1. ALABAMA STATE DEPARTMENT OF EDUCATION ALABAMA SCHOOL HEALTH SERVICES RESOURCE/GUIDELINES MANUAL 1 Taskforce One Year Later

2. RESOURCE GUIDELINES TASK FORCE  Caitlin Cauthen  Charlene Young  Diana Collins  Jan Peterson  Janis C. Ward  Lesa Cotton  Margaret Guthrie  Sharon Dickerson  Sherry McWhorter  Theresa Thompson 2

3. SUBCOMMITTEE TASK FORCE  Barbara Robertson  Brenda Caudle  Diana Collins  Janis C. Ward  Lesa Cotton  Margaret Guthrie  Sherry McWhorter  Wanda Hannon 3

4. 4 The State Board of Education members and the State Department of Education appreciate the time and effort expended by our committee members. We also appreciate the local superintendents who allowed these members time to participate in this project. COMMITTEE MEMBERS AND LOCAL EDUCATION AGENCIES

5. RESOURCE GUIDELINES  The material presented may be the first step in the development of local guidelines and procedures.  It is not intended as a substitute for local board policies and procedures, nor advice of counsel. 5

6. RESOURCE MANUAL  This manual is designed to serve as a guide  To ensure its usefulness, we solicited the assistance of selected school nurses from the local board of education level and our own department 6

7. WORD DOCUMENTS  This manual represents the committee’s attempt and recommendation to organize information from various sources Resource Guide : Index Tool to facilitate structure 7

8. TABLE OF CONTENTS Section 1 1. Alabama State Department of Education 2. Alabama Board of Nursing 3. Alabama Course of Study 4. Laws and References Act No 2014-405 HB0156 Enacted Anaphylaxis Preparedness Act No 2014-274 SB0075 Enacted Meningococcal (Jessica Elkins Act) Act No 2014-437 SB0057 Enacted Safe at Schools Rescind Attorney General Opinion 2006-127 8

9. TABLE OF CONTENTS Section 2 1. School Health Overview 2. AED/ CPR 3. Assessment (Form) Health Assessment Record HAR Memo and Act No 2009-280 4. Communicable Flu Lice Reportable Diseases 5. Documentation Records of Disposition 9

10. SECTION 2 (CONTINUED) 6. Emergency Action Plans Anaphylaxis – Act No 2014-437 Anaphylaxis Preparedness, EpiPen Diabetes – Act No 2014-437 Alabama Safe at Schools Act (Move to SAMPLES IN SECTION 3) Seizures - Diastat 7. First Aid (Form) First Aid 8. Immunization Immunization Memo, Law and schedule Act No 2014-274 SB 0075 Jessica Elkins Act (Meningococcal info to parents) 9. Medications 10. Procedures VNS 11. Screenings Scoliosis (Form) Vision and Hearing 10

11. TABLE OF CONTENTS  Section 3 1. Index 2. Web Resources 3. Opinions / Memorandums / Local Education Agency Samples (Statewide and/or Local Education Samples) 11

12. TASKFORCE ONE YEAR LATER Resource Guidelines Task Force and Subcommittee 12

13. TASKFORCE ONE YEAR LATER Medication Curriculum Forms 1. Prescriber Parent Authorization Medication 2. Prescriber Parent Authorization Procedures: Catheterization G-tube Tracheostomy Care Vagus Nerve Stimulator (VNS) 1. Unusual Occurrence Report 13

14. 14 Student’s Name:________________________ School: _______________ Date of Birth:_____/_____/______ Age: _____ Grade: ____ Teacher: __  No known drug allergies---if drug allergies list: ______________ WEIGHT: _____POUNDS REVISION: □ CHECK BOX ADDED TO DRUG ALLERGY INFORMATION IN ATTEMPT TO ENSURE THIS INFORMATION IS PROVIDED BY PARENT. STUDENT INFORMATION

15. 15 REVISIONS: PRESCRIBER AUTHORIZATION (To be completed by licensed healthcare provider)

16. 16 PARENT AUTHORIZATION Separate instructions provided for packaging and delivery of Rx & OTC meds Retained language related to authorization for school nurse to administer medication and/or to delegate task to trained unlicensed personnel in accordance with ABN administrative code practice guidelines. REVISIONS: PRESCRIPTION MEDICATION MUST BE REGISTERED WITH SCHOOL NURSE OR TRAINED MEDICATION ASSISTANTS. PRESCRIPTION MEDICATION MUST BE PROPERLY LABELED WITH STUDENT’S NAME, PRESCRIBER’S NAME, NAME OF MEDICATION, DOSAGE, TIME INTERVALS, ROUTE OF ADMINISTRATION AND THE DATE OF DRUG’S EXPIRATION WHEN APPROPRIATE. OVER THE COUNTER MEDICATION MUST BE REGISTERED WITH THE SCHOOL NURSE OR TRAINED MEDICATION ASSISTANT, OTC’S IN THE ORIGINAL, UNOPENED AND SEALED CONTAINER. LOCAL EDUCATION AGENCY POLICY FOR OTC MEDICATION TO BE FOLLOWED: PARENT’S/GUARDIAN’S SIGNATURE: ___________________________DATE: ___/___/___ PHONE: ( ) _______-_______

17. 17 SELF-ADMINISTRATION AUTHORIZATION (To be completed ONLY if student is authorized to complete self-care by licensed healthcare provider.) I authorize and recommend self-medication by my child for the above medication. I also affirm that he/she has been instructed in the proper self- administration of the prescribed medication by his/her attending physician. I shall indemnify and hold harmless the school, the agents of the school, and the local board of education against any claims that may arise relating to my child’s self-administration of prescribed medication(s). Parenthetical instruction added: (To be completed ONLY if student is authorized to complete self care by licensed healthcare provider). Revisions:

18. 18 Parenthetical instruction added: (To be completed ONLY if student is authorized to complete self care by licensed healthcare provider). Revisions: I authorize and recommend self-medication by my child for the above medication. I also affirm that he/she has been instructed in the proper self- administration of the prescribed medication by his/her attending physician. I shall indemnify and hold harmless the school, the agents of the school, and the local board of education against any claims that may arise relating to my child’s self-administration of prescribed medication(s). SELF-ADMINISTRATION AUTHORIZATION (To be completed ONLY if student is authorized to complete self-care by licensed healthcare provider.)

19. 19 UTILIZE THE SAME FORMAT AS THE MEDICATION AUTHORIZATION FORM LANGUAGE VARIES IN THE PARENT AUTHORIZATION SECTION AND THE SELF-ADMINISTRATION SECTION, TO REMAIN CONSISTENT WITH ABN ADMINISTRATIVE CODE PRACTICE GUIDELINES CLEAN INTERMITTENT CATHETERIZATION GASTROSTOMY TUBE CARE TRACHEOSTOMY CARE VAGUS NERVE STIMULATOR SCHOOL PROCEDURE PRESCRIBER/PARENT AUTHORIZATION FORMS

20. “ ” Health Assessment Record 20

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