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N o r t h C a r o l i n a Annual School Health Services Report 2 0 1 1 - 2 0 1 2 North Carolina Department of Health and Human Services Division of Public Health Women’s and Children’s Children and Youth Branch School Health Unit Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th i Table of Contents Executive Summary 1 Survey Population 5 Profile of Students Enrolled in N.C. Public Schools 5 Profile of Nurses Employed in N.C. Public Schools 6 Employment and Financing of School Health Services 10 School Health Services 13 Chronic Health Conditions 13 Diabetes – Compliance with State Law 15 Health Care Coordination and Case Management 16 Student Health Outcomes 17 Health Care Treatments and Procedures at School 18 Emergency Care 19 Medications at School 20 Health Counseling 24 Pregnancy 25 Tobacco Use by Students 27 Suicide/Homicide 27 Health Teaching 28 Health Screening, Referral, Follow-up and Securing Care 29 Health Policies 33 Community Involvement in School Health Services 35 School Health Advisory Councils 35 Cooperative Agreements with Local Health Departments 35 School – Located Influenza Clinics 35 School Based – School Linked Health Centers 36 Conclusion 37 Appendices 39 Appendix A: Chronic Health Conditions 39 Appendix B: Reported Injuries 41 Appendix C: School Nurse to Students Ratio by LEA 42 Appendix D: Map of School Nurse to Students Ratio 44 ii Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 1 Executive Summary th largest state public school system in the country.1 More than 1.4 million children were enrolled in North Carolina public schools during the 2011-2012 school year, an increase of 8,473 students from the previous school year. North of health-related barriers to learning is crucial to the academic success of every student. By the beginning of school year 2005-2006, North health services in every school district. This goal became a priority of the N.C. Public Health Task Force. Subsequently, the state’s Division of Public Health, the American Academy of Pediatrics, the Centers for Disease Control that every public school student in North Carolina have access to a school nurse in a Over the years, the state has made comprehensive school health services a priority through strategies such as the N.C. Healthy Schools Coordinated School Health Program, the School Health Advisory Councils Assembly, and establishment of a School Health Cabinet at the highest levels of state government. Other strategies include the funding directed toward school health services provided through the Department of Public including the state and regional school health nurse consultants, among others. During the 2011-2012 school year, the number slightly from the year before from 1173.5 to School nurses in North Carolina are employed by a variety of agencies. Among the 115 three-quarters of the school health programs are administered by the school districts themselves. The remaining quarter of the programs are administered by local health of all three. Funding for school nurse including local and state funds, federal Title V block grant dollars, categorical funds, management, supervision and payment, regardless of funding LEA 81 70% Health Department 16 14% Hospital 3 3% Health Alliance 2 2% 13 11% of school nurses this past year ensured that, 1:1201 in 2010-2011, to 1:1179 in 2011-2012. _________________________________________________________________________________________________________________ 1 1998, about 556 school nurses delivered carried caseloads of about 2,450 students each. Over the past dozen years, the number of students in the average nurse’s caseload has been cut by more than half, enabling more students to access health services from a school nurse. principles of professional nursing remain consistent, the school nurse also must possess skills related to: to visitors to residents. growth and development. unique health issues of children and adolescents. may be related to a health problem. Ability to problem-solve in order and health needs into the challenges of school. Knowledge of, and ability to, implement school nursing services in the federal and state programs designed for students with Ability to put epidemiological principles clusters of symptoms that may indicate an emerging health threat for students and emerging issues, to educate the school community and implement evidence-based problems. crisis. health professional. nurse’s role within the broader health care system in support of families and children. Ensures compliance with school entry health requirements such as Provides care and nursing case management for students with chronic health problems. Assures the health and safety of the Takes a lead role in managing disasters and planning for emergencies. programs. Assures school compliance with state and safety. advocates for necessary resources. in student care between the school and the student’s medical home provider. 2 Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 3 standard by which school nurses are judged to have the knowledge and skills necessary to provide these health services. During 2011- nurses, as a percentage of the total number of school nurses in North Carolina, increased slightly, by 1 percentage point to 53 percent. North Carolina remains the state with the nurses in the country.2 The skills and knowledge that the school nurse dual goals of improving both a student’s health and academic achievement. Data about these improved outcomes are described further under the heading “Student Health Outcomes,” this report. School nurses also provide general health 2011-2012 school year, the nurses reported programs for students. managing the care of students with chronic During 2011-2012, the most common chronic students in North Carolina, as reported by the nurses who care for them, included As part of care management, school nurses develop individual health care plans and train procedures delegated by the nurse to school state’s school nurses developed 105,760 individual health plans for those students. More than half of those plans, 54,965, were for students with asthma. For each plan, the individual student’s medical orders and individual needs were assessed, goals for members were trained and the student’s health status following treatment was evaluated. and health maintenance were discussed. During the 2011-2012 school year, school nurses provided 248,443 health counseling nurses facilitated health screenings conducted in schools. Over a half-million school children students were reported as seen by physicians or eye care professionals as a result of the referrals from school health professionals to obtain comprehensive eye exams. Nurses received 115,722 physician orders ordered to be given regularly during each use, as well as drugs ordered to be on hand should the student need them. Drugs ordered to be available included those for emergencies headaches and other ailments. The school _________________________________________________________________________________________________________________ 1 nurse reviews the orders prior to administer-of the order by a Registered Nurse trained to be given, can reduce the incidence of to students, the incidence of errors and risks reduced quickly. School nurses work with their local School Health Advisory Councils to develop and implement local programs designed to prevent illness and promote health. The SHACs are mandated by the North Carolina State Board disaster and emergency planning for their to grow, so must the availability of school is reached and, ideally, there is at least one school nurse in every school in North Carolina. Methodology by school nurses based on their recording and knowledge of health services provided in their assigned schools. The survey instruments are for use as surveillance or prevalence data. Data specialists and school health nurse consultants in the N.C. Division of Public Health’s Children and Youth Branch developed the survey electronically. These data address health services in North Carolina public schools, not schools. This report also does not include data from federal schools, such as those on military in private or parochial schools. The data were collected and sorted by Children in the School Health Unit and the Best 3 from other sources, including: North Carolina Department of Public Instruction; North Carolina Department of Health and Human Services, Division of Public Health, Women’s and Children’s Health Section; The National Society to Prevent Blindness North Carolina Affiliate, Inc., and North Carolina Child and Family Support Teams Initiative. by request. Contact: Ann Nichols, State School Health Nurse Consultant, Ann.Nichols@dhhs.nc.gov Carol Tyson, School Health Unit Manager, Carol.Tyson@dhhs.nc.gov 4 _________________________________________________________________________________________________________________ 3 D ATA S O U R C E S N.C. Annual School Health Nursing Survey: Summary Report of School Nursing Services 2009-2010 Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 5 North Carolina Annual School Health Services Report. For each school year since 1996-1997, the North Carolina Division of Public Health collected school health data from each school district. This report summarizes data for school health services as reported by school nurses during school year 2011-2012 and provides The survey of the school health service programs also asks for comments regarding outcomes and successes during the past school year and goals for future years. This report of successful outcomes; they are labeled student health issues. S u r v e y P o p u l a t i o n in North Carolina Public Schools school children are as diverse as the state’s 4 They come from all socio-economic backgrounds and represent ethnic backgrounds from around the globe. in our schools are: Black or African American, 26.3%; Asian, 2.6%; Hispanic, 13.5%; American student’s ability to learn. Nearly 12 percent of the state’s public school children have degree that they are eligible to receive from ages 3 through 21. During the 2011-2012 school year, approximately 19,928 preschool students and 172,157 students ages 6-21 in grades kindergarten through 12th were enrolled in EC programs.5 The incidence of EC enrollment peaks at around age 10; among students receiving EC services, one out of every ten is 10 years old.6 assistance of school nurses, as many of them primary disability that require health care school nurses are assigned to work exclusively in the EC program. All students eligible for EC services must meet criteria for one primary disability from among 13 eligible categories, and may meet criteria _________________________________________________________________________________________________________________ 4 students. 5 6 6 L O C A L O U T C O M E _________________________________________________________________________________________________________________ 7 among students in EC programs in North Carolina, “other health impairment” was the second most frequent primary disabil-brain injured,” “visual impairment,” “hearing impaired,” “orthopedically impaired” and “mul-in planning and caring for the student with a and overseeing nursing care provided by other general supervision of other nurses in the provided care to students who were medically fragile and needed care on a one-on-one basis under the supervision of a registered nurse as required by the N.C. Board of Nursing. LPNs may be hired by the school system or by an agency to provide direct care to an individual student who needs such a level of nursing care provided by a teaching assistant. The physical well-being of children when they to success in school, according to the N.C. government and the federal government provide funding for students in pre-school programs to promote future success in school. In the public schools, those students enroll in More at Four Pre-Kindergarten programs, Preschool. The state’s school nurses serve pre-K students to maximize their ability to be “healthy and ready to learn” at kindergarten entry, partnering with the community to provide health screening and health services to the children and their families. During the 2011-2012 school year, the school nurses reported serving 24,135 pre-K students. Many of these preschoolers have in preschool, 19,928 students, are enrolled 7 Although enrolled due to speech impairments or language delays and about 40 percent have developmental delays. The remaining 12 student enrollment is not counted in this survey for purposes of the formula that results in N.C. Public Schools Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Carol i na Publ i c Heal th 7 L O C A L O U T C O M E experiences, skills and knowledge than that of nurses working in acute care or even other has a crucial role in the seamless provision of comprehensive health services to children and youth.8 of May 2008 states that increasing numbers of students enter schools with chronic health the school day. School nurses provide outcomes. In North Carolina, the school nurse as the coordinator, of the local School Health Advisory Council. School nurses are involved in each of the eight components of a Coordinated School Health Program: health counseling and psychological services, healthy school environment, and family/community involvement. of School Nurses School nurses are registered nurses, licensed by the North Carolina Board of Nursing. registered nursing is through one of three routes: a bachelor’s degree from a four-year college or university, an associate degree in nursing from a community college or technical college, or a diploma conferred by a hospital. leaders in school health, and in part by requirements of funding partners, the level in North Carolina has increased steadily over the years. It increased again this year, with 85 percent of school nurses holding bachelor’s degrees or higher during the 2011-2012 school year. are new to the specialty of school nursing learn Division of Public Health and its co-sponsors, school district, health department or hospital _________________________________________________________________________________________________________________ 8 American Academy of Pediatrics: Policy Statement “Role of the School Nurse in Providing School Health Services” May 2008. Master’s 6% B.S.N.