bottle opposite the label, measuring dosage at the correct line Give with a full glass of water unless otherwise indicated Pour prescribed dose into medication cup without touching the pill/tablet/capsule If liquid, shake according to label instructions and use standard measuring device Pour at eye level from side of bottle opposite the label, measuring dosage at the correct line Give with a full glass of water unless otherwise indicated Medication Administration on Field Trips

What to do if… Student refuses: document and report to nurse, parent, and/or principal Student vomits after medication administration: Record time and whether medication was in vomit. Report to nurse, parent, and/or principal Student can’t swallow: sit in upright position, give one med at a time, give adequate water, place medication on back of tongue, give med slowly. Watch for choking. Give with other food or crushed if directed by physician or pharmacist What to do if: Student refuses: document and report to nurse, parent, and/or principal Student vomits after medication administration: Record time and whether medication was in vomit. Report to nurse, parent, and/or principal Student can’t swallow: sit in upright position, give one med at a time, give adequate water, place medication on back of tongue, give med slowly. Watch for choking. Give with other food or crushed if directed by physician or pharmacist Medication Administration on Field Trips

Asthma Inhaler Administration
Gather supplies Wash hands and place gloves Shake inhaler up and down to prime inhaler Remove mouthpiece cover Have student breathe out and release air from lungs Hold inhaler straight up, place mouthpiece (or spacer mouthpiece) in mouth, close lips tightly around it As inhaling, press down on top of inhaler and release a dose of medication into lungs Hold breath for 10 seconds Wait one minute then repeat Clean mouthpiece before replacing cover If you need to assist a student with an asthma inhaler, follow these steps: Gather supplies Wash hands and place gloves Shake inhaler up and down to prime inhaler Remove mouthpiece cover Have student breathe out and release air from lungs Hold inhaler straight up, place mouthpiece (or spacer mouthpiece) in mouth, close lips tightly around it As inhaling, press down on top of inhaler and release a dose of medication into lungs Hold breath for 10 seconds Wait one minute then repeat Clean mouthpiece before replacing cover Students that are allowed to carry and self-administer their inhaler have the proper authoirzation by the physician and parent and should carry a student permission pass from the nurse. Medication Administration on Field Trips

Epipen Injection Hold the Epipen firmly with the tip pointing downward Hold cylinder in your fist with your thumb toward the tip of the tip. Do not touch the tip Remove the gray safety cap Place the tip on the outside are of the thigh at a right angle to the leg ( It can be injected through clothing) To administer an Epipen: Hold the Epipen firmly with the tip pointing downward Hold cylinder in your fist with your thumb toward the tip of the tip. Do not touch the tip Remove the gray safety cap Place the tip on the outside are of the thigh at a right angle to the leg ( It can be injected through clothing) Medication Administration on Field Trips

Epipen Injection Raise your hand way from the child’s leg, and with a quick motion, bring it firmly to the child’s outer thigh. By pressing the pen firmly against the thigh, a spring-activated mechanism will cause a needle to inject the epinephrine. Keep the device firmly in this position for 10 seconds Remove the Epipen and massage the area for 10 seconds. Check the tip to see if the needle is showing, if it is not, you must follow the above step again Raise your hand way from the child’s leg, and with a quick motion, bring it firmly to the child’s outer thigh. By pressing the pen firmly against the thigh, a spring-activated mechanism will cause a needle to inject the epinephrine. Keep the device firmly in this position for 10 seconds Remove the Epipen and massage the area for 10 seconds. Check the tip to see if the needle is showing, if it is not, you must follow the above step again Medication Administration On Field Trips

What Every BISD Staff Needs to Know About:
Helping Belton ISD Students & Staff Stay Safe & Healthy What Every BISD Staff Needs to Know About: Blood borne Pathogens Board policy states we are to annually inform you of the district’s bloodborne pathogen exposure plan- so here goes…. Belton ISD Health Services BBP

