Las Virgenes school healthcare diagnosed
By Stephanie Bertholdo bertholdo@theacorn.com

Officials have completed an assessment of healthcare services in the Las Virgenes Unified School District, opening the door for additional personnel hirings and the expansion of medical services.

The report, prompted and paid for by the city of Calabasas, discussed the issues facing health clerks at local schools and the dangerous situations they must routinely manage.

Health clerks are required to provide first aid to ill and injured students and administer medications for a range of conditions, from attention deficit disorder and seizures to asthma, diabetes and other chronic conditions.

Health clerks must contend with emergency situations, including concussions and fractured skulls, drug overdoses, alcohol intoxication, broken bones, cuts and gashes, and other serious conditions. Health clerks also are expected to provide information and referrals to students who may be pregnant, suffer from an eating disorder, are addicted to drugs or abuse alcohol. They must peer into the minds of students and determine when a referral to a counselor or psychologist is justified. Psychological problems range from low selfesteem to suicidal tendencies and everything in between.

"This report is so bold and so startling in its findings and recommendations that it was beyond what I expected," said Mary Sue Maurer, a Calabasas City Council member who spearheaded the effort to examine school healthcare.

"I applaud the school district for taking a critical look at themselves and committing to making improvements in the area of healthcare services," Maurer said.

Among other things, the report looked at staffing. While the average ratio of school nurses to students in California is one nurse to 2,791 students, in the Las Virgenes district the ratio is 1 to 12,104. The recommended level is 1 to 750.

Other topics included emergency preparedness, medication management, schoolbased diseases and "infrastructure enhancement," which includes upgrading technology to allow better data collection regarding accidents, medication errors, injuries and lapses in policies.

"The intent of a thorough eventreporting system is to conduct rootcause analysis of critical (and) major events and to identify opportunities for improvement," said nurse Tammy Capretta in a report to the school board.

Each year, a health services advisory committee would review trends, standing orders and policies and procedures.

Better responders

Capretta recommended the school board adopt procedures outlined in the American Heart Association program "Response to Cardiac Arrest and Selected LifeThreatening Medical Emergencies: The Medical Emergency Response Plan for Schools."

"In the business world, management and employees routinely practice drills for emergencies, and this report recommends schools identify a team of trained staff to be able to respond to a serious injury or medical situation," Maurer said.

A credentialed nurse will be expected to create a health plan for each school to help identify students with special health needs.

Medication management

Schools have seen a sharp rise in medications administered to students each day. Several problems were identified, including the lack of correct student identification and the misinterpretation of medication dosages by health clerks. Clerks don't have sufficient time to accurately log the medications they are administering, which sometimes results in overdosing, the report said.

Periodically, a "front office" employee fills in for the health clerk at the school, Capretta said, a practice that is "not okay."

"We all have horror stories on that one," said Sandra Smyser, Las Virgenes School District superintendent.

Specifically, Capretta is calling for the development of a new district policy outlining the use of epinephrine and glucagons for emergencies. Epinephrine is used to ease breathing when a student has an allergic reaction. Glucagon is a medication for diabetes.

A district policy on the use of Diastat is another recommendation found in the report. Diastat helps control seizures.

Competency training, medication storage and new communication strategies are addressed in the report.

"We need another set of hands," Capretta said. "The nurse needs to be able to recognize if there is a problem with the prescription."

A districtwide diabetes and asthma management program were deemed necessary since the two conditions are often the cause of many emergencies on campus.

Staffing recommendations

Currently, the district employs one full-time credentialed school nurse (Gloria Doran), a part-time licensed school nurse and health clerks at each school site. An "itinerant health clerk" fills in when the health clerk is absent. The district also pays for contract nursing services to administer insulin shots to diabetic children. Under the new plan, Doran would become the district's nurse in charge.

An additional credentialed nurse was recommended. The new nurse would supervise and train all health clerks. The nurse would also be responsible for developing, managing and implementing a medical emergency response plan that accommodates the population and layout of each school.

What's the timeline?

The recommended changes in health services are expected to take two years to implement.

"The bottom line of this report is there are no policies and procedures for handling medical emergencies, medication management and tracking of incidents," Maurer said. "Concussions have not been identified; broken bones have been mismanaged; full on asthma attacks have not been properly diagnosed."