—Bachelor of Science in Nursing A.D.N.—Associate Degree in Nursing Diploma 2% ADN 11% Unknown 3% BSN, BS, BA 78% 8 L O C A L O U T C O M E Carolina nurses working in public schools hold As a rule, school nurses in North Carolina have nurse in acute care and community health specialty. During the 2011-2012 school year, 74 percent had more than three years’ needs; and 1:1 for some individual students nursing services.9 would allow all students to have their health 10 working solely as administrators, without caseloads of students, were not counted _________________________________________________________________________________________________________________ 9 People 2010. 10 employers. The N.C. Board of Nursing requires state’s registered nurses to renew licensure. through the nine regional Area Health of colleges of nursing, and through the Public Health Nursing Professional Development delivered through a network of state and regional nurse consultants within the N.C. Division of Public Health. Since 1998, the N.C. Department of Public date of employment. School nurses not employed by LEAs are encouraged, and in some cases required, through their funding of achieving this increasingly recognized exam that encompasses the full realm of school nursing, both from clinical and student that school nurses experience a full year in the Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Carol i na Publ i c Heal th 9 L O C A L O U T C O M E there were 1201.81 FTE budgeted school nurse year, 28.31 more than 2010-2011. Each school district in North Carolina must have at least one registered nurse available to provide school health services, though only only one. The number of schools assigned to each school nurse varies from one-to-ten with an average of two schools per nurse. varies widely from LEA to LEA. At the end of the 2011-2012 school year, the statewide 1:1,179. Most LEAs showed improvement, to 1:3,650 in Davidson County Schools. For a by LEA, see Appendix C. School Year 2007-2008 School Year 2008-2009 School Year 2009-2010 School Year 2010-2011 School Year 2011-2012 Schools* Agencies 2,354 2,399 2,422 2,425 2,512 Students** 1,404,957 1,410,497 1,402,269 1,409,895 1,417,458 School Nurse FTEs 1,146.51 1,169.04 1,183.36 1173.50 1201.81 Average N.C. School Nurse/ 1:1,225 1:1,207 1:1,185 1:1,201 1:1,179 School Nurse Personnel 1,266 1,231 1,233 1,231 1,244 * Public Schools of North Carolina, “Facts and Figures 2011-2012”, February 2012. ** The following chart shows the yearly changes in the number of North Carolina public school small number of school nurses are employed 10 School Health Services Employment School nurses are primarily employed by their responsibility for 69 percent of school health service programs in North Carolina lies within hires, supervises, and manages the school those services, and in the remainder, there is more than one agency providing oversight and management of the school nurses. districts (LEAs)* 70% Health Department 14% Hospital/ Health Alliance 5% agencies 11% * rounded to the nearest percent Funding In any school health program, the funding may come from a variety of sources and be responsibility over the program. Rarely is the through a sole source. Funding sources include: local tax revenue, through property taxes allocated to the local school and local health department; federal reimbursement, including approved Medicaid expense reimbursements or federal Title V grants and categorical funds; nurses were funded through non-categorical State categorical funds for school nurses of the school nurses: Child and Family Support health needs of school-age children and the funds through the School Nurse Funding the end of the 2011-2012 school year, the state allocated through the SNFI program. These funds are distributed by the N.C. Division of Public Health to local health departments, which may employ the nurses or may contract to employ the school nurses. In 2005, the Child and Family Support been reauthorized in the 2007, 2009 and 2011 state budgets. It is the state’s only inter-departmental, school-based family-centered student support service system. Leadership for the CFST comes from the North Carolina Child and Family Leadership Council and the Secretary of the Department of Health Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 11 members include the Secretary of the of school nurses and school social workers assigned to schools in 21 selected districts recurring funding for 79 of the teams, while out-of-home placement due to physical, social, to screen them for needed services; and then to provide family centered services to plan period of July 1, 2010 through March 31, 2012. end-of-grade scores. It did show that students services through the CFST program, and that students in 3rd-8th grade who were referred by the CFST team to tutoring services experienced improved math and reading scores in the school year in which they received tutoring. increase funding for school nurses, the number between the 2003-2004 and 2010-2011 school years. The labor demand for all nurses, the complexity of student health needs has grown. School health program supervisors retaining school nurses. In the 2011-2012 majority of the school year. 12 Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Carol i na Publ i c Heal th 13 School Health Services L O C A L O U T C O M E School nurses provide basic and including children with special health care A number of these children – about one of performance, and the students’ physical and work closely with students, their families, learning. Nurses serve as case managers, environment. The number of unduplicated individual students with chronic health was 232,183 in 2011-2012, approximately 16.4 percent of students. The number of reported students diagnosed with more than one past decade. The number and percent change illustrated in the following table. The chart counted and also indicates the number of care plans. Asthma, a major chronic illness among school children, is the leading cause of school experts on lung disease. The number of North Carolina students known to school nurses to have asthma during 2011-2012 school year, was 105,542. Severe allergies, such as peanut allergies or at school. During the 2011-2012 school year, 30,008 students were listed as having severe allergies, 5,202 more than during school year 2010-2011. There was a slight decline in the number of students reported with diabetes, to 4,803. School nurses provide care as well as train who bring to school increasingly complex needs and high technology. The school nurse works with the student, family and physician school personnel who are designated as 14 in 2003 to assure consistent care for students with diabetes during the school day. Students with diabetes are also encouraged to self-manage their symptoms, which will most likely Diabetes: Among the 4,803 students reported with diabetes 2011-2012: 3,915 monitor blood glucose at school at school; 1,698 manage insulin pumps; and 2,778 are known to self-carry their Students in North Carolina public schools in students with asthma, severe allergies and/ to increase in popularity. This past year, 3,454 more students with asthma, 1,338 more students with severe allergies, and 1,077 more students with diabetes selected that student to a registered nurse his or her ability appropriately, and to understand when to seek assistance. Students who are not able to demonstrate that ability and temporarily suspended and instead receive students who are able to self-medicate for seek the help of a school nurse to assist them. Number 10-11 Number 11-12 compared to all diagnosed Asthma inhalers known for self-carry 22,701 20,645 20% for self-carry 3,681 2,778 77% Epinephrine auto injectors known for self-carry 4,910 3,909 17% of students with severe allergies; 36% of students with orders for injectors ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 15 Number of Individual 11 And Percent Change Per Year School Year Number and Percent 00-01 131,589 01-02 02-03 03-04 04-05 05-06 06-07 07-08 08-09 09-10 10-11 11-12 12 Diabetes – Compliance with State Law School Health Unit of DPH surveyed all public schools in North Carolina, including charter compliance with the act. All public schools school year 2011-2012: 1. How many students with diabetes were enrolled in your LEA/charter school this generalized diabetes training to school 3. Did your LEA/charter school have at least two persons who were intensively trained on diabetes care, in any school in which one or more students with diabetes were 4. How many students with diabetes had an school nurse or other health care provider Public, non-charter school districts reported: Number and percent of school districts with one or more students with diabetes Number of students with diabetes generalized training about diabetes system-wide, as required by the statute Students with diabetes who had an Individual Health Plan or student over age 18 In each school where one or more students with diabetes were enrolled, there were two or more persons intensively trained on diabetes care services report does not otherwise contain summarizes data provided by charter schools reported: _________________________________________________________________________________________________________________ 11 12 16 L O C A L O U T C O M E Charter schools reported: Number and percent of charter schools with one or more students with diabetes students with Number of students with diabetes generalized training about diabetes wide, as required by the statute schools that had one or more students with Students with diabetes who had an Individual completed by a school nurse or other health or student over age In each school where one or more students with diabetes were enrolled, there were two or more persons intensively schools with one or more students with Case Management variety of strategies to communicate with all those involved in the care of a student. Nurses community agencies and families while of students. Among the strategies school nurses enlist to provide health care making visits to the homes of students. More than 11,187 home visits were conducted during the 2011-2012 school year to assist families with student health issues, to health plans with parents and to visit back to school. Nursing case management has been found to be an evidence-based model for In 59 school districts, the process has been formalized into a case management program with core components of assessment, health care management, community resources and for a student with special health care needs produced outcomes that indicate increased in school, and students who receive case management services from a school nurse Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Carol i na Publ i c Heal th 17 L O C A L O U T C O M E School nurse consultants made a concerted management, even in schools without a formalized case management program. improvement in students’ skills in improving their self-care, reducing their own exposures to allergens in order to reduce the need for and ability to manage their illnesses. Raw numbers of students receiving school nurse case management are tallied in the following table. The tables below demonstrate the provided case management of students: Student Health Outcomes Case Management: Asthma Student Outcomes students measured students who demonstrated improvement students measured who demonstrated improvement 1. Consistently verbalized an accurate knowledge of the pathophysiology of 2,124 1,770 83% 2. Consistently demonstrated the correct use of asthma inhaler and/or spacer 2,328 2,062 89% 3. Accurately listed his/her asthma triggers 2,142 1,827 85% pulse oximeter parameters according to care plan 506 395 78% 5. Improved amount and frequency of 1,169 956 82% 6. Improved grades 810 600 74% 7. Decreased number of absences 1,168 941 81% 18 School Nurse Case Management: Diabetes Student Outcome students measured students who demonstrated improvement students measured who demonstrated improvement 1. Consistently verbalized an accurate knowledge of the pathophysiology of 904 737 82% 2. Consistently maintained normal blood 753 561 75% 3. Demonstrated improvement in the ability to correctly count carbohydrates 649 544 84% 816 738 90% 285 226 79% 6. Calculated and delivered own dose of 614 520 85% 7. Improved grades 442 328 74% 8. Decreased number of absences 582 426 73% School Nurse Case Management: Weight Counseling Student Outcome students measured students who demonstrated improvement students measured who demonstrated improvement 1.Consistently verbalized accurate 288 214 74% 2. Kept a daily food diary for at least 30 days and as needed 69 47 68% school 177 151 85% 4. Consistently improved the ability to select choices 279 206 74% 5. Improved overall grades 78 60 77% 6. Decreased number of absences 64 54 84% Health Care Treatments and Procedures at School Some students with chronic illnesses, physical care procedures to be performed during the school day. The nurses reported processing orders for at least 34,625 individual medical treatments or procedures. Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Carol i na Publ i c Heal th 19 The chart that follows lists the number of medical orders for students for the listed treatments or procedures. In some, a emergency in a student with an underlying a tube feeding, a nurse or a person to whom the nurse has delegated the nursing care performs a daily procedure. Among all the listed procedures, only the epinephrine may be used by the student without adult assistance. Health Care Procedure Total Central venous line management 39 1,807 2,521 Nebulizer treatments 1,920 Shunt care 132 110 Tube feeding 607 13,575 For each of the listed procedures except nebulizer treatments, the numbers increased again from the previous year. For each of the procedures or treatments, an individual health plan, and in some cases also an emergency physician. Emergency Care Injuries and illnesses are common occurrences majority of school nurses cover more than one school building, few schools have a school nurse on duty every school day. Therefore, school nurses must assure that school in emergencies. Seventy-three percent daily in each school building. Currently, 109 LEAs reported having at least on one or more school campuses. During survived; three of the events were fatal. Many minor incidents occur to students and to assist with major injuries, of which there were more than 20,554 this past year, a decrease of 2,468. Serious injuries are immediate medical care plus the loss of one-half day or more of school. Of the serious injuries reported, most occurred 22 percent occurred in the classroom. For a complete breakdown of type and place of injury, refer to Appendix B. Three students died from their school-related injuries this past school year. Those deaths permanently disabled by their injuries, and L O C A L O U T C O M E 20 damage, right arm weakness, thyroid of the injuries resulted from an incident in The two students who died of football-related injuries during the fall of 2008 provided Concussion Awareness Act. It made North Carolina the 21st state with a concussion law. for high school and middle school sports. classroom teachers, and teacher assistants basis in the majority of school systems in North perform this task with safety and accuracy, of school policy and procedures, train and serve as coordinator among parents, medical providers, and the school. In nearly all of the LEAs, school nurses provided formal training programs for school employees who were charts and records to assure compliance with all physician and parent orders and to assess During the 2011-2012 school year, nurses daily to students while at school. Some daily basis included psychotropic controlled substances, including Ritalin®, Dexedrine®, and Lithium®. During the 2011-2012 school year, 87,213 is directed to be used “as needed” rather than student does not need that drug at all during any given school year. Students whose treatments. For example, an order for an Epi-pen® may not be needed if the student’s requiring Diastat. A student with diabetes whose blood sugar levels are frequently monitored and treated before they get dangerously low may not ever need a dose necessary responsibility that school health nurses manage. Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 21 Number 2009-2010 Number 2010-2011 Number 2011-2012 Number of students on long term 20,322 19,954 22,213 Number of students on short term 9,207 8,060 6,296 Number of students on emergency, as 51,412 51,511 59,666 Number of students on non- 32,265 34,879 27,547 The number of orders for non-emergency decreased slightly during the 2011-2012 school year, from 34,879 to 27,574. School nurses across the state, as well as physicians and other health care providers who can prescribe of the American Academy of Pediatrics to limit absolutely necessary to maintain the student 13 Because a number of over-the-counter drugs for the product. Determining whether the interviewing the student, assessing the nurse. Without a nurse at every school, school nurses in North Carolina must delegate the personnel. The school nurse provides training and oversight to these non-health care professionals, also called “Unlicensed commonly, those persons are teachers, teaching assistants, coaches or school secretaries. School administrators also parameters, such as providing “one or two pain relievers depending on pain level,” or providing delivers a dose of epinephrine in order to treat severe allergies. Although the student herself, there is a statutory process requiring physician orders and nurse assessment of the student’s ability to do so. Medical orders for Epi-Pens rose 21 percent during the 2011-2012 school year and have risen every year since children to carry and self-administer this drug. Between 2007 and 2012, orders for epinephrine increased from 3,847 in 2007 to 13,575 by the end of the 2011-2012 school students to self-carry and self-inject _________________________________________________________________________________________________________________ 13 22 epinephrine, only about 36 percent of the students with an order to have epinephrine available, and only 17 percent of all students with severe allergies, also had orders allowing to demonstrate this knowledge to school and in many cases, parents want adult management of their child’s emergency severe allergies, it has been agreed that it is experiencing a dangerously low blood glucose level. Insulin, by contrast, is a drug used to treat elevated blood glucose levels. Of the two extremes, low blood glucose is the most immediately life-threatening and needs to be treated quickly to increase blood glucose Diastat® is a drug with the generic name of Valium®, and is given through the rectum Versed is a form of anesthesia that some physicians prescribe for children with intractable seizures to be given through the Health Unit advises school districts to seek number of reasons, including the rare but extremely serious risk of depressing a student’s respiratory status quickly, leading to respiratory arrest and death. of midazolam, is given to children before medical procedures or before anesthesia for surgery to cause drowsiness, relieve anxiety, and prevent memory of the event. It breathing, their use is recommended to physicians who are expert in the management of airway and breathing.14 The NLM warns parents that the drug should only be given equipment that is needed to monitor heart and lungs and provide life-saving medical treatment and respond. No public school outside of of emergency respiratory treatment. who had administered Versed during school year 2009-2010 led the state’s school health nurse consultants to issue strong advisories to school nurses regarding requests to state’s school health nurse consultants led Versed was administered in N.C. public schools between those two years. The 2011-2012 surveys revealed zero instances of Versed per year the following drugs were given in N.C. public schools during the past two years. _________________________________________________________________________________________________________________ 14 . Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 23 2011-2012 2010-2011 2011-2012 Diastat Administered by licensed nurse 79 51 Administered by non nurse 121 94 Glucagon Administered by licensed nurse 7 2 Administered by non nurse 12 3 Versed Administered by licensed nurse 1 0 Administered by non nurse 0 0 school year. The following table and graph provide a 10-year overview of the numbers and percentage of Administered at School School year # Students Emergencies 2002-2003 1,279,468 N/A 2003-2004 1,311,163 N/A 2004-2005 1,332,009 N/A 2005-2006 1,363,695 N/A 2006-2007 1,386,363 N/A 2007-2008 1,404,957 2008-2009 1,410,497 2009-2010 1,402,269 2010-2011 1,409,895 2011-2012 1,417,458 24 such encounters reported by school nurses totaled 248,443—15,785 more than the The single most frequent topic for school nurse counseling was asthma. Second most frequent was chronic illness and third was hygiene. The school nurse is frequently engaged other issues related to puberty. Students also violence or bullying, and over possible neglect or abuse within their family or their concerns over a friend or neighbor. School nurses must report suspicions of child abuse/neglect whether observed or given credible suspicion by another person. Students also sought the advice of school nurses about substance abuse and tobacco use. Individual discussions around depression/suicide occurred in all grade levels. Health Counseling Students seek a school nurse for accurate, normal growth and development to serious expect a registered nurse to provide medically-related to their health and concerns. The chart that follows lists some of the health as any encounter with a student where direct maintenance were discussed. During the 2011-2012 school year, the numbers of 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 School Year L O C A L O U T C O M E Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Carol i na Publ i c Heal th 25 15 Health Counseling Elementary School Middle School High School Total ADD/ADHD 9,880 5,304 2,642 17,826 Asthma 29,624 10,701 7,054 47,379 Child abuse/neglect 2,477 1,061 658 4,196 16,198 10,701 8,133 35,032 1,313 1,989 3,022 6,324 Diabetes 10,653 10,004 7,678 28,335 Hygiene 21,873 8,281 4,453 34,607 Mental Health Issues 5,330 4,063 6,504 15,897 Pregnancy 60 1,313 7,790 9,163 3,774 4,332 7,600 15,706 Seizure disorders 2,581 1,556 1,752 5,889 Severe allergies 8,787 3,252 3,336 15,375 Sickle cell 343 296 266 905 Substance abuse including tobacco use, 471 1,555 2,710 4,736 82 334 413 829 Violence/bullying 2,301 2,558 1,385 6,244 Totals 115,747 67,300 65,396 248,443 Pregnancy For the fourth year in a row, there was a decrease in the number of pregnancies among public school students across all grade levels, as reported by the school nurses. Although student’s pregnancy as part of nursing case management or on physician orders, or guidance of labor and delivery and infant early pregnancies. The number of students reported by school nurses to be known to have been pregnant during 2011-2012 school year _________________________________________________________________________________________________________________ 15 Most but not all LEAs reported within these categories in the annual survey. L O C A L O U T C O M E 26 Status of School Enrollment for Students Known to be Pregnant Elementary Middle School High School Total Known pregnancies 2008-2009: 7 2009-2010: 3 2010-2011: 2 2011-2012: 1 2008-2009: 300 2009-2010: 278 2010-2011: 226 2011-2012: 183 2008-2009: 4,353 2009-2010: 3,996 2010-2011: 3,659 2011-2012: 3,475 2008-2009: 4,660 2009-2010: 4,277 2010-2011: 3,887 2011-2012: 3,659 Students receiving homebound 2011-2012 1 48 983 1,032 Known Pregnancies by Year and Percent Change from Previous Year School Year Pregnancies reported % increase or decrease 2002-2003 2,697 - 7.6% 2003-2004 3,131 2004-2005 3,406 2005-2006 4,072 2006-2007 4,422 2007-2008 4,904 2008-2009 4,660 - 5% 2009-2010 4,277 - 8% 2010-2011 3,887 - 9% 2011-2012 3,659 -6% is 3,659. That number is 228 fewer than the previous year. This represents more than 1,245 fewer student pregnancies from the recent high of 4,904 during school year 2007-08. decrease since 2008. This trend is also With assistance from school nurses, the majority of students managed their pregnancies well enough to remain enrolled the prenatal or postpartum period, or both, Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Carol i na Publ i c Heal th 27 L O C A L O U T C O M E Tobacco Use by Students Since Aug. 1, 2008, all schools must adopt, implement, and enforce tobacco-free16 school and school policy, schools communicate tobacco-free messages to young people and provide mentoring to youth groups In a May 2012 press release the North Carolina Department of Health and Human Services rate in North Carolina reached an historic low rates have fallen steadily, according to results from the 2011 N.C. Youth Tobacco Survey. The rate dropped to 4.2 percent from 4.3 percent in 2009, and high school smoking lowered to 15.5 percent from 16.7 percent in 200917. media campaigns and school and community www.tru.nc.gov Carolina. Suicide and Homicide suicide or homicide, is a public health emergency. Although the number is small loss of a student through homicide or suicide According to reports from the LEAs, suicide was students, and 19 of those suicides resulted in death. Suicide cases decreased slightly, from 23 the previous year to 19 in 2011-2012. Twelve students died through homicide. One suicide death occurred at school. None of the deaths from homicide were reported as occurring at school. _________________________________________________________________________________________________________________ 16 17 . 