Effective Date: September, 2007 Revision Date: June 19, FASA Handbook Chapter 8 SCREENING PROGRAM

Transcription

1 FASA Handbook Chapter 8 SCREENING PROGRAM Purpose: To complete mandatory screening (NRS ) for vision, hearing, height and weight at school entry and at scheduled intervals throughout the child s school years to facilitate educational success. Additional Authority: Clark County School District Regulation 5150, Health and Welfare: Students; Clark County School District Regulation 5111, Age of Entrance and Enrollment Identity Documentation Requirements; Nevada Assembly Bill 206; Nevada Revised Statute (NRS) , Physical examinations of pupils; qualifications of persons to conduct examinations; notice to parent of examination and opportunity for exemption; report of results to State Health Officer; Nevada Administrative Code (NAC) 632, Nursing; Nevada Nurse Practice Act; Nevada School Nurse Regulation and Advisory Opinion; National Association of School Nurses Scope: School Nurses, First Aid Safety Assistants (FASA), FASA Screeners, FASA Floats Responsible Party: Director of Health Services Distribution: Health Services Coordinators, School Nurses, Specialized Procedure Nurses (SPN), First Aid Safety Assistants (FASA), Unlicensed Assistive Personnel (UAP) 1.0 Policy Statement POLICY School-based screenings are performed to check for a variety of conditions or problems that may impact children at school and in accordance with state mandates. Children who are identified to have a problem are referred for a more thorough examination to determine the extent and severity of the condition. 1.1 FASA performance of screening procedures should be reviewed yearly by the School Nurse with a return demonstration of proper screening techniques.

2 1.2 The site School Nurse will provide training for vision, hearing, and measurement screening to ensure that the FASA completes these screenings according to established standards. 1.3 Those students who fail the initial (baseline) screening are to be rechecked by the School Nurse. All referrals will be made by the School Nurse. 1.4 FASAs may not perform postural screening for scoliosis. 2.0 Role of the FASA 2.1 The FASA is responsible to perform initial (baseline) vision and hearing screening on students new to the Clark County School District (CCSD) or as directed by the School Nurse. In addition, the FASA may assist the nurse with height/weight measurements for selected students. 2.2 The FASA may be asked to assist with clerical tasks related to any type of screening including postural screening. 2.3 The FASA, under the direction and supervision of the School Nurse will: Complete initial (baseline) vision and hearing screenings on all students new to the district, students who were absent during screening, or other designated students. 2.4 Vision and Hearing Screening Preparation - Screening responsibilities are under the direction of the School Nurse and may include: 3.0 Mass Screening Vision and Hearing: Preparation Procedure 1. Reserve a room for screening as early in the school year as possible. Meet with the site administrator to secure a quiet, appropriate location.

3 The library is preferable. 2. Adequate space is needed for Instalines. 3. Under the direction of the School Nurse, set up the screening schedule, considering number of students in the class and the total number of students per period. Office personnel can help reserve a room. Ideally, a separate room should be used for hearing screening, unless the library is being used. 2 feet between Instalines and 10 feet from Instaline to student. Consider minutes per class (Elementary); minutes per class. (Secondary). Do not schedule screening during a teacher s lunch period/prep schedule. 4. Print a report of missed exams (HMS 237) 5. Notify teachers of the screening date 2-3 weeks prior. May be ed and/or put in teachers boxes. Teachers may distribute Vision and Hearing Screening Letter to Parent (HS) (optional). 6. Distribute final screening schedule to teachers one week prior. 7. Have class lists and schedule ready for screening. Print from Infinite Campus (IC): For kindergarten, distribute Kindergarten Screening form to teachers (Forms & Handbooks friendly forms). Print adequate copies for each screening member and one for the health office. Index >> Attendance Reports >> Sub Attendance Roster, for grades 4, 7 & 10 th. Identify exempt students on class lists. 8. Have available waste baskets, sharpened pencils and pens for each nurse and screener, desks or tables, adult and child size chairs as needed, eye patches, sticky notes, envelopes, copy paper, highlighter Screeners MUST NOT screen exempt students. Vision and hearing equipment needs depend on the personnel performing the screening.

