Some individuals need special health services to participate
in an educational program. These individuals will receive special health
services along with their educational program.
(1)
Definitions. The
following definitions are used in this rule, unless the context otherwise
demands:
"Assignment and delegation." "Assignment"
means the routine health care, activities and health procedures that are within
the licensed health personnel's authorized scope of practice as defined by
state law. "Delegation" means the process within the licensed health
personnel's scope of practice in transferring a task, skill, or procedure of
the licensed health personnel to qualified designated personnel. Primary
consideration is given to the recommendation of the licensed health personnel
and health instruction competence of the delegate is documented to perform a
specific activity, skill, or procedure that is beyond the qualified personnel's
traditional role and not routinely performed.
"Co-administration" means the eligible
individual's participation in the planning, management and implementation of
the individual's special health service and demonstration of proficiency to
licensed health personnel.
"Educational program" includes all school
curricular programs and activities both on and off school grounds.
"Education team" may include the individual,
the individual's parent, administrator, teacher, licensed health personnel, and
others involved in the individual's educational program. The education team may
be the team under the Individuals with Disabilities Education Act or Section
504 of the Rehabilitation Act of 1973, both effective as of February 7, 2024,
if the child is eligible under either of those statutes.
"Health assessment" means the systematic
collection of data collected by the licensed health personnel to determine the
student's health status and initial plan of care, to identify any actual or
potential health problems, or upon any significant change in the student's
status relating to the individual's education program.
"Health instruction" means education by
licensed health personnel to prepare qualified designated personnel to deliver
and perform special health services contained in the eligible individual's
health plan. Documentation of education and periodic updates will be on file at
school.
"Individual health plan" means the
documented plan of care utilizing the nursing process as defined in 655-Chapter
6 for evidence-based management of the student's ongoing special health service
in the educational program. The school nurse may develop this plan in
collaboration with the education team. The plan also includes a provision for
emergencies to provide direction in managing an individual's health condition
(stable or unstable). Documentation of evaluation and updates to the plan are
completed as needed and at least annually.
"Licensed health personnel" means a licensed
registered nurse, licensed physician, licensed physician assistant, or other
licensed health personnel legally authorized to delegate or provide special
health services and medications under the auspices of the school.
"Prescriber" means licensed health personnel
legally authorized to prescribe special health services and medications.
"Qualified designated personnel" means
individuals who perform delegated tasks, activities and procedures beyond their
traditional role who are instructed, supervised, and competent in implementing
the eligible individual's health plan or delegation of special health
services.
"Special health services" includes services
for eligible individuals whose health status (stable or unstable)
necessitates:
1. Interpretation or
intervention,
2. Administration of
health procedures and health care, or
3. Use of a health device to compensate for
the reduction or loss of a body function.
"Supervision" means the assessment,
delegation, monitoring, and frequency of evaluation and documentation of
special health services by licensed health personnel. Levels of supervision
include situations in which:
1.
Licensed health personnel are physically present.
2. Licensed health personnel are available at
the same site.
3. Licensed health
personnel are available on call.
(2)
Special health services
policy. Each board of a public school or the authorities in charge of
an accredited nonpublic school shall, in consultation with licensed health
personnel, establish policy and guidelines for the provision of confidential
special health services in conformity with this chapter. Such policy and
guidelines will address the following:
a.
Licensed health personnel provide special health services under the auspices of
the school. Duties of the licensed health personnel include:
(1) Participating as a member of the
education team.
(2) Providing the
health assessment.
(3) Planning,
implementing and evaluating the written individual health plan.
(4) Planning, implementing and evaluating
special emergency health services.
(5) Serving as a liaison and encouraging
participation and communication with health service agencies and individuals
providing health care.
(6)
Providing health consultation, counseling and instruction with the eligible
individual, the individual's parent and the staff in cooperation and
conjunction with the prescriber.
(7) Maintaining a record of special health
services. The documentation includes the eligible individual's name, special
health service, prescriber or person authorizing, date and time, signature and
title of the person providing the special health service and any unusual
circumstances in the provision of such services.
(8) Reporting unusual circumstances to the
parent, school administration, and prescriber.
(9) Assigning and delegating to, instructing,
providing technical assistance to and supervising qualified designated
personnel.
(10) Updating knowledge
and skills to meet special health service needs.
b. Prior to the provision of ongoing special
health services, the following are to be on file:
(1) A written statement by the prescriber
detailing the specific method and schedule of the special health service, when
indicated.
(2) A written statement
by the individual's parent requesting the provision of the ongoing special
health service.
(3) A written
individual health plan available in the health record and integrated into the
IEP or 504 plan, if applicable, for ongoing health services and documentation
of the education team meeting.
c. Licensed health personnel delegating
health services, in collaboration with the education team, determine the
special health services to be provided designated qualified personnel. The
documented rationale will include the following:
(1) Analysis and interpretation of the
special health service needs, health status stability, complexity of the
service, predictability of the service outcome and risk of improperly performed
service.
(2) Determination that the
special health service, task, procedure or function is part of the person's job
description.
(3) Determination of
the assignment and delegation based on the scope of the licensed personnel's
practice, the student's needs and the qualifications of school personnel
performing health services.
(4)
Review of the designated person's competency.
(5) Determination of initial and ongoing
level of supervision, monitoring and evaluation required for safe, quality
services.
d. Licensed
health personnel supervise the delegated special health services, define the
level of frequency of supervision and document the supervision.
e. Licensed health personnel instruct
qualified designated personnel to deliver and perform delegated special health
services. Documentation of instruction, written consent of personnel pursuant
to Iowa Code section 280.23 and evaluations are to be
on file at the school.
f. Parents
provide the usual equipment, supplies, and necessary maintenance of the
equipment, unless the school is required to provide the equipment, supplies,
and maintenance under the Individuals with Disabilities Education Act,
effective February 7, 2024, and 281-Chapter 41 or Section 504 of the
Rehabilitation Act of 1973, effective February 7, 2024. The equipment will be
stored in a secure area.
The individual health plan is to designate the
responsibilities roles of the school, parents and others in the provision,
supply, storage and maintenance of necessary equipment.
(3)
Relationship between
this rule and other laws and rules. In complying with this rule, for
children who are eligible under the Individuals with Disabilities Education
Act, effective February 7, 2024, and 281-Chapter 41 or Section 504 of the
Rehabilitation Act of 1973, effective February 7, 2024, the school health
services is to comply with any additional or differing provisions of those laws
based on a specific child's needs.
Notes
Iowa Admin.
Code rr. 281-14.2
Reserved by
IAB
December 9, 2015/Volume XXXVIII, Number 12, effective
1/13/2016
Amended by
IAB
October 11, 2017/Volume XL, Number 8, effective
11/15/2017
Amended by
IAB
June 28, 2023/Volume XLV, Number 26, effective
8/2/2023
Adopted by
IAB
April 17, 2024/Volume XLVI, Number 21, effective
5/22/2024