28 nurses also conducted health fairs and made boards, and civic and community groups. School nurses reported providing a total of the 2011-2012 school year. programs for students. problem. In some cases, the nurse is the only health care provider the student sees for minor illnesses and injuries. During the 2011-2012 school year, school nurses assessed and man-aged 166,103 students for illness or injury that originated at home. Issues such as the stu-dent’s health insurance status, access to care, to the number of illnesses and injuries treated medical and dental resources and referring stu-dents to providers for the diagnosis and treat-ment of a wide variety of health problems. Health Teaching School nurses were involved in a variety to groups and in classrooms. Classroom other asthma management programs, AIDS management, including general training on diabetes, and intensive training for the care of individual students with diabetes. The Death by Suicide/Homicide: School Year 2011-2012 Elementary Middle School High School Total 29 99 264 392 Deaths from suicide 1 3 15 19 Suicides occurring at school 0 0 1 1 Death from homicide 1 3 8 12 Homicides occurring at school 0 0 0 0 L O C A L O U T C O M E Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Carol i na Publ i c Heal th 29 Screening Screened % Secured Care % Secured Care Body Mass Index 57,273 3,659 6% 116 3% Hearing 145,763 3,079 2% 2,048 67%% Vision 513,884 39,999 8% 28,897 72% L O C A L O U T C O M E Follow-up, and Securing Care Voluntary mass screenings by grade or school of trained volunteers or other health professionals. Vision screenings are conducted by school volunteers. School nurses follow up on those cases are the persons who locate sources of low-cost or free care for those unable screening process did not or were not able to secure that care from a health professional. follow-up and care management services for students may reduce this gap in the providers may also reduce the gap. The following table lists the results of some of the mass screening projects that were conducted during the 2011-2012 school year. L O C A L O U T C O M E 30 between mass screening of all students or occasional screening of students referred between referral for overweight or underweight. Some students with results in either height or weight may have been percentage of public school students screened for BMI in North Carolina by the school health screening for BMI is not universally accepted 2011-2012, 57,273 students were screened for BMI. About 6 percent of those students who were measured received referrals for either overweight or underweight. The referral rate of six percent is much lower than the expected 33 percent if the screening had but the sample of students screened was not due to the limited presence of formal screening programs for BMI in North Carolina schools. Three percent of those students the screening process. Vision Screening There is no mandate in North Carolina for screenings required for students needing other health care providers who examine children prior to entry into kindergarten are required to screen for vision as part of that state-created Kindergarten Health Assessment if indicated. One indicator of the success of a school health screening program is the percent students who did not pass a screening, were evaluated by another health care provider who could diagnose and determine the appropriate during the 2011-2012 school year, screening for vision achieved a 72 percent rate of screening process. Screening for Obesity North Carolina’s children and youth are among state ranking 11th obesity18. In North Carolina, nearly one-third of children aged 10 – 17 are overweight or to what is called an epidemic of obesity Force on Childhood Obesity. This task force to screen at least some students for overweight/obesity by measuring height and weight and obtaining the Body-Mass Index Some school districts measure growth in height to a BMI. These screenings are conducted height and weight data. In some cases, the other health partners. Data from 2011-2012 _________________________________________________________________________________________________________________ 18 Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 31 Many schools, however, follow state periodically through elementary age and once more in middle or high school. Screening for vision is the most frequent school screening program in North Carolina. More than half a had their vision checked for possible eye by the Prevent Blindness North Carolina Vision working under contract with the N.C. the Children and Youth Branch to deliver vision of Public Health’s primary means of assuring criteria across all schools in North school vision screening program is an example providers. screening conducted in schools and report their results both to Prevent Blindness and to the Division of Public Health. Hearing Screening As with vision screening, there is no mandate screen for hearing, although the same rules academic support. Physicians and other health care providers who examine children prior to entry into kindergarten are required to screen for hearing as part of that exam Not all school nurses are trained in and authorized to conduct hearing screenings. School nurses assist in hearing screenings, especially related to referrals and follow-up. 32 Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 33 H e a l t h P o l i c i e s health programs. All local health departments in the state develop an agreement, the are locally developed and provide an avenue and procedures. provide parents a consistent method of to health and safety. The School Health Unit of the Division of Public Health provides guidelines regarding policy development at the local level, and recommends, at minimum, that school boards study and on the chart below. The percentage column in the table that follows indicates the percent of LEAs that have policy addresses maintenance of electronic health records in school. The trend in the health care industry is greater reliance document at least some of the nursing care they provide onto computer systems. School Health Policy board-approved policy 100% Provision of emergency care 100% Screening, referral and follow-up 83% 59% 81% Maintenance of student health records 25% care needs 70% 90% 45% 27% 34 Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 35 C o m m u n i t y I n v o l v e m e n t i n S c h o o l H e a l t h S e r v i c e s Community involvement contributes to the programs and services. School nurses encourage and promote community involvement through: Establishment of school health advisory councils; Development of inter-agency planning Recruitment of local physician advisors; and, Development of parent-teacher community involvement include: Departments; and, School-Based School-Linked Health Centers School Health Advisory Council (SHAC) School Health Advisory Councils. These all of the SHACs have a school nurse among the have a physician serving on the council. According to the policy, each SHAC must behavioral health, safe school environment, parents/community members, the local health SHACs advise LEA leadership, superintendents, health and academics, and can disseminate Local Health Departments In every county in the state, a Memorandum of Agreement between the local health department and the school district is required in order for the health department to receive state funds. These annually reviewed to support the health of children in public of each regarding epidemics and other experts, 70 LEAs are able to consult with a physician regarding the school health program. physicians or pediatricians. During school year 2011-2012, 26 percent of the school districts hosted school-located in 2011-2012 experienced a more normal out- 36 during the previous year, there was a large source of federal funding that supported a to implement SLIC. School nurses and local health departments, hospitals and others, made it possible for more than 10,923 doses Parental permission was required to administer doses to students. School-based, School-linked Health Centers established school health centers in the schools using grants, local funding and some state funding assistance. During school year 2011-2012, there were at least 50 school-based or school-linked health centers 20 The clinics primarily serve students in middle and high adolescents for access to medical care, including care for mental health or behavioral health issues. Centers provide primary care the school nurse’s ability to refer a student or his family for medical care, especially in areas of low resources. The school-based or school-linked centers provide clinical health services and may bill for the services to the parent’s insurance, other insurance providers and Medicaid. Parental permission is required for receipt of school health center services, in-diagnosis and treatment for medical Nurses employed by school-based health these registered nurses working in the school health centers are not counted among the School Health Centers depend on a resources to support the health services that funded by the N.C. Division of Public Health. resources at the local level. Partners in these centers include N.C. Department of Public centers may be obtained from the NCSCHA website, www.ncscha.org. _________________________________________________________________________________________________________________ 20 Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 37 C o n c l u s i o n School health services are just one component of a Coordinated School Health Program. By Division of Public Health, North Carolina Division of Medical Assistance, North Carolina Carolina Pediatric Society, North Carolina Academy of Family Physicians, North Carolina Dental Society, Prevent Blindness North Carolina, North Carolina School and Community Health Alliance and more, school nurses are working to help students achieve at levels they might not otherwise reach. An increase in the number of school nurses outcomes. 38 Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 39 Appendi x A : Elementary Middle High Total Total with Total with a related 504 plan ADD/ADHD 35511 18501 13519 67531 3844 6009 18117 5965 5926 30008 18865 380 Asthma 57718 25724 22100 105542 54965 823 including Asperger’s Syndrome, PDD 6124 2290 2250 10664 1079 546 Blood disorders not chronic anemia, 624 316 442 1382 424 60 Cancer, including leukemia 428 189 263 880 335 141 2557 1277 1715 5549 1753 140 Cerebral Palsy 1287 545 702 2534 782 123 Chromosomal otherwise listed including Down's Syndrome, Fragile X, Trisomy 18 1397 518 610 2525 587 96 Chronic encopresis 501 111 72 684 226 17 diseases: including Toxoplasmosis, Cytomegalovirus, C, HIV, Syphilis, Tuberculosis 82 37 68 187 35 6 166 68 89 323 180 66 Diabetes Type I 1132 1060 1567 3759 5230 914 Diabetes Type II 218 350 618 1186 655 74 81 92 172 345 60 12 and/or psychiatric disorder not otherwise listed 5030 3438 3866 12334 778 817 Fetal Alcohol Syndrome 226 199 83 508 191 11 celiac disease, IBS, 2426 1418 1617 5461 1229 155 Hearing loss 2269 1015 1026 4310 561 344 Hemophilia 234 108 105 447 226 25 40 Elementary Middle High Total Total with Total with a related 504 plan Hydrocephalus 395 126 146 667 321 40 Hypertension 375 413 811 1599 399 17 Hypo/Hyperthyroidism 319 251 416 986 115 20 endocrine disorders not otherwise listed 446 237 311 994 257 52 Migraine headaches 3038 3324 4570 10932 2349 146 186 128 124 438 229 26 Muscular Dystrophy 99 56 72 227 77 20 6145 1871 1881 9897 112 22 Orthopedic disability 1216 719 851 2786 521 144 Other neurological listed 647 238 392 1277 383 142 Other neuromuscular listed 444 204 293 941 285 84 Renal / Adrenal / including Addison's 1192 635 747 2574 722 89 Rheumatological 311 227 361 899 374 82 Seizure Disorder/ Epilepsy 4674 2058 2351 9083 5352 401 Sickle Cell Anemia 814 376 385 1575 1334 85 892 378 395 1665 200 16 258 85 137 480 208 42 215 130 186 531 173 66 Visually impaired 1107 446 649 2202 333 249 Total Number: 148994 70584 66384 285962 96768 11388 Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 41 Appendi x B : Reported Injuries in North Carolina Public Schools Requiring EMS Response or Immediate Care by Physician/ School Year 2011-12 Abdominal/Internal Injuries 4 7 52 67 53 1 1 10 22 217 1% Anaphylaxis 5 7 87 32 10 0 1 37 27 206 1% Back or Neck Injuries 17 23 57 180 135 1 10 5 43 471 2% Dental Injury 13 30 116 321 177 2 14 31 49 753 4% Drug Overdose 16 15 98 5 5 2 8 7 37 193 1% Eye Injuries 14 42 268 209 170 29 1 15 82 830 4% Fracture 13 91 135 1240 718 12 17 24 447 2697 13% Head Injuries 48 172 357 933 718 8 80 50 315 2681 13% Heat Related Emer-gency 0 4 37 90 68 3 3 6 24 235 1% 47 132 520 712 379 99 49 51 362 2351 11% Other 34 119 531 393 298 9 32 63 376 1855 9% Psychiatric Emergency 7 41 527 17 15 0 10 9 142 768 4% Respiratory Emergency 9 27 583 214 202 1 10 18 332 1396 7% Seizure 48 72 870 76 59 1 14 33 104 1277 6% Sprain or Strain 76 270 316 1385 2025 18 35 68 431 4624 22% 351 1052 4554 5874 5032 186 285 427 2793 20554 100% Total % 2% 5% 22% 29% 24% 1% 1% 2% 14% 100% 42 Appendi x C : County/LEA Name (Nurse:Student) County/LEA Name (Nurse:Student) Alamance-Burlington Schools 902 Forsyth County Schools 1,815 Alexander County Schools 986 Franklin County Schools 1,105 724 1,471 469 601 Ashe County Schools 1,048 496 1,095 1,709 Beaufort County Schools 1,381 435 683 2,249 Bladen County Schools 916 478 Brunswick County Schools 1,197 724 Buncombe County Schools 1,425 512 Asheville City Schools 1,134 1,847 Burke County Schools 1,208 Haywood County Schools 1,181 Cabarrus County Schools 921 Henderson County Schools 1,464 688 619 Caldwell County Schools 1,141 Hoke County Schools 1,002 635 575 Carteret County Schools 1,204 Iredell-Statesville Schools 1,428 720 Mooresville City Schools 1,084 Catawba County Schools 1,139 Jackson County Schools 1,007 Hickory City Schools 848 Johnston County Schools 2,104 722 569 Chatham County Schools 1,336 Lee County Schools 1,131 Cherokee County Schools 740 Lenoir County Schools 1,304 572 Lincoln County Schools 1,459 664 Macon County Schools 854 Cleveland County Schools 1,123 1,275 Columbus County Schools 916 624 566 753 710 1,159 Cumberland County Schools 2,054 1,028 651 Montgomery County Schools 821 482 Moore County Schools 1,768 Davidson County Schools 3,118 Nash-Rocky Mount Schools 869 Lexington City Schools 592 New Hanover County Schools 745 803 582 Davie County Schools 927 Onslow County Schools 1,113 639 629 Durham Public Schools 1,292 649 Edgecombe County Schools 1,013 316 Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 43 Appendi x C : County/LEA Name (Nurse:Student) County/LEA Name (Nurse:Student) Pasquotank County Schools 981 Surry County Schools 1,055 Pender County Schools 843 Elkin City Schools 769 860 Mount Airy City Schools 536 985 333 1,276 Transylvania County Schools 1,170 1,166 565 Randolph County Schools 2,041 Union County Schools 1,190 Asheboro City Schools 913 687 Richmond County Schools 755 Wake County Schools 2,517 Robeson County Schools 1,013 615 Rockingham County Schools 1,691 583 Rowan-Salisbury Schools 1,677 Watauga County Schools 1,074 Rutherford County Schools 1,461 Wayne County Schools 1,111 Sampson County Schools 1,085 Wilkes County Schools 1,044 601 Wilson County Schools 2,006 473 Yadkin County Schools 968 Stanly County Schools 1,494 501 Stokes County Schools 1,369 North Carolina 1,179 44 Department of Health and Human Services | Aldona Z. Wos, M.D., Secretary Children and Youth Branch | School Health Unit www.ncdhhs.gov N.C. DHHS is an equal opportunity employer and provider. 10/13
Object Description
Description
Title | North Carolina annual school health services report for public schools : summary report of school nursing services |
Other Title | Summary report of school nursing services |