4 markers, masking tape, and hand sanitizer. 9. Have two or more computers ready for documenting screening results with WIFI code available. 10. All screening referrals must be generated through Healthmaster (HMS). Site nurse will log into HMS. Use group results tab in HMS to document mass screening normal results. Print out referrals, per site nurse direction. 11. Distribute referrals. May be given to student or mailed through district mail. 12. Complete screening on those students who were absent or who need rechecks or require follow-up. Follow-up appointments may be scheduled in HMS. 13. Document completed eye exam findings/completed referrals in HMS. 14. Under the direction of the School Nurse, follow up on outstanding referrals in a timely manner. Record follow up in HMS through the referral dropdown menu. 4.0 Scoliosis Screening Preparation - Clark County School District Health Services Department has designated seventh grade for this screening. FASAs do not perform postural screening but may assist with preparation and documentation under the direction of the School Nurse. 4.1 The locker room is generally utilized for scoliosis screening. Confirm dates with the PE teacher and administrator at least three weeks in advance. Ensure that privacy for each student is maintained.

5 4.2 Complete parent notification two weeks prior to screening utilizing Scoliosis Screening Parent Notification Letter, (HS), (required); optional notification may be done through ParentLink or school website. 4.3 Assist with printing class schedules utilizing class designated by School Nurse. Make copies for all screeners. 5.0 Mass Screening with FASA Screening Team Procedure 5.1 The Health Services FASA Screening Team, coordinated by a Health Services Coordinator, provides assistance with the completion of mandated vision, hearing and measurement screening activities under the supervision of the site School Nurse. 5.2 Screeners MUST NOT screen exempt students. 1. Site nurse will request the FASA screening team or teams, as coordinated by Health Services. 2. High schools/middle schools will be screened by the FASA screening team. 3. The FASA screening team will arrive at the designated school start time per site nurse and work their contract day. 4. Each FASA screening team member brings his/her own vision, hearing or measurement instruments and supplies. The screening team needs time to set up and prepare for screening. The site nurse is encouraged to utilize the team s services for the entire contracted day, (i.e. recording results in Healthmaster, screening new students, printing and addressing referrals, etc.). Site nurse to provide resource information (i.e. referrals, envelopes, copy paper, rubber bands). 5. The FASA screening team may Results are documented in HMS. Print

6 consider using library computers (if applicable) or may bring laptops to record results. out referrals per direction of site nurse. 6.0 Screening Guidelines with Grade Level Requirements GRADE * Pre-K, Kindergarten New-To-District (NTD) 4 th,7 th, 10 th or Retained Recording; Documentation Recommended Referral Criteria DISTANCE VISION Instaline: Lea Symbol for Pre-K and K, Lea Number for all other grades Monocular to 20/16 (binocular optional) Monocular to 20/32 (binocular optional) Monocular to 20/32 NEAR VISION Lea Near Vision Card: Symbols for Pre-K and K, Numbers for all other grades Binocular to 20/20 Binocular to 20/20 MUSCLE BALANCE* OR STEREO Instaline for Muscle Balance OR Stereo Fly, Reindeer, or Butterfly Instaline or Stereo Instaline or Stereo COLOR* Color Made Easy or Ishihara or Pseudo- Isochromatic Plates Boys only Boys only (binocular optional) * * * Pass or Fail Pass or Fail Pass or Fail Pass or Fail (acuities optional; (acuities note with or optional; note without with or without glasses/contacts) glasses/contacts) Pre-K and Kindergarten: Refer over 20/40 or any greater than 2 line difference between eyes; Grades 1 thru 12: Refer over 20/32 or any greater than two line difference between eyes. Pre-K and Kindergarten: Refer over 20/40; Grades 1 thru 12: Refer over 20/32. Hearing is done at K, 4 th, 7 th, 10 th, NTD, and Retained. See specific criteria for passing and referral in School Nurse manual. Do not screen students with hearing aids. Scoliosis is done in 7 th grade. Muscle balance: Sees one box only or two boxes not touching with either eye. Stereo: Touches book, does not see butterfly, unable to see L & R boxes right side, or cannot distinguish which animals pop out, on left side Refer to directions for specific color plates 7.0 Distance Vision Screening Procedure