BBP: INFORMATION ACCESS
Annual Training Web Access: Staff Training Tab of School Health Service Page Written Access: BBP Exposure Control the school health office of each campus or department in the district You can access information about blood borne pathogens and the district’s BBP exposure plan on the district website as well as in writing in the Health Services Office. Belton ISD BBP Exposure Control Plan BBP

Why do I need this training?
Your job duties may put you at risk of exposure to blood or other potentially infectious material (OPIM) Breaking up fights Assisting with nose bleeds, cuts Assisting diabetic student Working with combative students including those who bite and break the skin Providing swallowing therapy You need this training because Your job duties may put you at risk of exposure to blood or other potentially infectious material (OPIM) because your job duties may put you at risk of exposure to blood or other potentially infectious material. Some of you routinely Break up fights Assist with nose bleeds, cuts Assist diabetic student Work with combative students including those who bite and break the skin or you may Provide swallowing therapy BBP

What are Bloodborne Pathogens?
Viruses, bacteria, and other microorganisms that are carried in the bloodstream and can cause serious diseases The most common BBP are: Human Immunodeficiency Virus (HIV) Hepatitis B Virus (HBV) Hepatitis C Virus (HCV) Bloodborne pathogens are Viruses, bacteria, and other microorganisms that are carried in the bloodstream and can cause serious diseases . The most common BBP are: Human Immunodeficiency Virus (HIV) Hepatitis B Virus (HBV) Hepatitis C Virus (HCV) BBP

HIV Hepatitis C Hepatitis B
cirrhosis AIDS HIV Hepatitis C Hepatitis B Liver failure These disease can lead to problems like cirrhosis, liver cancer, liver failure, aids and death. Many Symptoms appear months after exposure and HEP B can survive outside of the body for up to a week death Liver cancer BBP

How do BBPs enter your body?
Direct contact with blood or OPIM of an infected person through: Open cuts, wounds, skin abrasions Blood splashing into your eyes, nose, or mouth BLOOD + ENTER BODY These bloodborne pathogens enter your body anytime you have direct contact with blood or other potentially infectious material of an infected person through open cuts, wounds, skin abrasions, or by blood splashing into your eyes, nose, or mouth BBP

Belton ISD provides the HBV Vaccine to:
Staff working in special-ed self-contained classrooms Staff working in the school health clinics Staff whose school duties placed them at risk to frrquently come in contact with blood or other potentially infectious material Free of charge Series of three shots Notify the BeltonISD School Health Coordinator immediately if you have not received the vaccine There is vaccination available only for Hepatitis B. It is , very effective, and recommended for all babies, sexually active adolescents, those who inject drugs, people exposed to blood at work, and people engaging in tattoing or body piercing. The district will provide this vaccine to staff that are at risk due to their school duties. The hepatitis B vaccine is free of charge and a series of 3 shots. Notify the BISD Health Services Coordinator by if you have not received the vaccine or write your name on the sign-in sheet today.

Best Work Practices Universal Precautions: All human blood may be infectious. Universally treat everyone the same. Wear gloves when coming in contact with the blood of anyone and other personal protective equipment when applilcable Wash Hands: Soap & water Use Sharps Containers- available in all health clinics Clean up blood & body fluid: ask for the right help! Report any exposure incidents Use Universal Precautions. Act like all human blood may be infectious and universally treat everyone the same. Wear gloves when coming in contact with the blood of anyone. Wear personal protective equipment like goggles and smocks when appropriate Wash hands with soap and water before eating, after any contact with blood, body fluids, or soiled objects, After using the toilet, after assisting with personal hygiene, after the removal of gloves Use sharps containers if you are diabetic and will be checking you blood sugar or give yourself injections at school and make sure students are using them as well. They are located in the health clinics, and we can make sure they are also available in staff lounges if needed. Clean up blood & body fluids, but that usually means finding the right person with the rights skills, training, & cleaners. Waste such as bloody tissues should be disposed of in a plastic-lined trash can and is not considered hazardous material. It can be thrown in the school dumpster after being double-bagged. Report any exposure incident- that is when Blood or OPIM gets in through non-intact skin or mucous membranes Wash the exposed area with soap and water, or irrigate the eyes with water or saline Report the incident to the school health coordinator for investigation and proper referral The district will provide for additional medical evaluation and treatment if needed