Date | 2013-10 |
Description | 2011-2012 |
Digital Characteristics-A | 10.7 MB; 50 p. |
Digital Format | application/pdf |
Pres File Name-M | pubs_serial_ncannualschool20112012.pdf |
Full Text | N o r t h C a r o l i n a Annual School Health Services Report 2 0 1 1 - 2 0 1 2 North Carolina Department of Health and Human Services Division of Public Health Women’s and Children’s Children and Youth Branch School Health Unit Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th i Table of Contents Executive Summary 1 Survey Population 5 Profile of Students Enrolled in N.C. Public Schools 5 Profile of Nurses Employed in N.C. Public Schools 6 Employment and Financing of School Health Services 10 School Health Services 13 Chronic Health Conditions 13 Diabetes – Compliance with State Law 15 Health Care Coordination and Case Management 16 Student Health Outcomes 17 Health Care Treatments and Procedures at School 18 Emergency Care 19 Medications at School 20 Health Counseling 24 Pregnancy 25 Tobacco Use by Students 27 Suicide/Homicide 27 Health Teaching 28 Health Screening, Referral, Follow-up and Securing Care 29 Health Policies 33 Community Involvement in School Health Services 35 School Health Advisory Councils 35 Cooperative Agreements with Local Health Departments 35 School – Located Influenza Clinics 35 School Based – School Linked Health Centers 36 Conclusion 37 Appendices 39 Appendix A: Chronic Health Conditions 39 Appendix B: Reported Injuries 41 Appendix C: School Nurse to Students Ratio by LEA 42 Appendix D: Map of School Nurse to Students Ratio 44 ii Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 1 Executive Summary th largest state public school system in the country.1 More than 1.4 million children were enrolled in North Carolina public schools during the 2011-2012 school year, an increase of 8,473 students from the previous school year. North of health-related barriers to learning is crucial to the academic success of every student. By the beginning of school year 2005-2006, North health services in every school district. This goal became a priority of the N.C. Public Health Task Force. Subsequently, the state’s Division of Public Health, the American Academy of Pediatrics, the Centers for Disease Control that every public school student in North Carolina have access to a school nurse in a Over the years, the state has made comprehensive school health services a priority through strategies such as the N.C. Healthy Schools Coordinated School Health Program, the School Health Advisory Councils Assembly, and establishment of a School Health Cabinet at the highest levels of state government. Other strategies include the funding directed toward school health services provided through the Department of Public including the state and regional school health nurse consultants, among others. During the 2011-2012 school year, the number slightly from the year before from 1173.5 to School nurses in North Carolina are employed by a variety of agencies. Among the 115 three-quarters of the school health programs are administered by the school districts themselves. The remaining quarter of the programs are administered by local health of all three. Funding for school nurse including local and state funds, federal Title V block grant dollars, categorical funds, management, supervision and payment, regardless of funding LEA 81 70% Health Department 16 14% Hospital 3 3% Health Alliance 2 2% 13 11% of school nurses this past year ensured that, 1:1201 in 2010-2011, to 1:1179 in 2011-2012. _________________________________________________________________________________________________________________ 1 1998, about 556 school nurses delivered carried caseloads of about 2,450 students each. Over the past dozen years, the number of students in the average nurse’s caseload has been cut by more than half, enabling more students to access health services from a school nurse. principles of professional nursing remain consistent, the school nurse also must possess skills related to: to visitors to residents. growth and development. unique health issues of children and adolescents. may be related to a health problem. Ability to problem-solve in order and health needs into the challenges of school. Knowledge of, and ability to, implement school nursing services in the federal and state programs designed for students with Ability to put epidemiological principles clusters of symptoms that may indicate an emerging health threat for students and emerging issues, to educate the school community and implement evidence-based problems. crisis. health professional. nurse’s role within the broader health care system in support of families and children. Ensures compliance with school entry health requirements such as Provides care and nursing case management for students with chronic health problems. Assures the health and safety of the Takes a lead role in managing disasters and planning for emergencies. programs. Assures school compliance with state and safety. advocates for necessary resources. in student care between the school and the student’s medical home provider. 2 Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 3 standard by which school nurses are judged to have the knowledge and skills necessary to provide these health services. During 2011- nurses, as a percentage of the total number of school nurses in North Carolina, increased slightly, by 1 percentage point to 53 percent. North Carolina remains the state with the nurses in the country.2 The skills and knowledge that the school nurse dual goals of improving both a student’s health and academic achievement. Data about these improved outcomes are described further under the heading “Student Health Outcomes,” this report. School nurses also provide general health 2011-2012 school year, the nurses reported programs for students. managing the care of students with chronic During 2011-2012, the most common chronic students in North Carolina, as reported by the nurses who care for them, included As part of care management, school nurses develop individual health care plans and train procedures delegated by the nurse to school state’s school nurses developed 105,760 individual health plans for those students. More than half of those plans, 54,965, were for students with asthma. For each plan, the individual student’s medical orders and individual needs were assessed, goals for members were trained and the student’s health status following treatment was evaluated. and health maintenance were discussed. During the 2011-2012 school year, school nurses provided 248,443 health counseling nurses facilitated health screenings conducted in schools. Over a half-million school children students were reported as seen by physicians or eye care professionals as a result of the referrals from school health professionals to obtain comprehensive eye exams. Nurses received 115,722 physician orders ordered to be given regularly during each use, as well as drugs ordered to be on hand should the student need them. Drugs ordered to be available included those for emergencies headaches and other ailments. The school _________________________________________________________________________________________________________________ 1 nurse reviews the orders prior to administer-of the order by a Registered Nurse trained to be given, can reduce the incidence of to students, the incidence of errors and risks reduced quickly. School nurses work with their local School Health Advisory Councils to develop and implement local programs designed to prevent illness and promote health. The SHACs are mandated by the North Carolina State Board disaster and emergency planning for their to grow, so must the availability of school is reached and, ideally, there is at least one school nurse in every school in North Carolina. Methodology by school nurses based on their recording and knowledge of health services provided in their assigned schools. The survey instruments are for use as surveillance or prevalence data. Data specialists and school health nurse consultants in the N.C. Division of Public Health’s Children and Youth Branch developed the survey electronically. These data address health services in North Carolina public schools, not schools. This report also does not include data from federal schools, such as those on military in private or parochial schools. The data were collected and sorted by Children in the School Health Unit and the Best 3 from other sources, including: North Carolina Department of Public Instruction; North Carolina Department of Health and Human Services, Division of Public Health, Women’s and Children’s Health Section; The National Society to Prevent Blindness North Carolina Affiliate, Inc., and North Carolina Child and Family Support Teams Initiative. by request. Contact: Ann Nichols, State School Health Nurse Consultant, Ann.Nichols@dhhs.nc.gov Carol Tyson, School Health Unit Manager, Carol.Tyson@dhhs.nc.gov 4 _________________________________________________________________________________________________________________ 3 D ATA S O U R C E S N.C. Annual School Health Nursing Survey: Summary Report of School Nursing Services 2009-2010 Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 5 North Carolina Annual School Health Services Report. For each school year since 1996-1997, the North Carolina Division of Public Health collected school health data from each school district. This report summarizes data for school health services as reported by school nurses during school year 2011-2012 and provides The survey of the school health service programs also asks for comments regarding outcomes and successes during the past school year and goals for future years. This report of successful outcomes; they are labeled student health issues. S u r v e y P o p u l a t i o n in North Carolina Public Schools school children are as diverse as the state’s 4 They come from all socio-economic backgrounds and represent ethnic backgrounds from around the globe. in our schools are: Black or African American, 26.3%; Asian, 2.6%; Hispanic, 13.5%; American student’s ability to learn. Nearly 12 percent of the state’s public school children have degree that they are eligible to receive from ages 3 through 21. During the 2011-2012 school year, approximately 19,928 preschool students and 172,157 students ages 6-21 in grades kindergarten through 12th were enrolled in EC programs.5 The incidence of EC enrollment peaks at around age 10; among students receiving EC services, one out of every ten is 10 years old.6 assistance of school nurses, as many of them primary disability that require health care school nurses are assigned to work exclusively in the EC program. All students eligible for EC services must meet criteria for one primary disability from among 13 eligible categories, and may meet criteria _________________________________________________________________________________________________________________ 4 students. 5 6 6 L O C A L O U T C O M E _________________________________________________________________________________________________________________ 7 among students in EC programs in North Carolina, “other health impairment” was the second most frequent primary disabil-brain injured,” “visual impairment,” “hearing impaired,” “orthopedically impaired” and “mul-in planning and caring for the student with a and overseeing nursing care provided by other general supervision of other nurses in the provided care to students who were medically fragile and needed care on a one-on-one basis under the supervision of a registered nurse as required by the N.C. Board of Nursing. LPNs may be hired by the school system or by an agency to provide direct care to an individual student who needs such a level of nursing care provided by a teaching assistant. The physical well-being of children when they to success in school, according to the N.C. government and the federal government provide funding for students in pre-school programs to promote future success in school. In the public schools, those students enroll in More at Four Pre-Kindergarten programs, Preschool. The state’s school nurses serve pre-K students to maximize their ability to be “healthy and ready to learn” at kindergarten entry, partnering with the community to provide health screening and health services to the children and their families. During the 2011-2012 school year, the school nurses reported serving 24,135 pre-K students. Many of these preschoolers have in preschool, 19,928 students, are enrolled 7 Although enrolled due to speech impairments or language delays and about 40 percent have developmental delays. The remaining 12 student enrollment is not counted in this survey for purposes of the formula that results in N.C. Public Schools Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Carol i na Publ i c Heal th 7 L O C A L O U T C O M E experiences, skills and knowledge than that of nurses working in acute care or even other has a crucial role in the seamless provision of comprehensive health services to children and youth.8 of May 2008 states that increasing numbers of students enter schools with chronic health the school day. School nurses provide outcomes. In North Carolina, the school nurse as the coordinator, of the local School Health Advisory Council. School nurses are involved in each of the eight components of a Coordinated School Health Program: health counseling and psychological services, healthy school environment, and family/community involvement. of School Nurses School nurses are registered nurses, licensed by the North Carolina Board of Nursing. registered nursing is through one of three routes: a bachelor’s degree from a four-year college or university, an associate degree in nursing from a community college or technical college, or a diploma conferred by a hospital. leaders in school health, and in part by requirements of funding partners, the level in North Carolina has increased steadily over the years. It increased again this year, with 85 percent of school nurses holding bachelor’s degrees or higher during the 2011-2012 school year. are new to the specialty of school nursing learn Division of Public Health and its co-sponsors, school district, health department or hospital _________________________________________________________________________________________________________________ 8 American Academy of Pediatrics: Policy Statement “Role of the School Nurse in Providing School Health Services” May 2008. Master’s 6% B.S.N.