District Nurse

Washtenaw County Health Department COVID-19 Guidance

WCHD School Guidance - Updated 3/17/2022

DCS district nurse Julie Liskiewicz is available to discuss health concerns and answer student and parent questions. Please contact her at 734-424-4100 ext.1051 or email liskiewiczj@dexterschools.org.

District nurse duties include follow-up on immunizations, injuries, and health concerns, writing emergency plans for students with medical needs, certifying First Responder Teams in each building in First Aid/CPR/AED, and educating staff about student health needs.

STUDENT COVID-19 SCREENING FORM

Sharing/Updating Medical Information for Students

Each September, we ask all families to review and update student information electronically. One question asks if there has been a change in the student's medical information and directs parents to contact the school nurse with that info. For 2021-2022, this is to be completed as part of the DCS Annual Acknowledgments Form that is-building specific and was distributed the first week in September.

Please use the Medical Update Form to any time there is a significant change to an existing student's medical information (including medication changes or significant health events and diagnoses). This information will be used only to meet this student's health and educational needs in school. It will be kept confidential and will only be shared with staff on an as-needed basis.

DCS Health Forms

When to keep a Sick child home

Children are most successful in school when they are present for as many days as possible. However, children who are sick need to stay home if they will not be able to concentrate sufficiently on learning or if they may cause others to become sick.

To help reduce the spread of illness to students and staff, please keep your child home for the following reasons:

Fever: Students should be fever free (temperature below 100 degrees F without being medicated) for 24 hours before returning to school.
Rash: Check with a doctor before bringing a child to school with a rash.
Vomiting: A child may return to school after s/he has not thrown up for 24 hours and is back on a regular diet.
Diarrhea: A child who has a loose stool more than one time in 24 hours should stay home. S/he may return to school after being diarrhea-free for 24 hours.
Cough/Cold: A child with a severe or frequent cough and a runny nose is likely not to feel well enough to concentrate sufficiently on learning. S/he would benefit from more rest and fluids at home.
Doctor Recommendation: If a child has been prescribed an antibiotic, check with the doctor to see if the child needs to be on medication 24 hours prior to returning to school.

Here is a tip sheet from the Washtenaw County Public Health Department regarding various symptoms.

When Should a Child Be Sent Home or Kept Home From School for Illness?

Injuries and Illness

All injuries must be reported to a teacher or the office. If the injury is minor, the student will be treated and may return to class. If medical attention is required, the office will follow the school’s emergency procedures.

A student who becomes ill during the school day should request permission to go to the office. An appropriate adult in the office will determine whether or not the student should remain in school or go home. No student will be released from school without proper parental permission.

immunizations

All enrolled students are required to be submit proof of up-to-date immunizations as recommended by the Michigan Department of Health and Centers for Disease Control.

Medical Waivers

For children with medical contraindications for vaccination, a current State of Michigan Medical Contraindication Form must be completed and signed by a physician and submitted to the school or childcare center.

Non-medical Waivers

A non-medical waiver is a parent’s/guardian’s written statement indicating the religious or philosophical (other) objections to a particular vaccination(s).

As of January, 2015, Michigan law requires schools and child care centers to refer parents/guardians requesting a nonmedical waiver for immunizations to the county health department for immunization waiver education and waiver certification. Schools and childcare centers will only be able to accept a certified State of Michigan Immunization Waiver Form, available upon completion of the health department immunization education program.

Michigan Immunization Waiver Rule Change FAQ

Food Allergies

Administrative guidelines are in place for students with food anaphylaxis (a life-threatening allergic reaction to a specific food). Common causes of food anaphylaxis are peanuts, tree nuts, wheat, soy, and dairy. Parents of students in K-8 classes with a severely food allergic child will be informed of the specific food the student is allergic to through the classroom teacher's newsletter and are requested not to bring the food causing the allergy into the classroom. parents are encouraged to provide ingredient lists for all baked goods brought to the classroom of the student with food anaphylasis. Ingredients in pre-packaged food should be checked prior to distribution in the classroom. If indicated, certain cafeteria tables may be permanently designated as nut-free or allergen-free tables to avoid cross contamination.

Children with known serious allergies should have an Allergy Action Plan on file.

Health and Medical Limitations

Communicable Diseases

General information

Please use the following links to access the Washtenaw County Health Department's library:

Control of Casual Contact Communicable Diseases AND PESTS

Because a school has a high concentration of people, it is necessary to take specific measures when the health or safety of the group is at risk. The school’s professional staff has the authority to remove or isolate a student who has been ill or has been exposed to a communicable disease or highly-transient pest, such as lice.