Questions or Comments? References & Resources
Emergency: American Academy of Pediatrics (AAP). (2008) Disaster planning for schools. Pediatrics, 122 (4) pp. 895‐ 901. doi: /peds.2008‐2170 Cole, V., Henry, B., Tyson, D., Fitzgerald, R., Hopkins, R. (2007). In the face of danger: Comprehensive emergency preparedness and response for schools. Penn GSE Perspectives on Urban Education, Retrieved from 2_In%20the%20Face%20of%20Danger.html Doyle, J., & Loyacono, T. (2007). Disaster preparedness guidelines for school nurses. Silver Spring, MD: National Association of School Nurses. Fitzpatrick, B. (2006). Emergency management, crisis response and the school nurse’s role. In J. Selekman (Ed.) School nursing: A comprehensive text. (pp. 205‐ 233). Philadelphia: F.A. Davis Company. Diabetes Care, 34(Supp 1), S70‐S74. American Association of Diabetes Educators (AADE). (2008). Position statement: Management of children with diabetes in the school setting. The Diabetes Educator, 34(3), 439‐443. American Nurses Association /National Association of School Nurses (ANA/ NASN). (2011). Scope and standards of practice: School nursing, 2nd ed. Silver Spring, MD: Nursebooks.org. Food Allergy American Academy of Allergy, Asthma and Immunology Board of Directors (1998). Position Statement-Anaphylaxis in schools and other child-care settings. Journal of Allergy Clinical Immunology: 102(2), Food Allergy Network (2001). Information about anaphylaxis: Commonly asked questions about anaphylaxis. Mudd, K. E. & Noone, S. A., (1995). Management of severe food allergy in the school setting. Journal of School Nursing: 11(3), 30-32 National Association of School Nurses (2000). Position Statement-Epinephrine use in life-threatening emergencies. Scarborough, ME: Author. You may review this training sections on the Health Services BISD district website – Please refer any questions to your school nurse.

Questions or Comments? References & Resources
Medication Belton Independent School District Board Policy (2012). FFAC Legal and Local: Wellness and Health Services: Medical Treatment: Administering Medication. Retrieved June 22, 2012 from Belton Independent School District Board Policy (2012). FFAF Legal: Wellness and Health Services: Individualized Health Plan. Retrieved June 22, 2012 from Texas Department of State Health Services (2011). Texas School Health Guidelines: School health Manual: Chapter 5, 208. Retrieved June 22, 2012 from American Academy of Pediatrics. (2009). Policy statement guidance for the administration of medication in school. Pediatrics 124, 1244‐1251. American Nurses Association / National Council of State Boards of Nursing (ANA/NCSBN). (2006). Joint statement on delegation. Retrieved from American Nurses Association (ANA). (2005). Principles of delegation. Silver Springs, MD: Author. Canham, D.L., Bauer, L., Concepcion, M., Luong, J., Peters, J., & Wilde, C. (2007). An audit of medication administration: A glimpse into school health offices. Journal of School Nursing, 23, 21‐27. doi: / Clay, D., Farris, K., McCarthy, A.M., Kelly, M.W., Howard, R. (2008). Family perceptions of medication administration at school: errors, risk factors and consequences. Journal of School Nursing, 24, 95‐102. doi: / Gursky, B. S., & Ryser, B. J., (2007). A training program for unlicensed assistive personnel. Journal of School Nursing, 23, 92‐97. doi: / BBP Contact info: Belton ISD Health Services

Helping Belton ISD Students Stay Safe & Healthy

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