Secondary Education and Assessment 18360 Caldart Avenue NE Poulsbo, WA 98370 Ph: (360) 396-3029 TO: Patty Page, Superintendent Board of Directors FROM: Jeff Sweeney, Director of Secondary Education and Assessments DATE: April 15, 2015 SUBJECT: Health Services Program Effectiveness and Cost Review - April 23, 2015 Meeting Attached is the Health Services program effectiveness/cost review information for your review. Vonnie Saucerman, Nursing Supervisor, and/or one of her staff nurses will be presenting this information at the Board Meeting, and we will both be available to answer any questions you may have about the report.
NKSD School Board April 2015 STUDENT HEALTH SERVICES PRESENTATION
WHO ARE OUR NURSES? Vonnie Saucerman,RN - Supervisor T.D. Hainline,RN - NKHS, PMS, PAL Kara Kohnke,RN - Gordon,Poulsbo El, Wolfle Nanci Powell,RN - Pearson, Suquamish Jennie Watkins,RN – KHS, KMS, Vinland Sally Holt – Secretary
STAFFING RATIOS NKSD Currently 1 : 2,100 OSPI Recommendation 1 : 1,500 Center of Disease Control Recommendation 1 : 750
Life Threatening Condition Health Care Plans 350 300 Number of Plans 250 200 17.5 % increase in 4 years 150 100 50 0 2011-2012 2012-2013 2013-2014 2014-2015 Year
Total Number of Health Care Plans 700 600 Number of Plans 500 400 40 % increase in 300 4 years 200 100 0 2011-2012 2012-2013 2013-2014 2014-2015 Year
Number of Diabetics 30 25 20 Number 19 % 15 decrease in 4 years 10 5 0 2011-2012 2012-2013 2013-2014 2014-2015 Year
Number of Life Threatening Allergies 200 150 Number 33.5 % 100 increase in 4 years 50 0 2011-2012 2012-2013 2013-2014 2014-2015 Year
Student Average Headcount 6500 6300 Number of Students 6100 8 % decrease in 5900 4 years 5700 5500 2011-2012 2012-2013 2013-2014 2014-2015 Year
Other Health Concerns 4500 4000 3500 3000 Number 2500 2000 76 % increase in 1500 4 years 1000 500 0 2011-2012 2012-2013 2013-2014 2014-2015 Year
NKSD Health Services Program Effectiveness/Cost Review Summary Sheet
2015 Health Services Program Effectiveness/Cost Review Contextual The North Kitsap School District contracts through School Health Consultants Inc. for health services. NKSD entered into a three-year contract in the 2012-13 school year. There are a total of at least four (4) Registered Nurses who provide the equivalent of 2.8 FTE of direct services to all enrolled students in the district. This includes the creation and implementation of all required student Health Care Plans, as well as supervision of medication administration to students by non-licensed school staff members. They also assist the district with developing medical response plans, first-aid/health policies and procedures, vision and hearing screening, immunization compliance and records training, and case management for referred students. Costs The Health Services program is paid from district funds. The total amount of the contract is $177,525/year. The amount is allocated through district funds that come from the state formula. The district also provides a budget for a part-time secretary, hearing screener, office and medical supplies, mailings, and technology support of approximately $30,000 in addition to the contracted amount. Health Conditions Approximately 40% of our students are affected by one or more health conditions that could potentially impact their education. Currently, in the NKSD we have a total of 506 care plans written for students with around 250 of them being life-threatening conditions (LTC). Examples of LTCs are severe allergies, asthma, heart conditions, cancer, and seizures. There has been a 17.5% increa se in LTC’s in the last four (4 ) years even with a decline in student enrollment. Over half of the cases of LTC are due to severe allergies. The number of diabetic students in the district has remained fairly stable, but the care required during the school day has grown more complex. Several of the buildings have staff members who have volunteered to be a Parent-designated Adult for students and receive additional training from Certified Diabetic Educators so they can assist students with insulin injections and blood glucose testing which would normally require a licensed nurse to perform. Mental Health issues are another growing concern among our student population. The number of students with known mental health conditions has doubled in the last 4 years. The Non-Life Threatening conditions, including; headaches, neurological issues, ADD/ADHD, hearing/vision loss, orthopeadic issues, skin issues, intestinal, allergies and other misc. diagnoses accounts for a 72% increase in the last 4 years. Our total number of care plans for students has increased 40% in the last 4 years. The care plans help us to direct any type of care needed, for any student, throughout the district. The parent, student, school administrator or designee, nurse, and health care provider all have a part in making sure the care plan is effective for the student and can be carried out within the building.
2015 Health Services Program Effectiveness/Cost Review Page 2 of 2 Immunizations We implemented a plan the beginning of this school year to help increase our herd immunity and decrease the number of school exclusion notices that we send out to families. All students in the district were required to provide us with all required immunization information by mid- September or face exclusion until rectified. This enabled us to increase our herd immunity from 85% last year to 92% this year, bringing it closer to the 95% recommended by the CDC. This also helped us comply better with the State RCW which requires that all students are immunized, have an exemption notice, or are in the process to complete their immunization series prior to starting school. Program Goals All of our Registered Nurses work hard to support our students so they are in the best possible condition to facilitate student learning. There are some items that we still need to improve to make sure that this happens, but we are making progress. Field Trip Planning : The Nursing Quality Assurance Commission has established guidelines delineating what school nurses must do before delegating nursing tasks such as medication administration to non-licensed school staff who are then covered under the umbrella of the nurse’s licensure. The nurses have created new training tools and testing material for school staff that are required to administer medications during field trips. Nurses are emphasizing the importance of allowing enough notice so that field trip training can take place. School staff are being told that without adequate notice for training, nurses will not delegate medication administration under their licensure. Health/ 504 Accommodations : The Americans with Disabilities Act Amendment Act of 2008 (Section 504) broadened the definition of health conditions that could impede equal opportunity for learning at school. In an effort to comply with the Act, nurses evaluated the students in their caseloads and identified 234 students as qualifying for Section 504 Plans. Families of these students were mailed information and permission forms. Eight percent (8%) of those families opted to have a Section 504 Plan for their student. Nurses are working with counseling staff to write plans for these students. Future Recommendations: As budgets become available, we need to address aligning our nurse-to-student averages closer to the OSPI recommendation. Currently, we have a 1:2100 nurse-to- student ratio. OSPI recommends 1:1500 ratio and the CDC recommends 1:750. The current nurse staffing ratio allows the nurses to be on site at their assigned buildings only one day a week. To align staffing with OSPI recommendations, an additional 1.1 FTE is needed. The lower the ratio, the better the care for our students which should translate to improved learning. Building administrators need to insure there is adequate time for nurses to train staff in group and 1:1 situations to provide for the optimum health support for our students.
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