Reopening Plan

SCHOOL HEALTH PROTOCOLS

1. ADMINISTERING NEBULIZER TREATMENTS WITH COVID-19 PRECAUTIONS
POLICY:
1. For each student receiving a nebulizer treatment a Physician’s written order will be on file. This order will be renewed at the beginning of each school year or as needed.
2. Included in the Physician’s order will be the name, dose, route, frequency, indications for treatment, and possible side effects of medications.
3. It will be the responsibility of Parents to provide the nebulizer equipment, doctor’s order and medication.
4. Parents, and, if necessary, the Physician, will be notified of the need and result of PRN nebulizer treatment.
5. Daily scheduled nebulizers must be done at home when possible and PRN nebulizer treatments will be performed as needed during school hours.
6. Check that the machine is clean and ready for use at the beginning of each school day to ensure the machine is ready to go at any given time.
7. Treatment should take 15-20 minutes and may induce coughing.
SETTING:
For all non-emergency situations, treatments will be performed only in designated Health Treatment room(s).
PPE :
• N95 mask most preferred (KN-95 or surgical masks may be used only if N95 masks are unavailable)
• Eye protection, e.g. eye goggles
• Face Shield
• Gloves
• Gowns
PROCEDURES:
1a. If the Student is not in distress, move to the treatment room.
1b. If a Student is in distress, instruct classroom staff to move other students out of the room as soon as possible (e.g. staff will take other students to the adult service kitchen area).
4. Position Student in an upright, sitting position.
5. Assess the Student’s lung sounds and respiratory status and check heart rate.
6. Insert medication as ordered by the Physician into machine
7. If using a nebulizer mask, apply now. If using a mouthpiece, have Student close mouth tightly around the mouthpiece.
8. Plug the machine into the outlet and turn on.
9. Monitor Student’s respiratory and cardiac status periodically during treatment and stay back at least 6 ft or more if possible, while continuing to monitor the Student throughout the treatment.
10. Continue with treatment until medication is finished.
11. Assess Student’s respiratory status after treatment
12. Remove PPE (gloves, gown, face shield, goggles, N95 mask) and wash hands
13. Call for Staff if available to return the Student to the classroom.
14. If no Staff are available, Nurse will shut and lock treatment room door and return the Student to their classroom.
15. Don clean PPE (gown, mask, gloves). Sanitize the treatment area and perform hand hygiene afterwards.
16. Remove PPE (gloves, gown, mask), and wash hands.
17. Document results of treatment.
2. REQUIRED IMMUNIZATIONS
• All immunizations required for school-age children must be maintained.
• In the 2020-2021 school year, the state of Massachusetts is requiring that all school-aged children be immunized with the flu vaccine. This requirement is for all children, whether learning in schools, remotely, or in a hybrid/combination model.
3. ORAL NASOPHARYNGEAL, TRACHEOSTOMY TUBE SUCTIONING WITH COVID-19 PRECAUTIONS
POLICY:
1. Licensed Nursing staff and Respiratory Therapists can perform oral and nasopharyngeal suctioning
2. A valid Physician’s order must be on file
3. The Physician’s order must be renewed yearly or as changes occur
4. It will be the responsibility of Parents to provide clean suctioning equipment and container/tubing.
5. Check for supplies and that the machine is working properly and ready for use at the beginning of each school day.
6. Family will be notified if suctioning has been performed.
7. Provide oxygen as needed before and/or between and after suctioning
SETTING:
• In Medical Treatment room if possible OR
• In Classroom with the use of an Intubation suctioning box
PPE :
• N95 mask most preferred (KN-95 or surgical masks may be used only if N95 masks are unavailable)
• Eye protections, i.e. eye goggles
• Face Shield
• Gloves
• Gowns
• Intubation suctioning box (see image below)
PROCEDURE:
1. Wash your hands and don PPE in this order- Gown, surgical mask, eye protection, and gloves.
2. Assess respiratory status, check O2 level, and administer O2 if needed before suctioning.
3. Open catheter package and attach connector to suction tubing; leave catheter inside package to prevent contamination.
4. If student is on mat table, position intubation box over student. Explain to student while positioning the box. (Students for whom suctioning may be necessary will have been shown and practice with intubation box during non-emergent time so they are comfortable with these extra precautions.) 
5. Turn on Student’s suction machine.
6. Apply clean gloves and remove catheter from package.
7. With vent open, gently insert catheter to desired depth.
8. Occlude vent. Rotate and provide intermittent suctioning while withdrawing catheter. The catheter should be withdrawn from the airway within five seconds.
9. Observe for color changes and discontinue suctioning if changes occur.
10. Note character of secretions.
11. Rinse catheter with saline.
12. Alternate if additional suctioning is necessary.
13. Provide oxygen as needed before and/or between and after suctioning.
14. Suction oral cavity, if necessary.
15. Assess respiratory status and reposition Student as needed.
16. Remove PPE in this order: Gloves, Gown, eye protection, and mask.
17. Don clean PPE (gown, mask, gloves). Clean suction equipment and Intubation suctioning box.
18. Sanitize treatment area and perform hand hygiene afterwards
19. Document procedure and results on progress notes. Be sure to describe secretions and effectiveness or adverse response to treatment.
Image of Medical Intubation Box Shore Nurses will use for suctioning students in rooms inhabited by at least one other person