Skilled Nursing Services

The Vendor is required to provide skilled nursing services also extends to all school-sponsored activities outside the school day, including co-curricular, extra-curricular and non-academic activities (e.g., summer school, overnight excursions, prom, etc.).
 - Examples of skilled nursing include but are not limited to:
•    Tracheostomy care and suctioning as needed;
•    Ventilator care and monitoring which includes diligent monitoring of patient and oxygenation;
•    Pulse oximetry for monitoring arterial oxygen saturation;
•    Preparation and administration of gastrostomy, jejunostomy, and nasogastric tube commercial and customized enteral formula feedings (physician ordered formulation due to medical condition which may involve parent or legal guardian preparation) by drip, pump, and syringe bolus methods;
•    Nebulizer treatments, routine and on an as needed basis (i.e., prn);
•    Administration of medications via various delivery routes both scheduled and as needed (i.e., prn);
•    Diabetic care which may include blood glucose monitoring; carbohydrate counting; monitoring and managing continuous glucose monitoring systems; and insulin dosage calculation and administration;
•    Urinary catheterizations; and
•    Nursing care coordination.
- Skilled nursing services are provided for students whose disability includes complex physical health needs; however, it may not be the primary cause of their learning difficulties.
- Skilled nursing services are a related service or related aids or services, which is required to assist a student with a disability to access the general education curriculum opportunities akin to student’s non-disabled peers.
- Provided primarily to eligible students may involve performance of ancillary, support, or administrative services related to the provision of skilled nursing services which include but are not limited to the following:
•    Lifting, moving, ambulating, and assisting in range of motion exercises, and positional changes of non-ambulatory students minimally every two (2) hours;
•    Developing and updating emergency-action and individualized health-care plans for students serviced;
•    Providing in-transit skilled-nursing care, e.g., nursing care on bus transports which may include lifting, moving, and positioning of eligible students;
•    Developing and maintaining student’s nursing chart and record, including health-related plans;
•    Documenting in student’s nursing chart and record, both hardcopy and electronically;
•    Clear, unequivocal communication with state personnel, its agents, and families to coordinate schedules and ensure appropriate staffing coverage;
•    First aid and cardio-pulmonary resuscitation (CPR) interventions when necessary; and
•    Other duties attendant to ensuring continuity of care.
- Time and frequency of care
•    Services must be integrated into the student’s educational program to ensure minimal disruption to the educational and other related services or related aids or services the student receives during the school day and during school sponsored co-curricular, extra-curricular or nonacademic activities. 
•    Services are to be provided during the student’s school day and school sponsored curricular, extra-curricular or nonacademic activities at the school or at a site identified, as appropriate, by the individualized education program (IEP) team that occur outside the school day.
•    The student’s school day may include transport time via school bus, to and from school, as indicated by the student’s specific requirements.
- Student’s nursing charts and records
•    The provider shall document all relevant nursing interventions in student’s nursing chart and records maintained at the school, and electronically, in accordance with professional nursing standards
•    Documentation shall occur for each face-to-face session with the student. 
•    Student nursing chart and records shall be considered educational records and the property of the state.
•    All records kept in connection with the contract shall be up to date, compliant, available for inspection, and maintained in accordance with all requirements concerning confidentiality, e.g., FERPA, HIPAA.
- Continuous nursing service
•    Begins the moment the qualified nursing personnel is expected to report (or the moment the qualified nursing personnel actually does report, whichever is later) to a designated site to begin services for the student(s) as specified on the authorization and communicated to the provider.
•    This may include: receiving the student(s) at school; departing the school on the bus to pick-up the student (other students may also be picked up and dropped off during the bus route).
•    Ends when the student is released from school to a parent, legal guardian, and legally appropriate qualified authority for the student; when the qualified nursing personnel returns to school campus on the bus after dropping the student at the student’s residence.