Clinic Log

[SchoolRN,BSN]

Hi,

I went to a conference last week & was told that a running log is a huge no-no for legal reasons. The presenter suggested using 2 part carbon-less slips (custom made by a local printer for their school corp) in which front copy is kept in clinic & back is sent back to teacher. At the end of the day, back part is sent home to parents so they know when student is in clinic & why. Front copy is batched monthly for data collection & then stored by year.

Wondering how others are keeping records? Suggestions & ideas appreciated

[schooldistrictnurse]

Our district still uses a running log but the information is transcribed by a secretary to each student's electronic school record. (there are several systems out there--we use PowerSchool for everything from attendance to grades) I use the running log to pull statistics monthly or quarterly (as time permits). Parents are notified via phone call if indicated and this is documented. The carbon system seems like a lot of paper, and I wonder if parents need to know every visit--might those visit slips be ignored after the first few?

Additionally, the teacher sends a "pass" to the health room which is returned with the student. There's a place on the pass to indicate "return to class" or "going home."

[SchoolRN,BSN]

schooldistrictnurse,

Thanks for the info!

We use PowerSchool as well, but I'm not sure how to use it the way you are describing. I think it was new as of last year and I was only there two days/week then. This year I will have my own school, so I will have a bit more flexibility & control over how I do things.

Where does the secretary transcribe the information? Where is the running log? On the left side of the screen there are places for immunizations, parent info, attendance, etc... but what else am I missing? Are there functions that maybe the school corp hasn't added that I should be asking about? I don't recall any place for electronic charting or documentation. Thanks for your help. I'm trying to get organized now so the first couple weeks run as smoothly as possible.

[schooldistrictnurse]

There is a standard page in PowerSchool called "health." That's where our immunizations are kept and also health room visits are documented. It has a pull-down menu with choices that we put it--like headache, stomach issue, scrape, cut, etc. We tried not to make too many categories. Then there is a place for a very short narrative. I think the system admin would institute the page. The running log we use is paper. We've only used this system for visit documentation for one year, although we've had PowerSchool for at least 5. I think if you went with the PS system, your whole district would have to do it--so that when students go from elementary to MS there is consistency in recordkeeping.

hope this helps!

[Jolie, BSN]

Just curious: What is the legal objection to a running log? If it is a privacy concern, isn't that answered by limiting access to the log to the nurse only?

If a note is sent back to the teacher for every visit, isn't that more of a privacy concern? Once the nurse determines that a student can safely return to class, is it appropriate or necessary to provide the details of the visit to the teacher? I wouldn't think so. Or is the note placed in an envelope to be opened by the parents only?

[Jolie, BSN]

We also use PS and have spent an incredible amount of time with district IT staff making it workable and usable. The standard program is not very practical or user-friendly for school health purposes. We've tweaked it to be used for documenting immunizations, physicals, vision evaluations, health history, yearly health screenings and referrals. We've not yet attempted to use it for daily narrative notes for routine visits.

[SchoolRN,BSN]

Per the conference staff the problem with the paper log is that if your records are subpoenaed then you have multiple students information on one page. I guess redacting isn't allowed? Thankfully, I haven't had to find out. I don't remember her mentioning putting the copy into an envelope for parents only. Maybe they do, but I understood it served as the child's pass back into class, so I don't know. I agree privacy could be an issue.

As for the health section, I will be sending an email to the IT coordinator as soon as I'm done here to find out if we can make that section workable. Sounds like it would be a great help.

Thanks everyone :)

[schooldistrictnurse]

I agree with Jolie that the PS program isn't always user-friendly. Sometimes I will just document "conference with nurse" in the running log and that's what goes into PS. Then I can keep a confidential file in my desk drawer--in cases like a HS student comes in asking about pregnancy, STI, or other more delicate issues. But I think it works ok for the usual scuffs and scrapes type activity. I believe the more we do electronically the easier things are---except for when the server goes down!!!

[Jolie, BSN]

Another thing about PowerSchool: Maybe this only applies to our district, since we have made significant changes to the program, but on the page where we document imms, physicals, health history...the entries are not permanent. They may be changed by the next person who accesses the page. We find that necessary in order to update the record over time, but that makes it un-usable as a record for clinic visits. Any narrative notes that we need to insure are permanent have to be documented in another section of the PS record. For us that is the administrative notes. It's a little awkward, but the best way we've come up with to maintain permanent notes.

[schooldistrictnurse]

It's funny how different districts use a tool like this in different ways. Out PS admin would do that exorcist head spin thing if she read Jolie's last post. She has been so fussy in who has "editing" capabilities--I can't edit medical pages, only one secretary per building has that ability. Which in some ways is ok with me, since inputting this info is a clerical function and maybe not the best use of my time. Jolie, do you also track your medical alerts for teachers through PS? We used to hand-write medical alerts for teachers, now they download their class list's alerts from PS.

[Jolie, BSN]

You're right, it is interesting to learn how others use this program.

Imms can be entered by the secretary, health aid or nurse, but must be verified by the nurse. Other, "less critical" information such as screeing results can be entered by the health aid without official nurse verification, but we do review the records for accuracy.

Critical health information that needs to be shared with teachers does not come from PS. We're not advanced enough to use it for that purpose. We compile a health needs list by grade which is kept in a binder in the nurse's office along with yearly health updates. (It's an Excel spreadsheet that can be e-mailed if needed.) It can be accessed by staff in emergencies when the nurse is not in the building. For students with critical health needs, that information is shared with teachers on a NTK basis at the beginning of the year.

[bergren]

"What is the legal objection to a running log? If it is a privacy concern, isn't that answered by limiting access to the log to the nurse only?"

The subpoena answer was accurate - to be entered into evidence, it cannot be altered. So if one child's records are subpoenaed, all of the records, all logs, are entered into evidence. I know if a case in Illinois where 6 years of original health office logs were entered into evidence.

FERPA allows each parent to examine all of the child's education records. - how would you locate them all and then how would you protect the other kids privacy?

When it is time for the child to move to middle and high school, how do you transfer the records? When they relocate to another state or district, how do you include a complete copy of their health record? For any child with an IEP, federal law requires all education records be transferred with the child. By definition, all school health office records are education records.

From a practice standpoint, you cannot meet the standard of care unless you can look at the childs records as a unit. Plus, if another nurse had to sub for you, they would have no way of reviewing a child seeking treament records to assess and treat him.

If you are not using electronic records, I have seen a one sheet per child log in a binder or one card per child on card stock in a shoe box size bin until full and moved to child's folder.

Also if no EHR, I suggest keeping a log, but not including any health complaint on it, only name, time in time out, disposition (back to class, home with mom, etc). That meets the definition of "directory information" and is not protected by FERPA (same as HIPAA). That way you can quickly account who was in office and when.