IHPs

  1. Hello Everyone,
    My school district will start implementing IHPs in the 2018-19 school year. There seems to be quite a bit of confusion already.
    Here's some of the questions that have been voiced:
    1. Does the IHP replace the Dr's order? Does the Dr. sign the order for say an albuterol inhaler AND the IHP?
    2. Are IHP's only done by RNs or can an LPN do them?
    3. What conditions are IHPs needed?
    4. If a school has 90 parent claimed asthmatics and only 10 have actual Dr. order and an inhaler at school, do we only do IHP on those with inhalers?
    5. Our diabetics have very specific action plans sent by their doctors, can that be used in
    place of an IHP?

    Sorry if it seems these are ridiculous question, but it seems the RNs cannot agree to how we should implement the IHPs. We do have our state's School Guidelines, but there seems to be a lot of gray areas.
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  2. Visit Ree250k profile page

    About Ree250k, LPN

    Joined: Feb '15; Posts: 31; Likes: 67

    7 Comments

  3. by   OldDude
    Quote from Ree250k
    Hello Everyone,
    My school district will start implementing IHPs in the 2018-19 school year. There seems to be quite a bit of confusion already.
    Here's some of the questions that have been voiced:
    1. Does the IHP replace the Dr's order? Does the Dr. sign the order for say an albuterol inhaler AND the IHP?

    ...No and it's unlikely a physician would sign your IHP.

    2. Are IHP's only done by RNs or can an LPN do them?

    ...in Texas only RNs can do "assessments," they would generate an IHP if not already dictated by MD.

    3. What conditions are IHPs needed?

    ...regarding any condition which may require some intervention at school AND medication/materials are available at school.

    4. If a school has 90 parent claimed asthmatics and only 10 have actual Dr. order and an inhaler at school, do we only do IHP on those with inhalers?

    ...see #3

    5. Our diabetics have very specific action plans sent by their doctors, can that be used in
    place of an IHP?

    ...yes

    Sorry if it seems these are ridiculous question, but it seems the RNs cannot agree to how we should implement the IHPs. We do have our state's School Guidelines, but there seems to be a lot of gray areas.
    IHPs don't have to be complicated; for instance, the RX label for an albuterol MDI can serve as an IHP...2 puffs every 4 to 6 hours for cough or wheeze.
  4. by   tamarae1
    Some of this may depend on district policy.
    For us: IHP needs to exist when there is a 504 or IEP in place with a health diagnosis that causes student to come to clinic frequently.
    In my state, RNs have to write them because it requires an assessment, nursing diagnosis and plan of care. BON says that isn't delegable.
    IHPs don't trump doctors orders and you need both. Doctor's orders give an emergency or routine medication plan, but the IHP has the nursing dx and nursing nursing plan of care, which is not something the doctor provides. Check with your state health dept and see if they have guidelines for writing a complete IHP.

    Hope this helps some.
  5. by   WineRN
    I think OD hit the points quiet well. An IHP is what the nurse does to care for a student with a specialized medical need.

    I have a lot of families who claim their child has food allergies/asthma/some rare disease but I've explained that without a note from the doctor I can't add it to their file here. I think they forget that when they enroll 99% of the time they bring in the last physical with their immunizations where the doctor puts that the student is completely healthy.
  6. by   ruby_jane
    Quote from Ree250k
    Sorry if it seems these are ridiculous question, but it seems the RNs cannot agree to how we should implement the IHPs. We do have our state's School Guidelines, but there seems to be a lot of gray areas.
    Not ridiculous at all and YUP. I would add....if you have a life-threatening illness (like anaphylaxis) or a seizure disorder AND the parent declines to provide information or MD orders...there's nothing stopping your from completing a generic IHP with basic instructions (seizure management instructions can come from policy or from several epilepsy organizations, ditto the anaphylaxis plan) instructing teachers on basic care until you get there and to call EMS as parent has declined to provide treatment or MD orders.

    We use Skyward and there are template IHPs that fill a lot of the boxes for me.
    Last edit by ruby_jane on May 16 : Reason: incomplete thought
  7. by   Ree250k
    Thank you. As of now we use Power School, which isn't medically friendly, so we will need to create our forms.... which is what has been delegated to me. LOL
  8. by   Ree250k
    Tamarae, thank you for your response. I thought the IHP was like the care plans in the hospital setting and that only an RN could complete them. Our district only has 2 RNs for 12 schools and LPNs that work the clinics in the individual schools, so they were hoping an LPN could do them. I like the idea of the IHP and think it would be a tremendous help to the nurses working the clinics, especially with some of the conditions they may not be as familiar with, such as sickle cell or addison's disease.
  9. by   bsyrn
    Buy the book, Individualized healthcare plans for the school nurse. Published by Sunrise river press. I have the 2nd edition. It is expensive but well worth it.
    It comes with a disc and you can personalize HCP's. Old Dude covered everything else wonderfully as usual

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