7 7.1 Observe student as they are being tested. Student should be facing directly forward towards the Installine equipment. Any attempt to reposition themselves or any evidence of squinting, blinking, eye movements, or other unusual behavior should be referred to the School Nurse. 1. Students are screened at 10 feet from Instaline; preferably at eye level with the Installine. 2. Ask if student wears glasses or contacts. Place marker on floor. Symbols or numbers are used depending on developmental/education level of student. Students are screened with glasses or contacts on. If student does not have glasses with them, document screened without glasses. 3. Position student with toes on floor marker. 4. Screen Binocular Vision. Binocular means with both eyes open and uncovered. Mandatory for pre K, New to District. Optional for 4, 7, 10 th grades, or retained students Mandatory for vision assessment. 5. Student must identify 3 out of 5 symbols/numbers per line to pass. Pre K and Kinder: Refer acuity over 20/40 Grades 1-12: Refer acuity over 20/32 6. Screen Monocular Vision: Student covers left eye with patch. 7. Student must identify 3 out of 5 symbols/numbers to pass. Avoid pressing on the covered eye. Both eyes remain open during screening. Pre K and Kinder: Refer acuity over 20/40 Grades 1-12: Refer acuity over 20/32

8 8. Student covers right eye with patch. Avoid pressing on the covered eye. Both eyes remain open during screening. 9. Student must identify 3 out of 5 symbols/numbers to pass. Pre K and Kinder: Refer acuity over 20/40 Grades 1-12: Refer acuity over 20/32 or greater than two line difference between eyes. 10. Results are recorded in HMS using appropriate global template. Acuity results must be entered manually. Refer to HMS guidelines in SHOMS. 8.0 Lea Near Vision Screening Procedure 6. LEA symbol/number near vision card is used. 7. Ask the student if they wear glasses or contacts. Symbols or numbers are used depending on developmental/education level of student. Students are screened with glasses or contacts on. If student does not have glasses with them, document screened without glasses. 8. Sit/stand directly in front of student. 9. Place vision card inches away from student. 10. Screen Binocular Vision. Binocular means with both eyes open and uncovered. 11. Student must identify 3 out of 5 symbols/numbers to pass. Measured using cord on card from the outer corner of the eye During screenings and annual updates only, results of both eyes ou are required. Pre K and Kinder: Refer acuity over 20/40 Grades 1-12: Refer acuity over 20/ Student covers left eye with patch. Avoid pressing on the covered eye.

9 Both eyes remain open during screening. 13. Student must identify 3 out of 5 symbols/numbers per line to pass. Pre K and Kinder: Refer acuity over 20/40 Grades 1-12: Refer acuity over 20/ Student covers right eye with patch or hand. 15. Student must identify 3 out of 5 symbols/numbers per line to pass. Avoid pressing on the covered eye. Both eyes remain open during screening. Pre K and Kinder: Refer acuity over 20/40 Grades 1-12: Refer acuity over 20/32 or greater than two line difference between eyes. 16. Results are recorded in HMS using appropriate global template. Acuity results may be entered manually. 9.0 Color Vision Procedure 1. Color vision screening is performed on males during mass screenings. Color vision screening is performed on both males and females during vision assessments. 2. Screening is completed on all male students once. 3. Use Color Vision Testing Made Easy Screener. This condition is more prevalent in males but may occur in females. All pre K, Kinder, New to District and as a component of an individual vision assessment if not previously completed. This is the standard for Health Services. 4. Hold screener 30 inches from student s eyes. 5. Student must identify all three symbols (dog, boat, house) correctly to pass. The car symbol is universally seen and not part of the screening results.

