School Nurse Improvement Plan Final 2

Category: Education

Presentation Description

Quality Improvement Plan for School Nursing Microsystem


Presentation Transcript




DESCRIPTION AND NEED FOR CHANGE Microsystem: P reschool and Kindergarten students – school nurse, OT, PT, teachers (special and regular education), paraprofessionals, principal, secretary, contracted staff as needed. Need: To include school nurses in the process of student evaluation from the beginning of the process/entry into the school system. Current process: 2 ways to enter school – home or referral from special supports and services Special Ed, PT/OT, speech, and teacher evaluations (principal also involved in placement and coordination of services) Staff will ask nurse to screen for hearing and vision and mention any potential health issues like ADHD, Autism, sensory dysfunctions, genetic conditions, etc. Asthma and allergies are determined after paperwork is complete from parents No formal plan/protocol exists for involving the school nurse in student evaluations IEP (Individualized Education Plan) will be developed and meeting scheduled to review with parents and seek approval .

Proposed Process:

Proposed Process Nurse evaluation to be included along with other staff evaluations using a student health information form (see Appendix A) If medical issues found, in-depth assessment completed (see Appendix B) IHP created (see Appendix C) IHP shared with staff


Specific and Global Aims Global : The mission of School Administrative Unit # 666 is to develop and support an educational community that advances rigorous standards for learning for all students, resulting in high student achievement. Specific: I aim to improve student outcomes by decreasing time waiting for medical reports by at least 50% and to include the school nurse in the new student evaluation process every time there is a student registered for school with an actual or potential health need.


EVIDENCE School nursing services generated an estimated net benefit of $98.2 million to society during the 2009-2010 school year. For every dollar invested in the program, society would gain $ 2.20. 89% percent of the 10,000 simulation trials resulted in a net benefit. S chool nursing services were a cost- beneficial investment of public money, warranting careful consideration by policy makers and decision makers when resource allocation decisions are made about school nursing positions . ( Wang, Vernon- Smiley, Desisto , Maughan , Sheetz , 2014)


EVIDENCE (continued) A new nurse case management policy implemented in an urban school district in the Southeast, enabled school nurses to select students with health and learning needs, target specific outcomes, implement interventions, and document the gains made. In the 4 years of the project, 84% of the students case managed improved in 1 or more of the 5 target areas ( Bonaiuto , M., 2007). S chools with higher rates of daily attendance tend to generate students who perform better on achievement tests than do schools with lower daily attendance rates (Sheldon, S., 2007). W hen students attend school more often, they are less likely to engage in delinquent or destructive behaviors (Sheldon, S., 2007). M issing school has been associated with negative and risky student behaviors, such as tobacco, alcohol, and illegal drug use (Sheldon, S., 2007).


BARRIERS Macrosystem level: Board of Education and School Superintendent Change Cost Time Training Possible perceived lack of benefit to district Mesosystem Level: Principal Change Acceptance of new idea Time Microsystem Level: Staff (teachers, paraprofessionals, OT/PT, SLP, secretary) Change Loss of control Personality conflicts Difficulty collaborating

Systems Thinking:

Systems Thinking

PDSA (Plan-Do-Study-Act):

PDSA (Plan-Do-Study-Act) Plan: School to implement an initial medical intake/assessment form for identified students as part of the evaluation process when they first come to school Speeds process of receiving medical diagnoses from students’ providers and coordination of services as well as improving student outcomes/learning Identify any medical needs, c ollaborate with other staff, c reate IHP Do: Implement IHP – share with staff - assess for problems, missing info Begin to analyze data and listen to team members’ feedback Study: Complete data analysis and compare to expectations What did we learn? What works? What doesn’t work? Discuss with team members Act: Make changes What is the next step? P D S A


Fishbone Diagram (Cause and Effect) People Environment Process Students/Families/Providers Resistance to change Undefined roles No flowchart of process No existing process for nurse evaluation Confidentiality issues No privacy in health office – half wall only/no door No dedicated fax machine for health office Medical paperwork not easily attainable Slow provider response time Confidentiality Vague school policies Lack of respect for nurse’s role N o medical evaluation completed by school nurse and increased time spent waiting for medical reports Slow parent response time How will it help them? Appropriate medication and supplies


Patient Value Compass Can be used in any population of patients Patient outcomes evolve over time A good way to compare progress/regression Can track costs and satisfaction over time as well The school nurse is able to look at a PVC for each identified student with a medical need as follows: Is the student learning about his/her illness (increase by at least 50%)? Number of absences over time (not more than 2 days per month) Is student progressing in classroom as expected(on grade level after 4 months) Do parents report positive outcomes (at least 90% of the time)?

Data Collection Plan:

Data Collection Plan Feedback from staff and parents (questionnaires) Weekly consults with staff on how plan is going Is the new process decreasing time to receive medical diagnoses from providers? Does the nurse’s involvement increase positive student outcomes (fewer absences, decrease in behaviors, etc.) Ways to Collect Data: A ction plan Gantt chart

Gantt Chart (example):

Gantt Chart (example)

QI Team (OT, SLP, SpEd, Classroom Teacher):

QI Team (OT, SLP, SpEd , Classroom Teacher) Review current process/flowchart Discuss need for change from nursing perspective and obtain their perspectives Go over new process plan Discuss maintaining these activities over time – fast, easy for all staff to understand, how will benefit students and staff Weekly consults Involvement in IEP/504 meetings as necessary to manage process and ensure positive outcomes At end of school year meet to discuss success/failures of plan and how to proceed for next school year

IT – Information Technology:

IT – Information Technology Excel spreadsheets Bar graphs Statistical programs if available


R eferences Batalden , P., Godfrey , M. & Nelson E., ( 2007). Quality by Design (1st ed.). San Francisco , CA : Jossey -Bass. Bonaiuto , M. (2007). School Nurse Case Management: Achieving Health and Educational Outcomes [Abstract]. Journal of School Nursing, 23 (4), 202-209. Retrieved February 5, 2016 from pubmed /17676967 . Colorado Department of Education. (2016, January 22). School Nursing and Health - Health Conditions. Retrieved February 16, 2016, from https:/ / / healthandwellness / snh_healthissues Sheldon, S. (2007, June 14). Improving Student Attendance with School, Family, and Community Partnerships. Retrieved February 15, 2016 from http:// /news/education/967472 . Wang , L., Vernon-Smiley, M., M. G., Desisto , M., Maughan , E., & Sheetz , A . ( 2014). Cost -Benefit Study of School Nursing Services . The Journal of the American Medical Association Pediatrics , E1-E6. Retrieved February 5, 2016 , from http:/ / archpedi.jamanetwork.comntranet .


Appendix A (Colorado Department of Education, 2016)


Appendix B (Colorado Department of Education, 2016)


Appendix C (Colorado Department of Education, 2016)