Exclusion Guidelines- AHHH

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Specializes in keeper of tiny humans.

Alright y'all, let's get to the nitty gritty. What Sx are you excluding?
Direction from our local Health Dept (OH) is to exclude for ANY symptoms, and then goes on to list eeeeverything under the sun. I mean, EVERYTHING. Congestion, runny nose, headache, nausea, fatigue...
So I brought this up to our Health Commissioner during a county wide SN conference call and he didn't even touch base on it. I'm in a PK-1 building that is starting out at 100% 5d/wk, so that applies to pretty much my entire student body on any given day. Between little people's anxiety, allergies, adjusting to waking up early ? I wouldn't have anyone in my building!... but that's a discussion no one is ready for ?

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Specializes in pediatrics, school nursing.

Mass DPH & DESE has this list for exclusion:

"Fever (100.0° Fahrenheit or higher), chills, or shaking chills

Cough (not due to other known cause, such as chronic cough or Asthma)

Difficulty breathing or shortness of breath

New loss of taste or smell

Sore throat

Headache when in combination with other symptoms

Muscle aches or body aches

Nausea, vomiting, or diarrhea

Fatigue, when in combination with other symptoms

Nasal congestion or runny nose (not due to other known causes, such as allergies) when in combination with other symptoms"

This gets dicey as you said... how many kids have growing pains or anxiety that presents as "pukey" feeling. Kids are not supposed to return to school until they have received a negative COVID test and are symptom free for 24 hours (and fever free w.o. meds) OR they must quarantine for at least 14 days and be symptom free for 24 hours.

I'll be using my clinical judgement on some kids, for sure. I am very very hopeful that families just keep kids home when they have any symptoms. Since we'll be offering remote school, they really shouldn't have to miss out on their education because of the sniffles this way. But, we all know how well that's going to go over.

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Specializes in keeper of tiny humans.

Our super (who is also my principal) told us that we have to be flexible, but I'm not sure how far I can stretch that when there are (clear as mud) guidelines to exclude for basically anything other than needing a bandaid. For my firsties it's a little easier, I know who is a FF or has allergies; but with our littles, I just have to take their "big person at home's" word for it that yep they have allergies? It's so daunting. ?

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That how it is here, too (TX) ? I participated in a meeting with our health department and local school nurses. I asked if there was any room for nursing judgement and was told "well it's your license..." so there's that.

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Specializes in School Nurse.

KeeperoftheIceRN, I believe I was in that same meeting! I'm also in Texas! This is frustrating! We've had kids a little over a week and so far, parents have been pretty understanding. I sent a note home with all of our students explaining to have multiple back-up plans and working phone numbers in case we had to send the kids home, and that we would probably be sending kids home more often than previous years, due to the COVID-19 pandemic. I hope it works!

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Specializes in school nursing, ortho, trauma.

we have pretty much the same guidance as @k1p1ssk. It's all as clear as mud

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Specializes in School Nursing, Pediatrics.

And you just know ONE cough or sneeze and a teacher will freak out! And the entire class will be shut down.

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I went home Friday Just exhausted from a 4 day week. My biggest complaint is that there is no clear cut guideance from any where.

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On 8/21/2020 at 3:23 PM, caretakerofkids said:

KeeperoftheIceRN, I believe I was in that same meeting! I'm also in Texas! This is frustrating! We've had kids a little over a week and so far, parents have been pretty understanding. I sent a note home with all of our students explaining to have multiple back-up plans and working phone numbers in case we had to send the kids home, and that we would probably be sending kids home more often than previous years, due to the COVID-19 pandemic. I hope it works!

I was thankful for that meeting but still feel a lot was left unanswered! It's definitely been chaotic but at this point, nothing really surprises me in 2020 anymore! In one way, it's easy as there is no "guess work" but in another way, its hard because they've essentially stripped us of our judgement! I like your idea of sending an expectation heads up letter home! I might do that as well so parents can MAYBE be a little prepared when the inevitable happens!

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Temp of 100.4F or higher

Sore throat or nasal congestion

New loss of taste or smell

New uncontrolled cough, difficulty breathing or shortness of breath

Diarrhea, vomiting, abdominal pain

Headache

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Specializes in School nursing.
On 8/21/2020 at 1:16 PM, k1p1ssk said:

Mass DPH & DESE has this list for exclusion:

"Fever (100.0° Fahrenheit or higher), chills, or shaking chills

Cough (not due to other known cause, such as chronic cough or Asthma)

Difficulty breathing or shortness of breath

New loss of taste or smell

Sore throat

Headache when in combination with other symptoms

Muscle aches or body aches

Nausea, vomiting, or diarrhea

Fatigue, when in combination with other symptoms

Nasal congestion or runny nose (not due to other known causes, such as allergies) when in combination with other symptoms"

This gets dicey as you said... how many kids have growing pains or anxiety that presents as "pukey" feeling. Kids are not supposed to return to school until they have received a negative COVID test and are symptom free for 24 hours (and fever free w.o. meds) OR they must quarantine for at least 14 days and be symptom free for 24 hours.

I'll be using my clinical judgement on some kids, for sure. I am very very hopeful that families just keep kids home when they have any symptoms. Since we'll be offering remote school, they really shouldn't have to miss out on their education because of the sniffles this way. But, we all know how well that's going to go over.

You and me both, @k1p1ssk. I was just on a PD last week where the doc presenting said "well, you know your students best but it is also best to be very conservative here and call the child's PCP to collaborate." Um, what? Like I'm going to get the child's PCP on the phone easily...

And testing availability is just UGH. I'll be sending kids out for tests that may take 14 days anyway, so I might as well just say "stay home for 14 days" if I don't use at least some of my nursing judgement here.

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Specializes in ICU/community health/school nursing.
2 hours ago, JenTheSchoolRN said:

"well, you know your students best but it is also best to be very conservative here and call the child's PCP to collaborate." Um, what? Like I'm going to get the child's PCP on the phone easily...

And testing availability is just UGH. I'll be sending kids out for tests that may take 14 days anyway, so I might as well just say "stay home for 14 days" if I don't use at least some of my nursing judgement here.

Actually it's not bad advice. You'll send the kid home and call the doc...might smooth the pathway for testing. Or the doc might blow you off as docs seem to do to school nurses.

This is absolutely nuts and it's the Wild West. I swing from wanting to send everything home to realizing that vomit is probably just what we usually see - a lot of snot, too much breakfast too fast or breakfast before the bumpy bus ride. But will I send it home? Yes.

Follow the policy which will undoubtedly change and then follow the new policy.

One interesting new study: The key first symptom in most cases: fever. So temp elevation may be what saves us. And we know how to send kids with fevers home.

Finally, remember that the biggest threat is from the asymptomatic kiddos...

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