Jump to content

Exclusion Guidelines- AHHH

Posted

Specializes in keeper of tiny humans. Has 6 years experience.

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 😉

k1p1ssk, BSN, RN

Specializes in pediatrics. Has 10 years experience.

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.

WyVy, LPN

Specializes in keeper of tiny humans. Has 6 years experience.

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. 😧

KeeperOfTheIceRN, ADN

Has 4 years experience.

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.

caretakerofkids, RN

Specializes in School Nurse. Has 24 years experience.

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!

Flare, ASN, BSN

Specializes in school nursing, ortho, trauma.

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

scuba nurse, BSN, MSN, RN

Specializes in School Nursing, Pediatrics. Has 31 years experience.

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

Bulldogs, CNA, EMT-B

Has 4 years experience.

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.

KeeperOfTheIceRN, ADN

Has 4 years experience.

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!

BrisketRN, BSN, RN

Has 4 years experience.

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

JenTheSchoolRN, BSN, RN

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.

ruby_jane, BSN, RN

Specializes in ICU/community health/school nursing. Has 12 years experience.

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...

BrisketRN, BSN, RN

Has 4 years experience.

First day of school and I just got my first "we've got a headache!" call which actually turned out to be a MS kid telling me he just wanted to take a screen break for a few minutes because his eyes were hurting from staring at a computer. He says "I've never stared at a screen for so long." Yep, used my nursing judgement there.

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

11 minutes ago, ruby_jane said:

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.

Oh, trust me I'm saving that nugget for the pedi that is made at me for sending a kid home, etc. Because that advice came from another pedi doc at a very well trusted pedi hospital, so...

And yep re: fevers - been reading this is actually becoming a more common symptom for kids that previously thought - at least for the ones that will show symptoms since some still will be carriers only. I had already done a temp check on nearly every kid in my office, so that won't change. I also bought some no touch thermometers, but they aren't great and I'm going back to my tried and true temporal that I can easily wipe down with alcohol pads (like I always have done agan) in between uses.

My school is investing in a pre-screening tool, though, that will require reporting a temp threshold (I'm prepped to get families thermometers that needs them). Will folks lie? I'm sure some will, of course, and I'll learn quickly who they are...

k1p1ssk, BSN, RN

Specializes in pediatrics. Has 10 years experience.

The guidelines from DESE have changed since early last week, and now say that a symptomatic student must be sent home and can either get tested and return after the negative test and 24 hours symptom free OR quarantine for at least 14 days. If they opt to test, and it is positive, of course the student quarantines for at least 14 days and everyone in the class must be notified and also quarantine at home. It is recommended they wait I believe 5-7 days from the day the initial symptomatic student was sent home/first reported absent. My new question is what happens if the family of the original student decides not to test but they actually have COVID. It's a little ridiculous to me that this could literally be a loophole where a family could purposefully choose not to test in order to allow other students to remain in school.

This is making me really envy the admin at my private school job, because they have literally made families sign contracts which dictate what has to happen in order for their students to remain in school (and this includes WEEKLY testing through a contractor).

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

13 hours ago, k1p1ssk said:

The guidelines from DESE have changed since early last week, and now say that a symptomatic student must be sent home and can either get tested and return after the negative test and 24 hours symptom free OR quarantine for at least 14 days. If they opt to test, and it is positive, of course the student quarantines for at least 14 days and everyone in the class must be notified and also quarantine at home. It is recommended they wait I believe 5-7 days from the day the initial symptomatic student was sent home/first reported absent. My new question is what happens if the family of the original student decides not to test but they actually have COVID. It's a little ridiculous to me that this could literally be a loophole where a family could purposefully choose not to test in order to allow other students to remain in school.

This is making me really envy the admin at my private school job, because they have literally made families sign contracts which dictate what has to happen in order for their students to remain in school (and this includes WEEKLY testing through a contractor).

It is actually now 10 days if symptomatic and choosing to not get tested IF symptoms have resolved for at least 24 hours. And I know DESE will change them again - just wait.

cowboysandangels, BSN

Specializes in Peds. Has 21 years experience.

We are only to exclude for the top 5: fever, chills, new cough, loss of taste/smell, and SOB/difficulty breathing.  Makes me nervous.

ruby_jane, BSN, RN

Specializes in ICU/community health/school nursing. Has 12 years experience.

15 minutes ago, jlrm50 said:

We are only to exclude for the top 5: fever, chills, new cough, loss of taste/smell, and SOB/difficulty breathing.  Makes me nervous.

Actually - this makes sense. The data we have indicate (and this is in adults) the earliest symptoms in most people are increased temperature and that loss of taste smell. You are missing headache in this list BUT headache usually (not always but in the data I'm reading mostly) comes along with diarrhea, fever, or the loss of taste and smell.

This will also likely have you sending home kids with asthma.

But this year, I think that's OK.