Specific diseases include meriting exclusion: diphtheria, scarlet fever, strep infections, whooping cough, mumps, measles, rubella, and other conditions indicated by the Local and State Health Departments.

Any removal will only be for the contagious period as specified in the school’s administrative guidelines.

Here are some resources for dealing with common infestations:

Bed Bug Website: Comprehensive information on bed bugs provided by the Michigan Dept. of Community Health.
Head Lice Manual: Link to everything you want to know about head lice from the Michigan Dept. of Community Health and the Michigan Dept. of Education
Head Lice Fact Sheet - Fact Sheet for Parents (English)
Head Lice Lessons from the National Association of School Nurses

Control of non-casual contact communicable diseases

In the case of non casual-contact communicable diseases, the school still has the obligation to protect the safety of the staff and students. In these cases, the person in question will have his/her status reviewed by a panel of resource people, including the County Health Department, to ensure that the rights of the person affected and those in contact with that person are respected. The school will seek to keep students and staff persons in school unless there is definitive evidence to warrant exclusion.

Non casual-contact communicable diseases include sexually transmitted diseases; AIDS (Acquired Immune Deficiency Syndrome); ARC-AIDS Related Complex (condition); HIV (Human-immunodeficiency); HBV; HCV (Hepatitis B, C); and other diseases that may be specified by the State Board of Health.

As required by Federal law, parents will be requested to have their child’s blood checked for HIV, HBV, and other blood-borne pathogens when the child has bled at school and students or staff members have been exposed to the blood. Any testing is subject to laws protecting confidentiality.

Emergency Plans

Please contact the district nurse if your child has a health condition that requires an emergency plan to be in place for his/her care and treatment. Examples of such conditions include: insulin dependent diabetes, seizure disorders, severe asthma, anaphylactic reactions to foods or insect stings, etc. The nurse is on call for medical concerns or injuries such as asthma attacks, sprains, strains, etc. In the event of a serious emergency, 911 will be called. Parents are always contacted in the event of an emergency.

For students who need to have an Allergy Action Plan, we have a form that parents can bring to appointments to be completed by the physician. Some offices prefer to use their own form, that is fine, too.

Medications

Prescription Medications Given by Mouth

MEDICATION PROCEDURES

Parents should determine, with their physician’s advice, whether the medication schedule can be adjusted to avoid administering medication during school hours.

MEDICATION DURING SCHOOL

When medication must be administered at school, written permission on the Parent’s Request for Administration of Medication at School Form must be kept in the medication administration area and retained until the end of the school year. A new request form must be submitted each school year and for each new medication.
The order of the physician must appear on the Parent’s Request for Administration of Medication at School Form. If this has not been done, the school nurse may call the physician for a telephone order to be followed by written orders.
All prescription medications must be in the original container labeled by the pharmacy. The label must specify the name of the medication, the dosage to be given, and the time of administration, as well as the student’s name. Over-the-counter medications must be in the original container.
The medication must be given by an adult: administrator, teacher, or another staff person designated by the administrator, such as a building secretary. Unless administered by a school nurse (R.N.), the medication must be administered in the presence of another adult.
Parents must notify the school in writing if the medication dosage, schedule, or procedure is changed or eliminated.
Refill of all medications shall be the responsibility of the parents. For grades K-6, parents must deliver medication to/ from school. For grades 7-12, agreement between parent and principal for satisfactory arrangements for transportation of medication should be made. Daily carrying of medication should be avoided, unless previous arrangements have been made through the school principal.
Any unused medication unclaimed by the parent will be destroyed by school personnel when a prescription is no longer to be administered or at the end of the school year.

Self Administration of Medication

Prescription medication may be self-administered at the high school level with written permission of the parent and physician on the Medication Prescriber/Parent Authorization Form for Self Administration/Self Possession. Over the counter medication may be self-administered in grades 7-12. Parents are encouraged to notify school staff if the student is on long-term medication, for example, anti-epileptics, psychotropic medication etc.
If, for supportable reasons, the principal wishes to discontinue the privilege of a student self administering a medication, s/he shall notify the parent of this decision in sufficient time for an alternative administration to be established.

Documentation

The person administering the medication must complete the Medication Record to include the following information:
- Student Name
- Name of medication
- Dosage (i.e. 10 milligrams)
- Date
- Time
- Initials of person dispensing the medication
- Initials of person witnessing the dispensing of medication
- Pupil medication containers shall be kept in a locked and reasonably secure place (safe, file cabinet, locked box, etc.) not accessible to pupils with the exception of emergency medication such as Epinephrine, which shall be kept in a safe but unlocked area.
- At the discretion of the teacher, or upon request of the doctor or parents, a Medication Monitoring Record may be kept daily to record effects of the medication. This record may be copied and sent to the physician or parent. The original will be kept in the student’s records.
- The first (or initial) dose of a new medication will not be given at school due to the possibility of an allergic reaction. A count of any medication classified as a controlled substance will be taken upon delivery of the medication to school. The date of receipt plus amount received will be recorded in the comment section of the “School District Daily Medication Log.”