10 6. If the student fails any of the three symbols, complete additional screening using the shapes in the remainder of the screening book. 7. Records pass or fail in HMS in the color vision field. Refer to instructions for pass/fail. Generate referral from HMS. 8. Notify the teacher of the possible deficit per School Nurse direction Muscle Balance Procedure 1. Muscle balance screening is done once. 2. Use stereo vectogram and 3D glasses. Preferably at pre K or Kinder level. Butterfly, Fly, or Reindeer 3. Student puts on 3D glasses. Worn over student s own glasses. 4. Hold the vectogram inches directly in front of student. 5. For the stereo butterfly test, the student must verbally identify or trace its shape. For the stereo fly, the student must pinch the wing of the fly above the flat picture plane. For the stereo reindeer, the student must pinch the nose or the antlers above the flat picture plane. A failed stereo butterfly test occurs when the student is unable to verbally identify or trace its shape. A failed stereo fly test occurs when the student is unable to pinch the wings or directly touches the book. A failed stereo reindeer test occurs when the student is unable to pinch the nose or the antlers or directly touches the book. 6. A failed stereo test may indicate a variety of eye issues that may need further evaluation. 7. Document pass or fail in HMS in the muscle balance field. Under the direction of the School Nurse, generate a vision referral from HMS.

11 11.0 Hearing Screening Procedure 1. Use standard audiometer. 2. Sit student so they cannot see the audiometer being operated. Small children may need to face examiner. Older students should face away from examiner. 3. Place hair behind ears. May interfere with proper placement of earphones. 4. Have student remove glasses, large earrings, etc. 5. Instruct student to raise hand to indicate when tone is heard. 6. Place the earphones Red on Right and Blue on Left, and then start testing the right ear first. Repeat steps with the left ear. May interfere with proper placement of earphones. May raise either hand. May need to practice with small children or those who have difficulty following directions. Older students may hold/place earphones independently. 7. Use of the pulse tone is preferred. May use warble if a more accurate response is obtained. 8. Test Hz frequencies 1000, 2000, 4000, 1000, 500* at 25 db. Test in standard order to allow hearing adjustment to changes in frequencies. *If environment is noisy, 30 db at 500 Hz is acceptable. 9. If student does not respond to tone: Readjust earphones. Repeat directions. Practice with louder frequencies. 10. If student still does not respond to the tone, increase decibels to Do not test greater than 40 db with the headphones on the student. May need to increase up to 40 db, and then decrease back to normal decibel level

12 maximum of 40 db. for sound to be heard. 11. Avoid testing in a rhythmic manner. Students may anticipate response which leads to an inaccurate result. 12. Refer failed hearing test to School Nurse for otoscope examination. 13. Students who fail to respond should be rechecked in a quiet environment. This exam may rule out a medical condition, such cerumen impaction or ear infection, prior to hearing referral. Students with congestion or ear pain should be rescreened at a later date. 14. Students with a documented hearing deficit or hearing aids should not be screened. 15. Document results as pass or fail in HMS using the appropriate global template. At the direction of the School Nurse, generate referrals from HMS. 16. Use referral criteria. Fail any single failed frequency above 30 db or two failed frequencies over 25 db on recheck. 17. Follow up on outstanding referrals in a timely manner. Record follow up in HMS through the actual referral dropdown menu Measuring Student s Height and Weight: Mass Screening Preparation and Protocol 12.1 Height and weight measurements can be delegated with training from the School Nurse. The FASA Screening Team, Float FASAs and School Nurse team may be utilized, as time and scheduling permits, to complete the screening The FASA may assist with the following procedures at the direction of the School Nurse:

