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Policy 5100 - Health Services

The purpose of this policy is to establish guidelines for the provision of health care in the Howard County Public School System (HCPSS) as outlined under existing federal, state, and local laws and regulations as well as school system policies.

Policy Document

I. Policy Statement

The Board of Education of Howard County recognizes the relationship between student health and student academic achievement. Optimal health and safety is the shared responsibility of the individual, the family, and the school system. The Board affirms its intention to provide, with the assistance of the Howard County Health Department (HCHD), health services in compliance with statutory and regulatory mandates for students with the primary goal of supporting students’ participation in the educational process.

The Board affirms its intention to provide necessary emergency health care within the scope of the health services program.

II. Purpose

The purpose of this policy is to establish guidelines for the provision of health care in the Howard County Public School System (HCPSS) as outlined under existing federal, state, and local laws and regulations as well as school system policies.

III. Definitions

Within the context of this policy, the following definitions apply:

  1. Emergency – A serious health situation or occurrence that happens unexpectedly and demands immediate attention.

  2. Exposure Incident – A specific contact between blood and/or other potentially infectious material (OPIM) and the eye, mouth, or other mucous membrane, non-intact (i.e., broken or cut) skin, vein, or muscle.

  3. Health Appraisal – The process by which a designated school health services professional identifies health problems that may interfere with learning.

  4. Health Assistant – An individual who is both a certified nursing assistant and certificated medication technician and is assigned to a school to provide delegated nursing services under the supervision of a nurse.

  5. Health Records – State mandated health screening forms such as immunization records, hearing and vision screening records, and other documents, including but not limited to medication administration records, individual health care plans, medical reports, and documentation of health room visits.

  6. Howard County School Health Council (HCSHC) – An advisory committee developed by the Superintendent of Schools and the Health Officer of the HCHD in accordance with the requirements of COMAR 13A.05.05.13 to advise the Superintendent and Health Officer. HCSHC is comprised of parents, community professionals, students, and representatives from the HCHD and the HCPSS.

  7. Nurse – An individual licensed by the Maryland Board of Nursing (MBON) to practice nursing as a registered nurse in accordance with COMAR 10.27.09. HCPSS nurses practice in one of the following capacities: cluster nurse, school nurse, or float nurse.

  8. Parent – Any one of the following recognized as the adult(s) legally responsible for the student:

    1. Biological Parent – A natural parent whose parental rights have not been terminated.

    2. Adoptive Parent – A person who has legally adopted the student and whose parental rights have not been terminated.

    3. Custodian – A person or an agency appointed by the court as the legal custodian of the student and granted parental rights and responsibilities.

    4. Guardian – A person who has been placed by the court in charge of the affairs of the student and granted parental rights and responsibilities.

    5. Caregiver – An adult resident of Howard County who exercises care, custody, or control over the student but who is neither the biological parent nor legal guardian as long as the person satisfies the requirements of the Education Article, §7-101 (c) (Informal Kinship Care).

    6. Foster Parent – An adult approved to care for a child who has been placed in the home by a state agency or a licensed child placement as provided by the Family Law Article, §5-507.

  9. Screening – A procedure used to identify students who are at risk of having a health problem. Examples of screenings include, but are not limited to, hearing and vision, lead poisoning prevention, immunization compliance, and review of physical examination.

IV. Standards

  1. The school health services program will support student participation in the educational process through prevention, identification, early intervention, and remediation of specific health problems. School health services will be provided for all students within the educational setting in accordance with COMAR. These services include, but are not limited to, the following:

    1. A health record will be created for each enrolled student. Health records will be reviewed and maintained in accordance with state requirements.

    2. A health appraisal for each student identified through the review of records as having health problems or concerns will be conducted in accordance with state requirements. Health services will be provided in accordance with the appraisal.

    3. Health screenings of students will be carried out in accordance with state mandated requirements, including screenings for immunization, physical examination, lead, and health care provider.

    4. Communicable disease prevention and control in the school setting will be provided jointly by the HCHD and the HCPSS.

    5. Written procedures for emergency care management will be jointly developed by the HCPSS and HCHD and implemented by the HCPSS.

    6. Do Not Resuscitate Orders (DNR) will be implemented for students as ordered in compliance with Maryland State Health Services Guidelines.

