HIPAA or FERPA - Privacy Issues at School

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Specializes in Pediatrics Retired.

There has been much said about providing confidential student medical information to school staff and how that impacts privacy issues.

Regardless of which rule applies, simply informing a child's teacher of a particular medical condition only scratches the surface. My major area of concern, especially on the elementary level, is that the kids aren't with the same person/teacher all day. They are supervised by multiple staff members throughout the day when the teacher may not be present; PE, Music, Music Movement, Computer Lab, Library, Science Lab, class switching, etc. For example all of these staff members must be informed that "little Johnny" in Mrs. XYZ's class has a life threatening allergy to peanut products. There is a variety of snack food and drink all over this campus. Additionally,...at some point in time throughout the school year these staff members will have substitutes. My opinion is if I disseminate to the appropriate staff and represent that the information is "Confidential Student Medical Data" and someone who needs to know this information discloses it in an inappropriate manner - then that's their individual liability and doesn't constitute a privacy violation by the nurse or school.

What other method of passing on the information is available in lieu of some written form?

By providing the medical information to the school, does a parent imply consent that those charged with the care of their child be informed of that medical information?

Whadda you guys think????

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Specializes in Complex pedi to LTC/SA & now a manager.

My sons school every year in the back to school paperwork has a blurb added to the emergency info card that the school nurse has permission to inform necessary school personnel about relevant medical conditions including asthma , allergies, diabetes, seizure precautions. In addition the parent gives general consent to contact the child's physician if necessary for clarification or informational updates (such as a failed or borderline health screening, or updated asthma plan). Now you have parental consent to use prudent nursing judgement to inform colleagues as needed. I know the one school has a list of anaphylactic risk students available to epi pen trained staff. (But my state also permits the nurse to have standing orders from the school physician for emergency epi pen and albuterol and I think a few other meds just in case)

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Specializes in School Nursing, Public Health Nurse.

I email the teachers with Emergency Care Plans instead of the full IHP for their students with a health concern. I also have a little blurb in the email:

This information is confidential and is provided to you for the education or health of the student. Substitutes and interns may need this information for student safety. Please make sure that you have this information in your substitute’s folder. The plan you receive for this student should be placed in a locked cabinet. You may make a list of your students with health concerns; however this list cannot be shared. Lists containing student names and their health concerns are for personal reference only. If distributed to others, this will be a violation of FERPA. Thank you for your help in making school a safe place for all students.

I also include the Vice Principal on the email list who shares the information with security staff who are our first responders to an emergency, besides myself. In the main office, I have a binder with copies of all my IHPs sorted by medical condition for emergencies. Other than that, it's on a need to know basis. I know students go to the library, computer lab, etc. but the teacher should always be present anyway.

When a parent indicates on the health information form that a student has a medical concern I send a letter home requesting more information. On that sheet includes an area asking to share the information with necessary parties and they sign it.

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Specializes in School Nurse.

This is a troubling issue. Here in Massachusetts, the DPH School Health Unit discusses this problem yearly. They admit that it is a problem. What happened here in Mass is that one of these “Medical Health Concerns List” was left on top of a teacher’s desk and there was a PTO meeting in that room and the list was circulated and everyone read it. A parent learned of this and was furious. Who got sued? Not the teacher, but the school nurse who gave the list to the teacher. DPH does not recommend printing a list out and giving it to the teachers. They recommend that the teachers be informed and if the teachers want to make a list for themselves that they write it out. However, they acknowledge that this is not the best solution to the problem.

Just this year, nurses in the district did not give this list out due to DPH recommendation. I too feel that it is not enough to simply inform the teachers, all the specials, and support staff. I am uncomfortable with just informing the staff, yet I can’t trust them to keep a written list confidential.

I am open to any suggestions. This is an important issue.

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Specializes in Pediatrics Retired.

Well said Massmagic...you know what they say in the legal field, "If it isn't written down, it didn't happen." It would appear pretty lame in the court room for you to say, "I told her about little Johnny's life threatening allergy to peanuts at the beginning of the school year," with no written documentation to support your statement. Punishing the school nurse for a teacher breaking the chain of confidentiality seems bizarre to me. If a nurse goes home from the hospital and tells a neighbor what's wrong with a patient, is the doctor punished for writing the diagnosis in the medical record?

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I'm in the same boat as you Massmagic. I'm from Massachusetts and have heard the same story and recommendation which is why I don't make any medical concern lists. I would also like to hear some suggestions. Each time a teacher wants to throw a classroom party I go through their list of students and inform the teacher of what can and cannot be given out. This takes up a lot of my time and I need to figure out a different solution that keeps children safe while keeping their information private.

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Specializes in kids.
I email the teachers with Emergency Care Plans instead of the full IHP for their students with a health concern. I also have a little blurb in the email:

This information is confidential and is provided to you for the education or health of the student. Substitutes and interns may need this information for student safety. Please make sure that you have this information in your substitute’s folder. The plan you receive for this student should be placed in a locked cabinet. You may make a list of your students with health concerns; however this list cannot be shared. Lists containing student names and their health concerns are for personal reference only. If distributed to others, this will be a violation of FERPA. Thank you for your help in making school a safe place for all students.

