In Delaware, every public school nurse can access childrens’ electronic health records, with parental consent, to better coordinate student care through a unique partnership involving Nemours Children’s Health System.
Nemours, the Delaware Department of Education and the Delaware School Nurse Association created the School Health Collaboration, which provides nurses in schools across Delaware with read-only access to student health records. Nurses can access records through a secure portal.
“It began in 2011, when nurses expressed concerns that their students were patients and when they tried to get information there were various barriers,” said Ann M. Hurst, BSN, MSM, RN, CNML, senior director of nursing at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del.
Previously, when school nurses called the hospital for medical information about a student, hospital staff were unclear what they could share.
“It really spoke to a larger problem that the school nurse was not being recognized as part of the healthcare team and that is a common misconception,” Hurst said. “A lot of times the school nurse is viewed as on the education side as opposed to the healthcare side. That was part of an underlying goal of the project — to get the school nurse recognized as an extension of the child’s healthcare team, since school is where they spend the majority of their time.”
Through the program, nurses can access any student’s records if the parents sign up, but it is primarily geared toward students with chronic conditions, complex medical conditions and special needs.
“It’s a wonderful tool for us, and in so many ways it ends up benefiting the kids,” said Jan Marcin, BSN, RN, NCSN, a school nurse at Henry B. DuPont Middle School in Hockessin, Del., where she works on a small program for students with complex medical conditions or special needs.
School nurses in the special program provide care for students with cystic fibrosis, cerebral palsy, seizures, autism, feeding disorders, cognitive impairments and endocrine disorders. They help students requiring assistance with personal care, speech augmentation devices, medications, tube feedings or special diets.
The program is in all 19 of the public school districts in Delaware, half of the charter schools and a few of the private schools. It serves about 1,400 students.
Having real-time access to the medical data of students with complex medical issues or special needs integrates their healthcare and helps families to view them as a trusted resource for information, school nurses say.
“Care coordination is key for the health of children,” said Beth Mattey, MSN, RN, NCSN, president-elect, National Association of School Nurses. “We’re all working together with a point person at home, a point person at the hospital and a point person at school. It also includes the child, especially a high school student who will soon graduate.”
School nurses play a vital role since students spend most of their waking hours in class, said Susan Hoffmann, MSN, RN, NCSN, president of the Delaware School Nurse Association and a school nurse at W.B. Simpson Elementary School in Camden, Del.
“If a child has a chronic illness the school nurse’s role with care coordination can be critical for that student to be healthy,” Hoffmann said. “The communication is so important with the physician and by being able to have direct access, we don’t have to filter everything through the eyes of the parents. It can make the communication so much clearer.”
Nurses say the program could be strengthened with more options. “What I would like to see in phase two of this is if our clinicians could see the medical records contained in the school,” Hurst said. “That would be great if we could get that two-way communication going.”
School nurses say in the future they would like to have more than read-only access.
“It would be nice to upload our blood sugar readings, or maybe the education we’re doing, so they can reinforce that as well,” Mattey said. “It would be a benefit on both sides.”
Marcin agrees. She said if a child’s behavioral medication is not working or is too much and the child is falling asleep in class, she has to call the physician’s office. She would like to be able to send messages through the secure portal.
“The nurses in my program that have very complex care look at (health records) very often,” she said.