    7. Issues of parental consent and confidentiality will be addressed in accordance with state regulations and Policy 9050 - Student Records.

    8. Each school will maintain a separate health suite in compliance with state requirements.

  2. Licensure and certification of nurses and health assistants will be maintained in accordance with state and system requirements.

  3. Nurses may only delegate nursing tasks to health assistants and other unlicensed employees in accordance with the Maryland Board of Nursing Nurse Practice Act.

  4. HCPSS will supply overdose reversing medication in accordance with state law.

  5. The school nurse, school health personnel, and other school staff will be trained to administer overdose reversing medication to a student or other person located on school property who is reasonably believed to be experiencing an opioid overdose.

  6. At least one employee assigned to each school, other than nurses and school health assistants, will be currently certified both in first aid and cardiopulmonary resuscitation (CPR) according to state standards.

  7. The Health Services Office, in consultation with the Safety, Environment and Risk Management Office, will develop and implement procedures for exposure incidents involving blood and body fluid exposures for students and employees in compliance with the Health Services Requirements and Procedures manual, the Maryland State School Health Services Guidelines, and the Occupational Safety and Health Administration (OSHA) regulations.

  8. Nurses and health assistants will provide health services to HCPSS students during the school day. Under COMAR 10.27.11.03, the nurse may delegate the responsibility to perform a nursing task to a health assistant.

  9. Nurses and health assistants will provide emergency first aid to employees and visitors within the scope of their licensure/certification and employment.

  10. Nurses and health assistants will provide emergency medication or treatment for diagnosed medical conditions to employees only in accordance with the HCPSS health services manual.

  11. Health services employees will address health related issues through classroom, small group, and individual education. Health services employees will collaborate with instructional employees to provide such education as appropriate.

  12. Activities of health services employees related to provision of health services will have precedence over non-health care activities.

  13. Professional development will be provided for health assistants and nurses to enable them to implement policy.

  14. Supervision and formal evaluation of nurses and health assistants will be provided in accordance with Maryland Board of Nursing and HCPSS requirements.

  15. School health services program information will be disseminated annually.

V. Responsibilities

  1. The health services coordinator/designee will supervise and evaluate professional registered nurses.

  2. The health services coordinator will develop and implement periodic audits as deemed appropriate.

  3. The health service will ensure that appropriate professional development is provided to health assistants and cluster nurses.

  4. School-based administrators will provide written input into the annual evaluation of health assistants and nurses assigned to their schools.

  5. Nurses will supervise and formally evaluate health assistants.

  6. Nurses will ensure compliance with health services procedures and state mandated services in the schools to which they are assigned.

  7. The Superintendent will appoint a Health Services Office representative to the HCSHC.

VI. Delegation of Authority

The Superintendent is authorized to develop procedures for the implementation of this policy.

VII. References

  • The Regulations of the U.S. Department of Health, Education, and Welfare; Title 34 C.F.R., Public Welfare, Part 99 (Privacy Rights of Parents and Students)

  • Individuals with Disabilities Education Act (IDEA), 20 U.S.C. §§1400 et seq.

  • Section 504 of the Rehabilitation Act of 1973

  • The Americans with Disabilities Act of 1990

  • The Annotated Code of Maryland, Education Article, §7-401 to §7-403.1, §7-411, §7-426.5

  • The Annotated Code of Maryland, Health Occupations Article, Title 8, Nurse Practice Act

  • COMAR 10.27.09

  • COMAR 10.27.11.03

  • COMAR 13A.05.05–15, School Health Standards

  • COMAR 13A.08.02, Individual Student Records

  • Family Educational Rights and Privacy Act of 1974 (FERPA)

C. Relevant Data Sources

D. Other

  • HCPSS Student & Parent Handbook

  • Health Services Requirements and Procedures Manual

  • Maryland Board of Nursing Nurse Practice Act

  • Maryland State School Health Services Guidelines

  • National Safety Council Recommendations

  • Occupational Safety and Health Administrator (OSHA)

  • Worker’s Compensation First Report of Injury or Illness Report and Employee Injury Reports

VIII. History

ADOPTED: August 3, 1971

REVIEWED:

MODIFIED: February 12, 2015, September 19, 2017

REVISED: December 10, 1992, June 28, 2007, April 15, 2010, February 10, 2011

EFFECTIVE: September 19, 2017