I also include the Vice Principal on the email list who shares the information with security staff who are our first responders to an emergency, besides myself. In the main office, I have a binder with copies of all my IHPs sorted by medical condition for emergencies. Other than that, it's on a need to know basis. I know students go to the library, computer lab, etc. but the teacher should always be present anyway.

When a parent indicates on the health information form that a student has a medical concern I send a letter home requesting more information. On that sheet includes an area asking to share the information with necessary parties and they sign it.

I have stolen this!! I will use it in addition to the info I send out.. I pull schedules and email teachers on particular kids they have and refer them to general guidlines posted on our internal whiteboard...there is general info on seizures, asthma, epi pens...if there is a special consideration or concern then I am in touch with that teacher.

Thanks!

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Specializes in School Nursing, Public Health Nurse.
I have stolen this!! I will use it in addition to the info I send out.. I pull schedules and email teachers on particular kids they have and refer them to general guidlines posted on our internal whiteboard...there is general info on seizures, asthma, epi pens...if there is a special consideration or concern then I am in touch with that teacher.

Thanks!

Go ahead ahead and steal! I also have to mention for my students with epi pens I add a link to a fantastic YouTube video about Epi pens and s/sx of anaphylaxis. I'm still looking for a really good video for asthma, diabetes, etc. I also put a little sentence that this video is for reference and not a substitution for training with the School Nurse. I would love to do a little asthma/seizure/diabetes training with teachers but it would be so hard to schedule that.

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Specializes in School nursing.

I, too, an in MA and hit rock/hard place. I debated what to do. I was lucky in the fact that every child with an allergy had a check in the box that stated I could share medical information with necessary teachers/staff (I include that statement on our . So, instead of printing a list, I saved a list to a private folder on the shared teacher/staff drive. I send an email with instructions on how to access the list and not to print it to maintain confidentiality. I still reference checking the list with all teachers prior to field trips.

(I then created a general allergy action plan to post in all classrooms, ran an epi-pen training. We don't have a cafeteria, so kids eat everywhere and every staff member at my school can interact with them during a meal/snack time. We are a peanut/nut free school so teachers are good at catching any of those foods that sneak in.)

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Specializes in Pediatrics Retired.
This information is confidential and is provided to you for the education or health of the student. Substitutes and interns may need this information for student safety. Please make sure that you have this information in your substitute’s folder. The plan you receive for this student should be placed in a locked cabinet. You may make a list of your students with health concerns; however this list cannot be shared. Lists containing student names and their health concerns are for personal reference only. If distributed to others, this will be a violation of FERPA. Thank you for your help in making school a safe place for all students.
...I'm liking this wording, thank you kenderella89. I haven't actually "printed" a list for the staff in several years since I started emailing the information. I believe if I preface the email with this introduction, along with not actually producing a paper printing of the information, I can show due diligence in attempting to keep the confidentiality chain intact and should satisfy one of the exceptions to FERPA's general consent requirement..34CFR 99.30.
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Specializes in school nursing, ortho, trauma.

I use an electronic system for the teachers, which by and large seems to work fine - it creates an icon that when clicked gives an explanation of what the medical concern is. The problem is disseminating that info to the teachers that don't necessarily have access to that red cross icon. I have brought this up before - i have made suggestions that the teachers communicate these issues to the elective teachers. It tends to fall on deaf ears. At the end of the day - the teachers have 25 students a piece to worry about, i have 800 to worry about... some of you have more.... In addition I make up a master list that gets distributed to the principals in the beginning of the year and also cafeteria head (since she doesn't get to see red crosses and i feel like she should know who has allergies since she is very familiar with the children and their lunch buying habits) and I update that with emails as needed.

This reared it's ugly head yesterday when one of my special ed pre-k students was given a substance with egg whites to play with and he has a documented egg allergy. He broke out in hives, i gave benadryl and called mom. Mom wasn't too upset, i think i was more upset that there was no inquiry and that the activity wasn't run by me first, especially with a student that wasn't regular to the classroom.

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Specializes in kids.
Go ahead ahead and steal! I also have to mention for my students with epi pens I add a link to a fantastic YouTube video about Epi pens and s/sx of anaphylaxis. I'm still looking for a really good video for asthma, diabetes, etc. I also put a little sentence that this video is for reference and not a substitution for training with the School Nurse. I would love to do a little asthma/seizure/diabetes training with teachers but it would be so hard to schedule that.

I have a PPT on our internal site that has a video link to both Epi pens and Avui Q, developed (and fully credited to) NASN as well as PPT on Managing seizures in the classroom. The Asthma and Allergy foundation has an asthma PPT. Sometimes when I use them from outside, I will limit it a the important slides that are necessary...dont want to lode them partway through the presentation :)

I make it clear in the email I send (and save! ) they are responsible to review and to see me with any questions. We did a district wide training with epi pens.

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