13 1. Set up date and location with site administrator under the direction of the School Nurse. 2. Arrange for a private location to perform screening. 3. Inform teachers of date at least 3 weeks in advance. 4. Send home written Parent Notification Letter (HS). 5. Obtain measuring equipment from Health Services department, if needed. 6. Obtain class schedules from IC (See above, Sub Attendance Roster) 7. Set up screening schedule, considering number of students in class and the total number of students per period. 8. Notify teachers of the screening date 2-3 weeks prior to schedule. 9. Distribute final screening schedule to teachers one week prior to screening. 10. Exempted students should be indicated on the class lists. 11. Have 2 or more computers available to record results. Try to confirm date early in the year to avoid interfering academic testing dates. May schedule at the same time as scoliosis. If not screening in locker rooms, cover all windows. May be ed or a hard copy placed in teachers mailboxes. This is required. May be mailed or send home with students. Two stadiometers, minimum. Two electronic scales, minimum. For Secondary, classes of a required subject for 7 th and 10 th grades should be used. Make separate copies of boys and girls rosters. IC reports will separate classes by gender minutes per class, staggering screening throughout periods. Do not schedule screening during a teacher s lunch period or prep time. May be ed and/or put in teachers boxes. May be put in teachers boxes or ed via Interact Screeners MUST NOT screen exempt students. Results must be entered manually Measuring Student s Height Protocol: Mass Screening

14 1. Provide privacy as permitted within the confines of the school setting. 2. Inform student regarding purpose and procedure. 3. Student removes shoes and empties pockets. 4. Have student step onto measuring device with heels together and placed at the back of the measurement surface. Improves student cooperation and behavior. To obtain an accurate measurement of the student, have container or small table available for pocket contents. Arms hang loosely at sides. Legs are straight. Shoulders relaxed. Student looks straight ahead. Head must be horizontal. 5. Heels, buttocks, and shoulders need to all touch the vertical surface of the measurement area. Head may or may not touch measurement area. 6. Instruct student to stand up tall and hold still for a few seconds. 7. Slide headpiece down until it touches skull. 8. Document measurement before moving the headpiece, or zeroing the stadiometer. Headpiece should compress hair. Headpiece should be level. If hairstyle or ornaments interfere with measurement, enter value observed, add exempt to the RAD (R), and enter a note in comment section. Height measurement results may be given to specific student only at their request. 9. Round height measurement up to nearest quarter inch. 10. Student steps off/away from measurement area and puts on shoes and collects personal belongings. Document correct decimals in HMS. 1/4 inch = /2 inch = /4 inch = 0.75

15 11. Transfer measurements from working copy to HMS. Must be done manually, not through a group screening global template Measuring Student s Weight Protocol 1. Completed in conjunction with height measurement. 2. Obtain additional scales from Health Minimum of two. Services department, if needed. 3. Ensure scale is functional. Check batteries, plug/energy source. 4. Place scale on flat, hard surface or Assists in obtaining accurate results. low, dense carpet. 5. Provide privacy. Only student and recorder should be able to see digital display. 6. Ensure the scale reads 0.0. Clean foot plate with damp towel if the electronic scale is not zeroing. 7. Student stands on the center of scale without support. 8. When display stabilizes, take measurement. 9. Record measurement as it appears on the digital display on working copy. 10. If body weight exceeds electronic scale s maximum, record as If accurate weight cannot be obtained, record as exempted in RAD and add note in comment section. 12. Transfer the results from the working copy to HMS. Arms loosely by side. Head facing forward. Weight distributed evenly on both feet. Do not read measurement out loud. Document weight to the 0.1 pound. Do not round numbers. Student with crutches, brace, unable to stand unassisted, etc. Must be done manually, not through a group screening global template Documentation 15.1 Screening results are to be recorded in Healthmaster 16.0 References, Sources, Bibliography

16 16.1 American Association for Pediatric Ophthalmology and Strabismus (2015). Vision screening recommendations. Retrieved from American Speech-Language-Hearing Association (ASHA). School-age hearing screening. Retrieved from National Association of School Nurses (2016). Vision and Eye Health. Retrieved from Selekman, J. (2013). School nursing: A comprehensive text (2 nd. Ed.). F.A. Davis Company, Philadelphia, PA Authorizations Health Services Director (Print) Signature Date