—Bachelor of Science in Nursing A.D.N.—Associate Degree in Nursing Diploma 2% ADN 11% Unknown 3% BSN, BS, BA 78% 8 L O C A L O U T C O M E Carolina nurses working in public schools hold As a rule, school nurses in North Carolina have nurse in acute care and community health specialty. During the 2011-2012 school year, 74 percent had more than three years’ needs; and 1:1 for some individual students nursing services.9 would allow all students to have their health 10 working solely as administrators, without caseloads of students, were not counted _________________________________________________________________________________________________________________ 9 People 2010. 10 employers. The N.C. Board of Nursing requires state’s registered nurses to renew licensure. through the nine regional Area Health of colleges of nursing, and through the Public Health Nursing Professional Development delivered through a network of state and regional nurse consultants within the N.C. Division of Public Health. Since 1998, the N.C. Department of Public date of employment. School nurses not employed by LEAs are encouraged, and in some cases required, through their funding of achieving this increasingly recognized exam that encompasses the full realm of school nursing, both from clinical and student that school nurses experience a full year in the Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Carol i na Publ i c Heal th 9 L O C A L O U T C O M E there were 1201.81 FTE budgeted school nurse year, 28.31 more than 2010-2011. Each school district in North Carolina must have at least one registered nurse available to provide school health services, though only only one. The number of schools assigned to each school nurse varies from one-to-ten with an average of two schools per nurse. varies widely from LEA to LEA. At the end of the 2011-2012 school year, the statewide 1:1,179. Most LEAs showed improvement, to 1:3,650 in Davidson County Schools. For a by LEA, see Appendix C. School Year 2007-2008 School Year 2008-2009 School Year 2009-2010 School Year 2010-2011 School Year 2011-2012 Schools* Agencies 2,354 2,399 2,422 2,425 2,512 Students** 1,404,957 1,410,497 1,402,269 1,409,895 1,417,458 School Nurse FTEs 1,146.51 1,169.04 1,183.36 1173.50 1201.81 Average N.C. School Nurse/ 1:1,225 1:1,207 1:1,185 1:1,201 1:1,179 School Nurse Personnel 1,266 1,231 1,233 1,231 1,244 * Public Schools of North Carolina, “Facts and Figures 2011-2012”, February 2012. ** The following chart shows the yearly changes in the number of North Carolina public school small number of school nurses are employed 10 School Health Services Employment School nurses are primarily employed by their responsibility for 69 percent of school health service programs in North Carolina lies within hires, supervises, and manages the school those services, and in the remainder, there is more than one agency providing oversight and management of the school nurses. districts (LEAs)* 70% Health Department 14% Hospital/ Health Alliance 5% agencies 11% * rounded to the nearest percent Funding In any school health program, the funding may come from a variety of sources and be responsibility over the program. Rarely is the through a sole source. Funding sources include: local tax revenue, through property taxes allocated to the local school and local health department; federal reimbursement, including approved Medicaid expense reimbursements or federal Title V grants and categorical funds; nurses were funded through non-categorical State categorical funds for school nurses of the school nurses: Child and Family Support health needs of school-age children and the funds through the School Nurse Funding the end of the 2011-2012 school year, the state allocated through the SNFI program. These funds are distributed by the N.C. Division of Public Health to local health departments, which may employ the nurses or may contract to employ the school nurses. In 2005, the Child and Family Support been reauthorized in the 2007, 2009 and 2011 state budgets. It is the state’s only inter-departmental, school-based family-centered student support service system. Leadership for the CFST comes from the North Carolina Child and Family Leadership Council and the Secretary of the Department of Health Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 11 members include the Secretary of the of school nurses and school social workers assigned to schools in 21 selected districts recurring funding for 79 of the teams, while out-of-home placement due to physical, social, to screen them for needed services; and then to provide family centered services to plan period of July 1, 2010 through March 31, 2012. end-of-grade scores. It did show that students services through the CFST program, and that students in 3rd-8th grade who were referred by the CFST team to tutoring services experienced improved math and reading scores in the school year in which they received tutoring. increase funding for school nurses, the number between the 2003-2004 and 2010-2011 school years. The labor demand for all nurses, the complexity of student health needs has grown. School health program supervisors retaining school nurses. In the 2011-2012 majority of the school year. 12 Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Carol i na Publ i c Heal th 13 School Health Services L O C A L O U T C O M E School nurses provide basic and including children with special health care A number of these children – about one of performance, and the students’ physical and work closely with students, their families, learning. Nurses serve as case managers, environment. The number of unduplicated individual students with chronic health was 232,183 in 2011-2012, approximately 16.4 percent of students. The number of reported students diagnosed with more than one past decade. The number and percent change illustrated in the following table. The chart counted and also indicates the number of care plans. Asthma, a major chronic illness among school children, is the leading cause of school experts on lung disease. The number of North Carolina students known to school nurses to have asthma during 2011-2012 school year, was 105,542. Severe allergies, such as peanut allergies or at school. During the 2011-2012 school year, 30,008 students were listed as having severe allergies, 5,202 more than during school year 2010-2011. There was a slight decline in the number of students reported with diabetes, to 4,803. School nurses provide care as well as train who bring to school increasingly complex needs and high technology. The school nurse works with the student, family and physician school personnel who are designated as 14 in 2003 to assure consistent care for students with diabetes during the school day. Students with diabetes are also encouraged to self-manage their symptoms, which will most likely Diabetes: Among the 4,803 students reported with diabetes 2011-2012: 3,915 monitor blood glucose at school at school; 1,698 manage insulin pumps; and 2,778 are known to self-carry their Students in North Carolina public schools in students with asthma, severe allergies and/ to increase in popularity. This past year, 3,454 more students with asthma, 1,338 more students with severe allergies, and 1,077 more students with diabetes selected that student to a registered nurse his or her ability appropriately, and to understand when to seek assistance. Students who are not able to demonstrate that ability and temporarily suspended and instead receive students who are able to self-medicate for seek the help of a school nurse to assist them. Number 10-11 Number 11-12 compared to all diagnosed Asthma inhalers known for self-carry 22,701 20,645 20% for self-carry 3,681 2,778 77% Epinephrine auto injectors known for self-carry 4,910 3,909 17% of students with severe allergies; 36% of students with orders for injectors ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 15 Number of Individual 11 And Percent Change Per Year School Year Number and Percent 00-01 131,589 01-02 02-03 03-04 04-05 05-06 06-07 07-08 08-09 09-10 10-11 11-12 12 Diabetes – Compliance with State Law School Health Unit of DPH surveyed all public schools in North Carolina, including charter compliance with the act. All public schools school year 2011-2012: 1. How many students with diabetes were enrolled in your LEA/charter school this generalized diabetes training to school 3. Did your LEA/charter school have at least two persons who were intensively trained on diabetes care, in any school in which one or more students with diabetes were 4. How many students with diabetes had an school nurse or other health care provider Public, non-charter school districts reported: Number and percent of school districts with one or more students with diabetes Number of students with diabetes generalized training about diabetes system-wide, as required by the statute Students with diabetes who had an Individual Health Plan or student over age 18 In each school where one or more students with diabetes were enrolled, there were two or more persons intensively trained on diabetes care services report does not otherwise contain summarizes data provided by charter schools reported: _________________________________________________________________________________________________________________ 11 12 16 L O C A L O U T C O M E Charter schools reported: Number and percent of charter schools with one or more students with diabetes students with Number of students with diabetes generalized training about diabetes wide, as required by the statute schools that had one or more students with Students with diabetes who had an Individual completed by a school nurse or other health or student over age In each school where one or more students with diabetes were enrolled, there were two or more persons intensively schools with one or more students with Case Management variety of strategies to communicate with all those involved in the care of a student. Nurses community agencies and families while of students. Among the strategies school nurses enlist to provide health care making visits to the homes of students. More than 11,187 home visits were conducted during the 2011-2012 school year to assist families with student health issues, to health plans with parents and to visit back to school. Nursing case management has been found to be an evidence-based model for In 59 school districts, the process has been formalized into a case management program with core components of assessment, health care management, community resources and for a student with special health care needs produced outcomes that indicate increased in school, and students who receive case management services from a school nurse Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Carol i na Publ i c Heal th 17 L O C A L O U T C O M E School nurse consultants made a concerted management, even in schools without a formalized case management program. improvement in students’ skills in improving their self-care, reducing their own exposures to allergens in order to reduce the need for and ability to manage their illnesses. Raw numbers of students receiving school nurse case management are tallied in the following table. The tables below demonstrate the provided case management of students: Student Health Outcomes Case Management: Asthma Student Outcomes students measured students who demonstrated improvement students measured who demonstrated improvement 1. Consistently verbalized an accurate knowledge of the pathophysiology of 2,124 1,770 83% 2. Consistently demonstrated the correct use of asthma inhaler and/or spacer 2,328 2,062 89% 3. Accurately listed his/her asthma triggers 2,142 1,827 85% pulse oximeter parameters according to care plan 506 395 78% 5. Improved amount and frequency of 1,169 956 82% 6. Improved grades 810 600 74% 7. Decreased number of absences 1,168 941 81% 18 School Nurse Case Management: Diabetes Student Outcome students measured students who demonstrated improvement students measured who demonstrated improvement 1. Consistently verbalized an accurate knowledge of the pathophysiology of 904 737 82% 2. Consistently maintained normal blood 753 561 75% 3. Demonstrated improvement in the ability to correctly count carbohydrates 649 544 84% 816 738 90% 285 226 79% 6. Calculated and delivered own dose of 614 520 85% 7. Improved grades 442 328 74% 8. Decreased number of absences 582 426 73% School Nurse Case Management: Weight Counseling Student Outcome students measured students who demonstrated improvement students measured who demonstrated improvement 1.Consistently verbalized accurate 288 214 74% 2. Kept a daily food diary for at least 30 days and as needed 69 47 68% school 177 151 85% 4. Consistently improved the ability to select choices 279 206 74% 5. Improved overall grades 78 60 77% 6. Decreased number of absences 64 54 84% Health Care Treatments and Procedures at School Some students with chronic illnesses, physical care procedures to be performed during the school day. The nurses reported processing orders for at least 34,625 individual medical treatments or procedures. Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Carol i na Publ i c Heal th 19 The chart that follows lists the number of medical orders for students for the listed treatments or procedures. In some, a emergency in a student with an underlying a tube feeding, a nurse or a person to whom the nurse has delegated the nursing care performs a daily procedure. Among all the listed procedures, only the epinephrine may be used by the student without adult assistance. Health Care Procedure Total Central venous line management 39 1,807 2,521 Nebulizer treatments 1,920 Shunt care 132 110 Tube feeding 607 13,575 For each of the listed procedures except nebulizer treatments, the numbers increased again from the previous year. For each of the procedures or treatments, an individual health plan, and in some cases also an emergency physician. Emergency Care Injuries and illnesses are common occurrences majority of school nurses cover more than one school building, few schools have a school nurse on duty every school day. Therefore, school nurses must assure that school in emergencies. Seventy-three percent daily in each school building. Currently, 109 LEAs reported having at least on one or more school campuses. During survived; three of the events were fatal. Many minor incidents occur to students and to assist with major injuries, of which there were more than 20,554 this past year, a decrease of 2,468. Serious injuries are immediate medical care plus the loss of one-half day or more of school. Of the serious injuries reported, most occurred 22 percent occurred in the classroom. For a complete breakdown of type and place of injury, refer to Appendix B. Three students died from their school-related injuries this past school year. Those deaths permanently disabled by their injuries, and L O C A L O U T C O M E 20 damage, right arm weakness, thyroid of the injuries resulted from an incident in The two students who died of football-related injuries during the fall of 2008 provided Concussion Awareness Act. It made North Carolina the 21st state with a concussion law. for high school and middle school sports. classroom teachers, and teacher assistants basis in the majority of school systems in North perform this task with safety and accuracy, of school policy and procedures, train and serve as coordinator among parents, medical providers, and the school. In nearly all of the LEAs, school nurses provided formal training programs for school employees who were charts and records to assure compliance with all physician and parent orders and to assess During the 2011-2012 school year, nurses daily to students while at school. Some daily basis included psychotropic controlled substances, including Ritalin®, Dexedrine®, and Lithium®. During the 2011-2012 school year, 87,213 is directed to be used “as needed” rather than student does not need that drug at all during any given school year. Students whose treatments. For example, an order for an Epi-pen® may not be needed if the student’s requiring Diastat. A student with diabetes whose blood sugar levels are frequently monitored and treated before they get dangerously low may not ever need a dose necessary responsibility that school health nurses manage. Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 21 Number 2009-2010 Number 2010-2011 Number 2011-2012 Number of students on long term 20,322 19,954 22,213 Number of students on short term 9,207 8,060 6,296 Number of students on emergency, as 51,412 51,511 59,666 Number of students on non- 32,265 34,879 27,547 The number of orders for non-emergency decreased slightly during the 2011-2012 school year, from 34,879 to 27,574. School nurses across the state, as well as physicians and other health care providers who can prescribe of the American Academy of Pediatrics to limit absolutely necessary to maintain the student 13 Because a number of over-the-counter drugs for the product. Determining whether the interviewing the student, assessing the nurse. Without a nurse at every school, school nurses in North Carolina must delegate the personnel. The school nurse provides training and oversight to these non-health care professionals, also called “Unlicensed commonly, those persons are teachers, teaching assistants, coaches or school secretaries. School administrators also parameters, such as providing “one or two pain relievers depending on pain level,” or providing delivers a dose of epinephrine in order to treat severe allergies. Although the student herself, there is a statutory process requiring physician orders and nurse assessment of the student’s ability to do so. Medical orders for Epi-Pens rose 21 percent during the 2011-2012 school year and have risen every year since children to carry and self-administer this drug. Between 2007 and 2012, orders for epinephrine increased from 3,847 in 2007 to 13,575 by the end of the 2011-2012 school students to self-carry and self-inject _________________________________________________________________________________________________________________ 13 22 epinephrine, only about 36 percent of the students with an order to have epinephrine available, and only 17 percent of all students with severe allergies, also had orders allowing to demonstrate this knowledge to school and in many cases, parents want adult management of their child’s emergency severe allergies, it has been agreed that it is experiencing a dangerously low blood glucose level. Insulin, by contrast, is a drug used to treat elevated blood glucose levels. Of the two extremes, low blood glucose is the most immediately life-threatening and needs to be treated quickly to increase blood glucose Diastat® is a drug with the generic name of Valium®, and is given through the rectum Versed is a form of anesthesia that some physicians prescribe for children with intractable seizures to be given through the Health Unit advises school districts to seek number of reasons, including the rare but extremely serious risk of depressing a student’s respiratory status quickly, leading to respiratory arrest and death. of midazolam, is given to children before medical procedures or before anesthesia for surgery to cause drowsiness, relieve anxiety, and prevent memory of the event. It breathing, their use is recommended to physicians who are expert in the management of airway and breathing.14 The NLM warns parents that the drug should only be given equipment that is needed to monitor heart and lungs and provide life-saving medical treatment and respond. No public school outside of of emergency respiratory treatment. who had administered Versed during school year 2009-2010 led the state’s school health nurse consultants to issue strong advisories to school nurses regarding requests to state’s school health nurse consultants led Versed was administered in N.C. public schools between those two years. The 2011-2012 surveys revealed zero instances of Versed per year the following drugs were given in N.C. public schools during the past two years. _________________________________________________________________________________________________________________ 14 . Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 23 2011-2012 2010-2011 2011-2012 Diastat Administered by licensed nurse 79 51 Administered by non nurse 121 94 Glucagon Administered by licensed nurse 7 2 Administered by non nurse 12 3 Versed Administered by licensed nurse 1 0 Administered by non nurse 0 0 school year. The following table and graph provide a 10-year overview of the numbers and percentage of Administered at School School year # Students Emergencies 2002-2003 1,279,468 N/A 2003-2004 1,311,163 N/A 2004-2005 1,332,009 N/A 2005-2006 1,363,695 N/A 2006-2007 1,386,363 N/A 2007-2008 1,404,957 2008-2009 1,410,497 2009-2010 1,402,269 2010-2011 1,409,895 2011-2012 1,417,458 24 such encounters reported by school nurses totaled 248,443—15,785 more than the The single most frequent topic for school nurse counseling was asthma. Second most frequent was chronic illness and third was hygiene. The school nurse is frequently engaged other issues related to puberty. Students also violence or bullying, and over possible neglect or abuse within their family or their concerns over a friend or neighbor. School nurses must report suspicions of child abuse/neglect whether observed or given credible suspicion by another person. Students also sought the advice of school nurses about substance abuse and tobacco use. Individual discussions around depression/suicide occurred in all grade levels. Health Counseling Students seek a school nurse for accurate, normal growth and development to serious expect a registered nurse to provide medically-related to their health and concerns. The chart that follows lists some of the health as any encounter with a student where direct maintenance were discussed. During the 2011-2012 school year, the numbers of 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 School Year L O C A L O U T C O M E Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Carol i na Publ i c Heal th 25 15 Health Counseling Elementary School Middle School High School Total ADD/ADHD 9,880 5,304 2,642 17,826 Asthma 29,624 10,701 7,054 47,379 Child abuse/neglect 2,477 1,061 658 4,196 16,198 10,701 8,133 35,032 1,313 1,989 3,022 6,324 Diabetes 10,653 10,004 7,678 28,335 Hygiene 21,873 8,281 4,453 34,607 Mental Health Issues 5,330 4,063 6,504 15,897 Pregnancy 60 1,313 7,790 9,163 3,774 4,332 7,600 15,706 Seizure disorders 2,581 1,556 1,752 5,889 Severe allergies 8,787 3,252 3,336 15,375 Sickle cell 343 296 266 905 Substance abuse including tobacco use, 471 1,555 2,710 4,736 82 334 413 829 Violence/bullying 2,301 2,558 1,385 6,244 Totals 115,747 67,300 65,396 248,443 Pregnancy For the fourth year in a row, there was a decrease in the number of pregnancies among public school students across all grade levels, as reported by the school nurses. Although student’s pregnancy as part of nursing case management or on physician orders, or guidance of labor and delivery and infant early pregnancies. The number of students reported by school nurses to be known to have been pregnant during 2011-2012 school year _________________________________________________________________________________________________________________ 15 Most but not all LEAs reported within these categories in the annual survey. L O C A L O U T C O M E 26 Status of School Enrollment for Students Known to be Pregnant Elementary Middle School High School Total Known pregnancies 2008-2009: 7 2009-2010: 3 2010-2011: 2 2011-2012: 1 2008-2009: 300 2009-2010: 278 2010-2011: 226 2011-2012: 183 2008-2009: 4,353 2009-2010: 3,996 2010-2011: 3,659 2011-2012: 3,475 2008-2009: 4,660 2009-2010: 4,277 2010-2011: 3,887 2011-2012: 3,659 Students receiving homebound 2011-2012 1 48 983 1,032 Known Pregnancies by Year and Percent Change from Previous Year School Year Pregnancies reported % increase or decrease 2002-2003 2,697 - 7.6% 2003-2004 3,131 2004-2005 3,406 2005-2006 4,072 2006-2007 4,422 2007-2008 4,904 2008-2009 4,660 - 5% 2009-2010 4,277 - 8% 2010-2011 3,887 - 9% 2011-2012 3,659 -6% is 3,659. That number is 228 fewer than the previous year. This represents more than 1,245 fewer student pregnancies from the recent high of 4,904 during school year 2007-08. decrease since 2008. This trend is also With assistance from school nurses, the majority of students managed their pregnancies well enough to remain enrolled the prenatal or postpartum period, or both, Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Carol i na Publ i c Heal th 27 L O C A L O U T C O M E Tobacco Use by Students Since Aug. 1, 2008, all schools must adopt, implement, and enforce tobacco-free16 school and school policy, schools communicate tobacco-free messages to young people and provide mentoring to youth groups In a May 2012 press release the North Carolina Department of Health and Human Services rate in North Carolina reached an historic low rates have fallen steadily, according to results from the 2011 N.C. Youth Tobacco Survey. The rate dropped to 4.2 percent from 4.3 percent in 2009, and high school smoking lowered to 15.5 percent from 16.7 percent in 200917. media campaigns and school and community www.tru.nc.gov Carolina. Suicide and Homicide suicide or homicide, is a public health emergency. Although the number is small loss of a student through homicide or suicide According to reports from the LEAs, suicide was students, and 19 of those suicides resulted in death. Suicide cases decreased slightly, from 23 the previous year to 19 in 2011-2012. Twelve students died through homicide. One suicide death occurred at school. None of the deaths from homicide were reported as occurring at school. _________________________________________________________________________________________________________________ 16 17 . 