Over-the-Counter Medications Taken Orally

Non-Prescription Medication Given by Mouth

Grades K-6

For students in grades K-6, over-the-counter drugs may be administered during school hours only if:

When medication must be administered at school, written permission on the Parent’s Request for Administration of Medication at School Form must be kept in the medication administration area and retained until the end of the school year. A new request form must be submitted each school year and for each new medication.
Over-the-counter medications must be in the original container and must be labeled with the student's name.
The medication must be given by an adult: administrator, teacher, or another staff person designated by the administrator, such as a building secretary. Unless administered by a school nurse (R.N.), the medication must be administered in the presence of another adult.
Parents must notify the school in writing if the medication dosage, schedule, or procedure is changed or eliminated.
Refill of all medications shall be the responsibility of the parents. For grades K-6, parents must deliver medication to/ from school. For grades 7-12, agreement between parent and principal for satisfactory arrangements for transportation of medication should be made. Daily carrying of medication should be avoided, unless previous arrangements have been made through the school principal.
Any unused medication unclaimed by the parent will be destroyed by school personnel when a prescription is no longer to be administered or at the end of the school year.

Grades 7-12

Students in grades 7-12 may carry and administer their own over-the-counter medications.

URGENT SITUATIONS

No over-the-counter medication will be administered by school personnel unless the above guidelines are met with the following exception:

In times of urgent need, the school nurse may contact a parent for permission to administer the appropriate dose of acetaminophen or ibuprofen. The medication must be administered per District policy.

Posession and Use of Asthma Inhalers - Grades K-12

The Medication Prescriber/Parent Authorization Form for Self Administration/Self Possession shall be completed and signed by a physician and the parents authorizing the student use of metered dose or dry powder inhaler(s) at school, on District transportation, and at school activities. This form must be received at the school office. Notice of this authorization shall be delivered to the staff members and transportation personnel to whom the student is assigned.

Asthma inhalers may be kept at the office with other medication. However, students in grades K-12 may possess and self administer a metered dose or dry powder inhaler for the relief of asthma, or before exercise to prevent the onset of asthma symptoms, while at school, or on school sponsored transportation or activities, if the following conditions are met:

There is written approval from the student’s physician or other health care provider and the student’s parent/guardian to possess and use the inhaler, AND
The building administrator has received a copy of the written approvals from the physician and parent.

prescription medications given by injection

EMERGENCY MEDICATION

School personnel should administer only physician-prescribed medication.
Schools are to be notified, in writing, of a student who may need emergency medication by his/her parents or physician. In all cases, this information should be conveyed to the District’s nurse who will be responsible for ensuring that selected staff members receive appropriate instruction in the administration of such medication.
The medication must be taken on field trips and should be available to the leader or designee who should be trained in its proper application.
The Transportation Department should be notified so the appropriate bus driver can be made aware of the student who may need emergency medication. Bus drivers transporting such students should have the medication available and be trained in its proper application.
The student’s parent is responsible for providing the medication and is to be informed that the school will call 911 when his/her child receives the medication.
If a serious situation does occur requiring the administration of emergency medication, the school personnel will contact 911 and request that a mobile unit be dispatched to the school to deal with complications that may arise. The parents and District’s nurse should also be contacted.
Injectable medications will only be given in a life-threatening situation, (e.g. Epinephrine for a severe reaction to a bee/ wasp sting). Therefore, the parent releases the District from any liability or damage, which may occur to the child from the administration of injectable medication.

All syringes used for the administration of injectable medication must be disposed of in the appropriate sharps container provided for this purpose in each building office or given to the EMS if an emergency medication such as an Epipen was used.

unauthorized Medication

If a student is found with a medication in his/her possession, his/her record should be checked to determine if the proper authorization is on file. If not, the matter is to be reported to the principal for disciplinary action. The principal may use one or more of the following procedures, depending on the particular situation:

Contact the parent and arrange for the parent to submit the Medication Prescriber/Parent Authorization Form for Self Administration/Self Possession as soon as possible;
Take the medication from the student and keep it in the office until a completed form has been submitted;
Place the student in school restriction for failure to abide by school rules;
Suspend the student from school.

The purpose of any disciplinary action on this matter should be to make it clear to all students and parents, that, because of its policy on drug use, the school cannot allow possession or use of any form of unauthorized drug or medication at any time.