LEGALISSUES-CSNO法律问题-加利福尼亚学校护士组织

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1、LEGAL ISSUES,LEGISLATION AND HIPAA/FERPA in SCHOOL NURSING PRACTICE,1,Cathy Owens, R.N., M.Ed., NCSN cowensmurrieta.k12.ca.us,Factors that Influence our Practice,Increased students with medically fragile conditions Nurse/student ratio State and Federal laws County and State regulations District heal

2、th policies Expanded role of the school nurse,Legal Considerations,Federal Regulations IDEA, 504, ADA, FERPA HIPAA, OSHA State Regulations and Guidelines Legislation, CEC, Health and Safety Code, NPA, CCTC Standard of Practice CSNO/NASN Policies Local Regulations and Policies County mandates, “Like

3、practice” School District Policies Board Policies and Administrative Regulation Manuals/guidelines,FERPA,Family Educational Rights and Privacy Act Applies to all educational agencies (or anyone who receives federal funding from Dept of Ed-therefore private schools are usually exempt) Right to inspec

4、t, review and amend student records Educational record=directly related to student and maintained by educational agency Health records-part of educational record IEP-records are covered under FERPA,FERPA-cont,School officials, including teachers, that the school or district has determined to have le

5、gitimate educational interests”. Health concerns notification? In an emergency if knowledge of the information is necessary to protect the health or safety of the student or other individuals” Instances of abuse or neglect. Mandatory reporting of communicable diseases Information that is required by

6、 a school to which the student is transferring. Certain legal situations including subpoenas or investigations of criminal offenses.,FERPA-Nurses notes,If a school nurse maintains personal notes, are they part of the educational record and thus subject to FERPA? No, but only if all of the following

7、criteria are met: The notes are kept only as a memory aid; They remain in the sole possession of the writer; They are shared with no one except a temporary substitute nurse; and They are not used to replace or avoid normal documentation. In general, personal notes are not recommended. Information re

8、lated to health office visits should be documented in the students individual record.,HIPAA,Health Insurance Portability and Accountability Act (not HIPPA) Instituted to govern electronic health transactions Requires covered entities to protect privacy of records Fax machine-secure location, limited

9、 access? Care provided through school health clinic -if conduct transactions electronically-falls under HIPAA unless records are educational. MOST school records are covered under FERPA,HIPAA cont,Medical records from healthcare provider-HIPAA Not able to be shared with anyone who is not providing t

10、reatment or care-however schools may share this information under FERPA if applicable to education. If translate those records into student record-then FERPA Allows discussion between dr and nurse re: medication, treatment/care plan w/o authorization from student or parent Also allows sharing of inf

11、ormation to law enforcement, school officials, family members, etc-if there is potential for safety concerns (Virginia Tech),Board of Registered Nursing,Nurse Practice Act Delegating vs Assigning Only statute/legislation can delegate to UAP-nurse does not delegate Supervision and Training responsibi

12、lities-do others practice under our license?,Legislation,Most education codes are as a result of a legislative decision Ed Code defines how to implement it in the schools ie: SB 161- Diastat administration 49414.7 SB 191-Asthma inhalers in schools 49423.1 AB 559-Epi Pen standing orders 49414,Califor

13、nia Education Code,Governs schools practice Defines medical services in schools- Permissive (not prescriptive) Ed Codes that refer to health services/nursing 49414 Administration of epinephrine 49414.5 Glucagon administration 49423 Carry or self administer epinephrine 49423.1 Carry or self administe

14、r asthma medication 49423.5 Sphcs (specialized physical health care services) 49423.6 Medication Administration 49423.7 Diastat administration 49452.5 Scoliosis-suspended mandate at this time 49452.6 Acanthosis nigricans 3 year program 49452.7 Type II diabetes information-7th grade,Delegation by Sch

15、ool Nurses,Only can delegate if: -Task is routine -Client is stable/outcome is predictable -Task poses little or no risk to client -No pre or post assessment is required -Does not require any technical skill or scientific knowledge,Negligence and MalpracticeDefinitions,Negligence is a deviation from

16、 the accepted standard of care which places a person at risk. Malpractice is professional negligence when the conduct fails to meet the legal standard of care and someone is damaged as a result.,Malpractice Insurance,It is your own decision! School district is required to defend you in civil action

17、unless Act or omission was not in course and scope of employment Negligence was result of fraud, corruption or malice If there is a specific conflict of interest School district may defend you in administrative proceeding or criminal action if: Act was in course and scope of your employment and Prov

18、iding a defense would be in best interests of public entity,Liability Issues,Most lawsuits against school nurses allege negligence: Failing to provide appropriate care-either directly or indirectly Failing to provide proper supervision/training-notify administration of incompetent staff Failing to h

19、ave procedures and protocols in place Misdiagnosis an illness or injury Assignment of tasks that are not appropriate or safe,Contributing factors to district and nursing liability,Failure to document adequately medication, care plans, trainings, supervision do you have clear protocols, SPHCS, ER pla

20、ns-who gets them? Failure to follow school district policy Do you have written policies on illness, injuries, medication policy? Failure to challenge administrative decisions that put students at risk Do you notify administration of staffing issues, incompetent staff, risky/unsafe situations? Failur

21、e to obtain informed consent Do you have release info on medication, H/H apps?,Summary,School nurses are medical expert in an Educational world Reports, communication, in-services Join local and state organizations Contact local legislators-we are the voice for students with medical needs in the school!,ANY QUESTIONS?,