28 nurses also conducted health fairs and made boards, and civic and community groups. School nurses reported providing a total of the 2011-2012 school year. programs for students. problem. In some cases, the nurse is the only health care provider the student sees for minor illnesses and injuries. During the 2011-2012 school year, school nurses assessed and man-aged 166,103 students for illness or injury that originated at home. Issues such as the stu-dent’s health insurance status, access to care, to the number of illnesses and injuries treated medical and dental resources and referring stu-dents to providers for the diagnosis and treat-ment of a wide variety of health problems. Health Teaching School nurses were involved in a variety to groups and in classrooms. Classroom other asthma management programs, AIDS management, including general training on diabetes, and intensive training for the care of individual students with diabetes. The Death by Suicide/Homicide: School Year 2011-2012 Elementary Middle School High School Total 29 99 264 392 Deaths from suicide 1 3 15 19 Suicides occurring at school 0 0 1 1 Death from homicide 1 3 8 12 Homicides occurring at school 0 0 0 0 L O C A L O U T C O M E Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Carol i na Publ i c Heal th 29 Screening Screened % Secured Care % Secured Care Body Mass Index 57,273 3,659 6% 116 3% Hearing 145,763 3,079 2% 2,048 67%% Vision 513,884 39,999 8% 28,897 72% L O C A L O U T C O M E Follow-up, and Securing Care Voluntary mass screenings by grade or school of trained volunteers or other health professionals. Vision screenings are conducted by school volunteers. School nurses follow up on those cases are the persons who locate sources of low-cost or free care for those unable screening process did not or were not able to secure that care from a health professional. follow-up and care management services for students may reduce this gap in the providers may also reduce the gap. The following table lists the results of some of the mass screening projects that were conducted during the 2011-2012 school year. L O C A L O U T C O M E 30 between mass screening of all students or occasional screening of students referred between referral for overweight or underweight. Some students with results in either height or weight may have been percentage of public school students screened for BMI in North Carolina by the school health screening for BMI is not universally accepted 2011-2012, 57,273 students were screened for BMI. About 6 percent of those students who were measured received referrals for either overweight or underweight. The referral rate of six percent is much lower than the expected 33 percent if the screening had but the sample of students screened was not due to the limited presence of formal screening programs for BMI in North Carolina schools. Three percent of those students the screening process. Vision Screening There is no mandate in North Carolina for screenings required for students needing other health care providers who examine children prior to entry into kindergarten are required to screen for vision as part of that state-created Kindergarten Health Assessment if indicated. One indicator of the success of a school health screening program is the percent students who did not pass a screening, were evaluated by another health care provider who could diagnose and determine the appropriate during the 2011-2012 school year, screening for vision achieved a 72 percent rate of screening process. Screening for Obesity North Carolina’s children and youth are among state ranking 11th obesity18. In North Carolina, nearly one-third of children aged 10 – 17 are overweight or to what is called an epidemic of obesity Force on Childhood Obesity. This task force to screen at least some students for overweight/obesity by measuring height and weight and obtaining the Body-Mass Index Some school districts measure growth in height to a BMI. These screenings are conducted height and weight data. In some cases, the other health partners. Data from 2011-2012 _________________________________________________________________________________________________________________ 18 Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 31 Many schools, however, follow state periodically through elementary age and once more in middle or high school. Screening for vision is the most frequent school screening program in North Carolina. More than half a had their vision checked for possible eye by the Prevent Blindness North Carolina Vision working under contract with the N.C. the Children and Youth Branch to deliver vision of Public Health’s primary means of assuring criteria across all schools in North school vision screening program is an example providers. screening conducted in schools and report their results both to Prevent Blindness and to the Division of Public Health. Hearing Screening As with vision screening, there is no mandate screen for hearing, although the same rules academic support. Physicians and other health care providers who examine children prior to entry into kindergarten are required to screen for hearing as part of that exam Not all school nurses are trained in and authorized to conduct hearing screenings. School nurses assist in hearing screenings, especially related to referrals and follow-up. 32 Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 33 H e a l t h P o l i c i e s health programs. All local health departments in the state develop an agreement, the are locally developed and provide an avenue and procedures. provide parents a consistent method of to health and safety. The School Health Unit of the Division of Public Health provides guidelines regarding policy development at the local level, and recommends, at minimum, that school boards study and on the chart below. The percentage column in the table that follows indicates the percent of LEAs that have policy addresses maintenance of electronic health records in school. The trend in the health care industry is greater reliance document at least some of the nursing care they provide onto computer systems. School Health Policy board-approved policy 100% Provision of emergency care 100% Screening, referral and follow-up 83% 59% 81% Maintenance of student health records 25% care needs 70% 90% 45% 27% 34 Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 35 C o m m u n i t y I n v o l v e m e n t i n S c h o o l H e a l t h S e r v i c e s Community involvement contributes to the programs and services. School nurses encourage and promote community involvement through: Establishment of school health advisory councils; Development of inter-agency planning Recruitment of local physician advisors; and, Development of parent-teacher community involvement include: Departments; and, School-Based School-Linked Health Centers School Health Advisory Council (SHAC) School Health Advisory Councils. These all of the SHACs have a school nurse among the have a physician serving on the council. According to the policy, each SHAC must behavioral health, safe school environment, parents/community members, the local health SHACs advise LEA leadership, superintendents, health and academics, and can disseminate Local Health Departments In every county in the state, a Memorandum of Agreement between the local health department and the school district is required in order for the health department to receive state funds. These annually reviewed to support the health of children in public of each regarding epidemics and other experts, 70 LEAs are able to consult with a physician regarding the school health program. physicians or pediatricians. During school year 2011-2012, 26 percent of the school districts hosted school-located in 2011-2012 experienced a more normal out- 36 during the previous year, there was a large source of federal funding that supported a to implement SLIC. School nurses and local health departments, hospitals and others, made it possible for more than 10,923 doses Parental permission was required to administer doses to students. School-based, School-linked Health Centers established school health centers in the schools using grants, local funding and some state funding assistance. During school year 2011-2012, there were at least 50 school-based or school-linked health centers 20 The clinics primarily serve students in middle and high adolescents for access to medical care, including care for mental health or behavioral health issues. Centers provide primary care the school nurse’s ability to refer a student or his family for medical care, especially in areas of low resources. The school-based or school-linked centers provide clinical health services and may bill for the services to the parent’s insurance, other insurance providers and Medicaid. Parental permission is required for receipt of school health center services, in-diagnosis and treatment for medical Nurses employed by school-based health these registered nurses working in the school health centers are not counted among the School Health Centers depend on a resources to support the health services that funded by the N.C. Division of Public Health. resources at the local level. Partners in these centers include N.C. Department of Public centers may be obtained from the NCSCHA website, www.ncscha.org. _________________________________________________________________________________________________________________ 20 Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 37 C o n c l u s i o n School health services are just one component of a Coordinated School Health Program. By Division of Public Health, North Carolina Division of Medical Assistance, North Carolina Carolina Pediatric Society, North Carolina Academy of Family Physicians, North Carolina Dental Society, Prevent Blindness North Carolina, North Carolina School and Community Health Alliance and more, school nurses are working to help students achieve at levels they might not otherwise reach. An increase in the number of school nurses outcomes. 38 Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 39 Appendi x A : Elementary Middle High Total Total with Total with a related 504 plan ADD/ADHD 35511 18501 13519 67531 3844 6009 18117 5965 5926 30008 18865 380 Asthma 57718 25724 22100 105542 54965 823 including Asperger’s Syndrome, PDD 6124 2290 2250 10664 1079 546 Blood disorders not chronic anemia, 624 316 442 1382 424 60 Cancer, including leukemia 428 189 263 880 335 141 2557 1277 1715 5549 1753 140 Cerebral Palsy 1287 545 702 2534 782 123 Chromosomal otherwise listed including Down's Syndrome, Fragile X, Trisomy 18 1397 518 610 2525 587 96 Chronic encopresis 501 111 72 684 226 17 diseases: including Toxoplasmosis, Cytomegalovirus, C, HIV, Syphilis, Tuberculosis 82 37 68 187 35 6 166 68 89 323 180 66 Diabetes Type I 1132 1060 1567 3759 5230 914 Diabetes Type II 218 350 618 1186 655 74 81 92 172 345 60 12 and/or psychiatric disorder not otherwise listed 5030 3438 3866 12334 778 817 Fetal Alcohol Syndrome 226 199 83 508 191 11 celiac disease, IBS, 2426 1418 1617 5461 1229 155 Hearing loss 2269 1015 1026 4310 561 344 Hemophilia 234 108 105 447 226 25 40 Elementary Middle High Total Total with Total with a related 504 plan Hydrocephalus 395 126 146 667 321 40 Hypertension 375 413 811 1599 399 17 Hypo/Hyperthyroidism 319 251 416 986 115 20 endocrine disorders not otherwise listed 446 237 311 994 257 52 Migraine headaches 3038 3324 4570 10932 2349 146 186 128 124 438 229 26 Muscular Dystrophy 99 56 72 227 77 20 6145 1871 1881 9897 112 22 Orthopedic disability 1216 719 851 2786 521 144 Other neurological listed 647 238 392 1277 383 142 Other neuromuscular listed 444 204 293 941 285 84 Renal / Adrenal / including Addison's 1192 635 747 2574 722 89 Rheumatological 311 227 361 899 374 82 Seizure Disorder/ Epilepsy 4674 2058 2351 9083 5352 401 Sickle Cell Anemia 814 376 385 1575 1334 85 892 378 395 1665 200 16 258 85 137 480 208 42 215 130 186 531 173 66 Visually impaired 1107 446 649 2202 333 249 Total Number: 148994 70584 66384 285962 96768 11388 Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 41 Appendi x B : Reported Injuries in North Carolina Public Schools Requiring EMS Response or Immediate Care by Physician/ School Year 2011-12 Abdominal/Internal Injuries 4 7 52 67 53 1 1 10 22 217 1% Anaphylaxis 5 7 87 32 10 0 1 37 27 206 1% Back or Neck Injuries 17 23 57 180 135 1 10 5 43 471 2% Dental Injury 13 30 116 321 177 2 14 31 49 753 4% Drug Overdose 16 15 98 5 5 2 8 7 37 193 1% Eye Injuries 14 42 268 209 170 29 1 15 82 830 4% Fracture 13 91 135 1240 718 12 17 24 447 2697 13% Head Injuries 48 172 357 933 718 8 80 50 315 2681 13% Heat Related Emer-gency 0 4 37 90 68 3 3 6 24 235 1% 47 132 520 712 379 99 49 51 362 2351 11% Other 34 119 531 393 298 9 32 63 376 1855 9% Psychiatric Emergency 7 41 527 17 15 0 10 9 142 768 4% Respiratory Emergency 9 27 583 214 202 1 10 18 332 1396 7% Seizure 48 72 870 76 59 1 14 33 104 1277 6% Sprain or Strain 76 270 316 1385 2025 18 35 68 431 4624 22% 351 1052 4554 5874 5032 186 285 427 2793 20554 100% Total % 2% 5% 22% 29% 24% 1% 1% 2% 14% 100% 42 Appendi x C : County/LEA Name (Nurse:Student) County/LEA Name (Nurse:Student) Alamance-Burlington Schools 902 Forsyth County Schools 1,815 Alexander County Schools 986 Franklin County Schools 1,105 724 1,471 469 601 Ashe County Schools 1,048 496 1,095 1,709 Beaufort County Schools 1,381 435 683 2,249 Bladen County Schools 916 478 Brunswick County Schools 1,197 724 Buncombe County Schools 1,425 512 Asheville City Schools 1,134 1,847 Burke County Schools 1,208 Haywood County Schools 1,181 Cabarrus County Schools 921 Henderson County Schools 1,464 688 619 Caldwell County Schools 1,141 Hoke County Schools 1,002 635 575 Carteret County Schools 1,204 Iredell-Statesville Schools 1,428 720 Mooresville City Schools 1,084 Catawba County Schools 1,139 Jackson County Schools 1,007 Hickory City Schools 848 Johnston County Schools 2,104 722 569 Chatham County Schools 1,336 Lee County Schools 1,131 Cherokee County Schools 740 Lenoir County Schools 1,304 572 Lincoln County Schools 1,459 664 Macon County Schools 854 Cleveland County Schools 1,123 1,275 Columbus County Schools 916 624 566 753 710 1,159 Cumberland County Schools 2,054 1,028 651 Montgomery County Schools 821 482 Moore County Schools 1,768 Davidson County Schools 3,118 Nash-Rocky Mount Schools 869 Lexington City Schools 592 New Hanover County Schools 745 803 582 Davie County Schools 927 Onslow County Schools 1,113 639 629 Durham Public Schools 1,292 649 Edgecombe County Schools 1,013 316 Nor th Ca rol ina Annua l S chool Hea l th Ser vi ces Repor t : 2011-2012 Nor th Ca rol ina Publ ic Hea l th 43 Appendi x C : County/LEA Name (Nurse:Student) County/LEA Name (Nurse:Student) Pasquotank County Schools 981 Surry County Schools 1,055 Pender County Schools 843 Elkin City Schools 769 860 Mount Airy City Schools 536 985 333 1,276 Transylvania County Schools 1,170 1,166 565 Randolph County Schools 2,041 Union County Schools 1,190 Asheboro City Schools 913 687 Richmond County Schools 755 Wake County Schools 2,517 Robeson County Schools 1,013 615 Rockingham County Schools 1,691 583 Rowan-Salisbury Schools 1,677 Watauga County Schools 1,074 Rutherford County Schools 1,461 Wayne County Schools 1,111 Sampson County Schools 1,085 Wilkes County Schools 1,044 601 Wilson County Schools 2,006 473 Yadkin County Schools 968 Stanly County Schools 1,494 501 Stokes County Schools 1,369 North Carolina 1,179 44 Department of Health and Human Services | Aldona Z. Wos, M.D., Secretary Children and Youth Branch | School Health Unit www.ncdhhs.gov N.C. DHHS is an equal opportunity employer and provider. 10/13 |
OCLC number | 821948212 |