Exclusion Guidelines- AHHH

[WyVy]

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 ?

[BrisketRN, BSN, RN]

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]

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]

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]

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]

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]

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.

[k1p1ssk, BSN, RN]

Where are you all planning on assessing these kids? In your office? We are to have a "Medical Waiting Room" (isolation room) for kids that are being sent home. I'm struggling with the idea of seeing sick kids in my office as well as injured kids. It would be 1 at a time, but if a kid is really sick, should I just bring them right to the MWR? A lot of the faker kids are going home anyway with these guidelines. But if I end up with more than one kid in the MWR and one isn't that sick, and one has COVID, I have exposed the "clean" kid. But it would be sorta similar if they were both in my office at separate times? I am really starting to worry about this...... 

[kunaspud]

We have a screening area that is not my office. Daily meds, diabetics, scrapes etc. can come to my clean office, but others go to the screening area for a quick assessment and then wait in a quarantine room for pick up if needed.

[JenTheSchoolRN, BSN, RN]

2 hours ago, kunaspud said:

We have a screening area that is not my office. Daily meds, diabetics, scrapes etc. can come to my clean office, but others go to the screening area for a quick assessment and then wait in a quarantine room for pick up if needed.

I'm doing the exact same thing.

[nursetlm, ADN]

Are you Covering both rooms? I am. Going to interesting. 

[ruby_jane, BSN, RN]

3 hours ago, k1p1ssk said:

 But if I end up with more than one kid in the MWR and one isn't that sick, and one has COVID, I have exposed the "clean" kid. But it would be sorta similar if they were both in my office at separate times? I am really starting to worry about this...... 

Happens with influenza every year. If all the kids are masked, cross-contamination will be mitigated but not eliminated.

Here's the thing: Parents who send their kids F2F are essentially taking on the risk that their child will be exposed at school.  We've asked that they take their kids' temps (the honor system, my least favorite system) and that they plan to arrive within 30 minutes of the time we call them to come pick up an ill child.

You cannot worry more about this than the parent does, friend.

Just now, nursetlm said:

Are you Covering both rooms? I am. Going to interesting. 

The schools that have an aide will have the nurse in the isolation room UNLESS there's a procedure or an emergency. The nurses without aides....they are utilizing a principal designated staff (often the secretary) to hold the fort and administer oral meds while the nurse is in the isolation room.

[nursetlm, ADN]

I wish I had an aide. My nurses office has a door to the timeout/ behavioral room that will be used by that employee until I have to use it as an isolation room. We have a clear shower curtain ? in the door to “separate” the 2 rooms. I’m supposed to limit my assessment to under the 15 minutes, call the parent to pick up and head back to my office. The Ill child will wait for parent while I can supervise through the shower curtain. I’m trying to stay positive but not sure how this will work with kids aged 5-9.