Navigating medicine in the school setting

Navigating medicine in the school setting | Image Credit: © Studio Romantic - © Studio Romantic - stock.adobe.com.

In this Q+A interview, Mary Beth Miotto, MD, MPH, FAAP, and Donna Hallas, PhD, PPCNP-BC, CPNP, PMHS, FAANP, FAAN, discuss how important communication is between providers, school personnel, families, and the child regarding medication delivery and organization in the school setting.

Miotto, is a pediatrician at Mattapan Community Health Center in Boston Massachusetts, as well as a member of the American Academy of Pediatrics (AAP) Council on School Health. Donna Hallas, clinical professor, program director, Pediatrics NP, New York University Rory Meyers College of Nursing, New York, New York, is also an editorial advisory board member of Contemporary Pediatrics.

Miotto highlights and explains some adjustments recently made to the AAP’s “Safe Administration of Medication in School” policy, including reminders for state and district laws regarding school administration of medicine, as well as the importance of improving processes and protocols.

Hallas breaks down what type of role a school nurse or other health-based school personnel play in the school setting, and how to best communicate to improve overall care of the child.

Contemporary Pediatrics:

What were key policy updates related to school medication in the school setting?

Mary Beth Miotto, MD, MPH:

The first goal of the policy statement was to update what a school health team looks like, and that school health team includes the student and their family as well as the community prescriber. Also, trying to let people know that because of school staffing issues, that you not only have licensed school nurses, but you will often have different members of the school health team who may not be clinically licensed, and because of that, we need as pediatricians and the office prescriber team to think a little bit differently about how to write our orders. Then we did also just update people about what they should be thinking about as far as federal, state and district laws, so that they feel comfortable allowing students to bring medication and how you communicate optimally in that legal atmosphere.

Contemporary Pediatrics:

On a larger scale, what do providers and school personnel need to know regarding regulation and legalities regarding medicine administration in school?

Miotto:

We can improve our processes and protocols. We have 2 major federal regulations that interact with our communication with school health teams. One is HIPAA, which we're pretty much all dealing with day-to-day. When we think about healthcare professionals that we're sharing with, school nurses are nurses who who fall under that umbrella. Now, as is in as is true with any health communication, the patient or their responsible guardian should be involved in that, so we want to get consent and make them front and center when we switch to Family Educational Rights and Privacy Act (FERPA), that is a little bit different. The school nurses are sort of straddling both of those because school documents are mandated to be private also.

One specific piece that a lot of my peers as well as school nurses struggle with, is the idea that treatments and orders actually do not need specific consent. So most of the orders that we're giving for administration, we're just talking about how to implement it, and that doesn't necessarily actually need separate consent than just writing the order. So I think that should put a lot of our colleagues at ease. In general, though, it's really over-communicate, right? If you over-communicate, you're going to do well.

Contemporary Pediatrics:

How important is communication between all parties, the school nurse and the doctor, and the family?

Donna Hallas, PhD, PPCNP-BC, CPNP, PMHS, FAANP, FAAN:

I always ask the parent, "do you give us permission to send the material to the school?"That's important, that communication piece. If the nurse would like to call us, they have that permission, as long as the parents have said we can talk to the nurses. I think that it's huge because the child might be doing one thing at home, well, the school nurse is just focusing on helping that child's health. They're not they're not teaching them, they're not doing their homework, doing all the things on the day-to-day. A lot of parents do depend on the school nurses and the school nurse practitioners that run the school based health clinics. They become almost a part of the family. When you have a child with a chronic illness, because they're the first ones to recognize the child needs to step up their treatment, depending on what their conditions are, or they need to go back to the office that's caring for them, whether it's the pediatrician, the nurse practitioner, to get something straightened out. The nurses have that expertise, especially when you're working pediatrics for a long time. There's a lot of children with chronic illnesses in the school systems, so they're right on top of that.

The school nurses are our colleagues, whether you know the nurse practitioner, the pediatrician, the school nurses see those children day-to-day. For children with chronic illness, they often make rounds at lunchtime, especially if you have someone who's not eating properly or has some food restrictions, either gluten have a gluten free problem, for example. So there's they're doing those types of things. So the more we are allowed to communicate with them, the more they feel free to call us about vaccines, foods, about the medications, and the more the nurses get comfortable, as well as the parents, [the better it will be].

Contemporary Pediatrics:

When it comes to school staff, what is the pediatrician’s role when communication with them as they navigate their own practice and the family of the child?

Miotto:

It varies by the situation. I always defer to talking to the families first about the conversation we're going to do well. We have automatic partners in the school health team. It can be a real pain in the neck to fill out a lot of forms, but if we can springboard those forms, say we get them at the end of or the beginning of the school year, or at each child's well visit, and we have the conversation with the family to figure out adherence at home and at school, we figure out what the barriers are, and then we pick up the phone, we make our lives so much simpler.

If we talk there first, then we can take time later to pick up the phone and usually call the school nurse directly, but I do think we have to be aware that not every school in this country has a school nurse. [With this approach], we don't find out that this child pops into the emergency room regularly because they're not taking medication. We can leverage this partnership in ways that are unimaginable, and they save time, effort and obviously, the lives and flourishing of children.

Reference:

Miotto MB. Policy outlines steps to take when students need medicine at school. AAP News. May 28, 2024. Accessed July 12, 2024. https://publications.aap.org/aapnews/news/28867/Policy-outlines-steps-to-take-when-students-need?searchresult=1