IHPs

OldDude · May 16, 2018

Hello Everyone,
My school district will start implementing IHPs in the 2018-19 school year. There seems to be quite a bit of confusion already.
Here's some of the questions that have been voiced:
1. Does the IHP replace the Dr's order? Does the Dr. sign the order for say an albuterol inhaler AND the IHP?
...No and it's unlikely a physician would sign your IHP.
2. Are IHP's only done by RNs or can an LPN do them?
...in Texas only RNs can do "assessments," they would generate an IHP if not already dictated by MD.
3. What conditions are IHPs needed?
...regarding any condition which may require some intervention at school AND medication/materials are available at school.
4. If a school has 90 parent claimed asthmatics and only 10 have actual Dr. order and an inhaler at school, do we only do IHP on those with inhalers?
...see #3
5. Our diabetics have very specific action plans sent by their doctors, can that be used in
place of an IHP?
...yes
Sorry if it seems these are ridiculous question, but it seems the RNs cannot agree to how we should implement the IHPs. We do have our state's School Guidelines, but there seems to be a lot of gray areas.

IHPs don't have to be complicated; for instance, the RX label for an albuterol MDI can serve as an IHP...2 puffs every 4 to 6 hours for cough or wheeze.

tamarae1 · May 16, 2018

Some of this may depend on district policy.

For us: IHP needs to exist when there is a 504 or IEP in place with a health diagnosis that causes student to come to clinic frequently.

In my state, RNs have to write them because it requires an assessment, nursing diagnosis and plan of care. BON says that isn't delegable.

IHPs don't trump doctors orders and you need both. Doctor's orders give an emergency or routine medication plan, but the IHP has the nursing dx and nursing nursing plan of care, which is not something the doctor provides. Check with your state health dept and see if they have guidelines for writing a complete IHP.

Hope this helps some.

WineRN · May 16, 2018

I think OD hit the points quiet well. An IHP is what the nurse does to care for a student with a specialized medical need.

I have a lot of families who claim their child has food allergies/asthma/some rare disease but I've explained that without a note from the doctor I can't add it to their file here. I think they forget that when they enroll 99% of the time they bring in the last physical with their immunizations where the doctor puts that the student is completely healthy.

ruby_jane, BSN, RN · May 16, 2018

Sorry if it seems these are ridiculous question, but it seems the RNs cannot agree to how we should implement the IHPs. We do have our state's School Guidelines, but there seems to be a lot of gray areas.

Not ridiculous at all and YUP. I would add....if you have a life-threatening illness (like anaphylaxis) or a seizure disorder AND the parent declines to provide information or MD orders...there's nothing stopping your from completing a generic IHP with basic instructions (seizure management instructions can come from policy or from several epilepsy organizations, ditto the anaphylaxis plan) instructing teachers on basic care until you get there and to call EMS as parent has declined to provide treatment or MD orders.

We use Skyward and there are template IHPs that fill a lot of the boxes for me.

Feral.Cat.Herder, RN · May 17, 2018

Thank you. As of now we use Power School, which isn't medically friendly, so we will need to create our forms.... which is what has been delegated to me. LOL

Feral.Cat.Herder, RN · May 17, 2018

Tamarae, thank you for your response. I thought the IHP was like the care plans in the hospital setting and that only an RN could complete them. Our district only has 2 RNs for 12 schools and LPNs that work the clinics in the individual schools, so they were hoping an LPN could do them. I like the idea of the IHP and think it would be a tremendous help to the nurses working the clinics, especially with some of the conditions they may not be as familiar with, such as sickle cell or addison's disease.

bsyrn, ASN, RN · May 17, 2018

Buy the book, Individualized healthcare plans for the school nurse. Published by Sunrise river press. I have the 2nd edition. It is expensive but well worth it.

It comes with a disc and you can personalize HCP's. Old Dude covered everything else wonderfully as usual :)

LSicilioRN · Aug 8, 2018

These are great questions and definitely questions school nurses need to have clarification. There are great resources.

The National Association of School Nurses has a position statement on IHPs

Individualized Healthcare Plans: The Role of the School Nurse - National Association of School Nurses

There is also a document on the DSHS School Health Services page about IHPs

School Health Services - School Nurse Notes

An IHP is a nursing care plan and a nursing document and not a document ever placed in a 504 or IEP. Components of the IHP can make up the Action Plan which can be given to teachers or placed in 504 and IEP.

1. The IHP does not replace doctor orders as this is a nursing document.

The doctor does not sign the IHP. You can develop the IHP with the parent and parent can sign acknowledging nursing care and goals for their child.

2. IHPs must be formulated by the RN and can have input from the LVN. This comes down to Scope of Practice with our NPA scope of practice. Texas Administrative Code Title 22, Part 11, Chapter 217, Rule 217.11

3. We are legally required by the state under (LEGAL) Policy FFAF to have an IHP on students with Diabetes. However, the RN can decide what students might need an IHP based on a few questions. A guide for this can be found on the Texas School Nurses Organization website in the community library that can be accessed by members. If you are not a member, please feel free to contact me and I can get that document to you.

4. Not every student with a reported health issue requires an IHP. Again, the guide is very helpful for the RN to determine that. IHPs do not need to be complicated. And the big book on Individualized Healthcare Plans mentioned earlier is a great book AND very expensive- so maybe one per district if you are small.

The IHP needs to be a useful and easy to follow plan that you actually follow to determine course of care for your student such as skills to learn, education and safety measures you are implementing, etc. If it is too lengthy and complicated or you never look at it again during the school year, then it serves no purpose.

5. There are several documents that your Diabetics require

Medical Management Plan from the doctor (totally different from an IHP)

IHP developed by the RN

Emergency Action Plan that can be shared with teachers and a 504 or IEP

UDCA authorization by parent

Documented list of the person(s) assigned to be an UDCA by your Principal

Training they received (knowledge and skills)

The only ridiculous questions are those not asked ;o)