Table of Contents
Bronchodilator - SB 322     --     DOE Certification     --   ENDS     --       Epinephrine - SB 25     --     Glucagon - SB    
Naloxone     --     Off Label Medications     --      Vaccine Registry

SB 322:  Bronchodilator/spacer/nebulizer

Asthma Action Plan Form          Fact Sheet on SB322          Download SB322 here

Senate Bill 322, passed in May 2016, allows school nurses to maintain a stock bronchodilator for the emergency treatment of asthma.  The use of the bronchodilator is limited to those students with a diagnosis of asthma, have a current Asthma Action Plan, and whose own inhaler is not available.  The inhaler can be used for multiple students but each student must be provided with a separate spacer.  The spacers cannot be shared.  The Office of Student Wellness website has is a powerpoint module that school nurses are welcome to use or adapt for staff training.  Each school year the use of the stock bronchodilator is to be reported; the form is also posted on the website.

The New Hampshire School Nurses Association has been collaborating with the New Hampshire Department of Education, the New Hampshire Public Health Association, the New Hampshire Asthma Collaborative, Acelleron and Convenient MD to find bronchodilator, spacer and nebulizer resources.

DOE School Nurse Certification

House Bill 1193 on School Nurse Certification

HISTORY:  The board of the New Hampshire School Nurses' Association is collaborating with the New Hampshire Department of Education to develop a certification process for School Nurses. It is the postion of NHSNA that  certification would establish a standard of practice to ensure that all children are receiving the highest level of health care that will allow them to reach their full educational potential.  This certification will be separate from teacher certification and school nurses will not be expected to teach.

NOTE:  It is not the position of the New Hampshire School Nurses' Association to interpret the rules.  Any questions on how the rules apply to you should be asked of the NH DOE Credentialing Office.

History/Context:
There are approximately 500 school nurses in New Hampshire, serving 618 public and private schools.  The role of the professional school nurse is currently defined by New Hampshire School Nurse Certification Law (RSA 200:29, II), with the current rules approved by JLCAR (Ed 306.12).  Certification ensures a professional level of qualification for the position of school nurse, which will support a minimal standard of care for students with acute and chronic health needs in school. 

New Hampshire school nurses are members of a unique discipline of professional nursing and are often the sole healthcare providers in their districts.  They are both an independent clinician and manager of school health services.  It is imperative that school nurses are prepared for and practice at the same level as their colleagues, such as teachers who are certified, as well as other adjunct therapists who are prepared with Masters Degrees, for example occupational therapists, physical therapists, and speech therapists.  


Senate Bill 25 FN-Relative to Epinephrine

HISTORY: This bill was introduced lin 2016 by Senator D’Alessandro of the Education Committee and was referred to committee.  This bill allows schools to acquire and maintain a supply of epinephrine auto-injectors with the intent of making them available to ANY student showing symptoms of anaphylaxis, and for the school nurse to train designated school personnel to receive training in the administration of an epinephrine auto-injector to any student with symptoms of anaphylaxis.
 FULL BILL FOUND HERE

CURRENT STATUS:  
Completed Legislative Action
Spectrum: Partisan Bill (Democrat 1-0)
Status: Passed on May 4 2016 - 100% progression
Action: 2016-05-04 - Signed by the Governor on 05/03/2016; Chapter 0039; 

Effective 07/02/2016
Text: Latest bill text (Chaptered) [HTML]

UNH STUDENT TRAINING RESOURCES     The school nurse has the authority to possess and administer epinephrine as a stock medication to use in the event of anaphylaxis, a severe and life threatening allergic reaction. There are students who experience their initial allergic episode during the school day and having access to epinephrine has prevented serious life threatening results. An EpiPen provides a safe and easy delivery system of epinephrine that can be used by an unlicensed person. This module has been developed as a training tool for school staff and includes essential information about anaphylaxis and the use of an EpiPen. Each school nurse maintains a list of those staff members trained. We would like to thank the senior nursing students from the University of New Hampshire for participating in this project.

Epinephrine Training Certificate

Epinephrine Auto Injector Training Evaluation Form

Epinephrine Auto Injector Training PPT

Glucagon injections
HISTORY: Sponsor: Senator Stiles District 4   This bill passed without input from NHSNA. This bill allows parents to train and delegate school staff on glucagon administration.  

CURRENT STATUS: Effective Date: July 4, 2015   FULL TEXT HERE

Glucagon Administration Training for Non-Medical School Personnel

A joint project project of NHSNA, Office of Student Wellness and Senior UNH Nursing Students

In an effort to provide the highest quality information and training in an accessible manner, the Office of Student Wellness is please to provide the following information on the administration of Glucagon to students by non-medical personnel. School nursing staff are encouraged to utilize the documents below and to contact our office with questions. We would like to thank the senior nursing students from the University of New Hampshire for participating in this project.

Glucagon Training PowerPoint       Please be aware that the slides will advance after one minute, your arrow buttons will work to advance or back up.

Glucagon Pre-Test and Answer Key
Post-Test and Answer Key
Glucagon Administration Checklist
Training Program Evaluation
Program Certificate of Completion

Naloxone

The New Hampshire School Nurses' Association formed a study committee in October 2015 to look at the issue of Naloxone in the schools.  Their work is now complete and the board of the NHSNA approved the a position statement for distribution.

Opioid related  overdose kills hundreds in New Hampshire every year. Many of these deaths are preventable with the timely use of an opioid antagonist (naloxone) as well as the quick summoning of EMS and the initiation of care. NH school nurses, as allowed by local administration and policy, are in the position to administer life-saving measures in the event of an opioid overdose. In addition, as an integral part of the interdisciplinary team, school nurses are also in the unique position to provide prevention awareness and support to students, family, faculty, and staff-- a critical step in the on-going management of substance abuse and misuse.

In response to the opioid crisis in New Hampshire, the state has created the campaign "Anyone. Anytime." to educate the public and professionals about addiction, emergency overdose medications, and support services for anyone experiencing opioid addiction. 

NH Naloxone laws and resources: 
NHSNA Position Statement
Anyone, Anytime  DrugfreeNH
House Bill 270 - Good Samaritan Law
House Bill 271 - Friends & Family Access to Naloxone

NH Board of Nursing Position Statement: RN Role in Off Label Medication UsePosted March 16th, 2016
The board determined that an off label medication can be administered or delegated with an appropriate provider order. The nurse should be familiar with the drug purpose and side effects in relation to the client that is receiving the medication.

FULL TEXT HERE

Vaccine Registry
HISTORY:  
New Hampshire is the only state without a centralized immunization registry. The NH Legislature in 1998 ordered the creation of a “single repository of accurate, complete and current immunization records to aid, coordinate and promote effective and cost-efficient disease prevention and control efforts.” But the initiative was never funded. 

The NH  Executive Council on in April 2014 approved a $1.3 million contract with an Arizona company to get a registry up and running. Everyone who administers vaccinations will enter information into the system, but only designated DHHS personnel would have the passwords needed to access the information on an aggregate or individual basis.
Massachusetts became the 49th state to adopt an online vaccination registry in 2011, leaving New Hampshire as the only state without one

CURRENT STATUS:
Years in the making, N.H. immunization registry hits snag during rulemaking
By CASEY McDERMOTT,   Concord Monitor Staff:  January 4, 2015


ENDS = Electronic Nicotine Delivery SystemsSince 2010, it has been illegal (RSA 126 K) for NH youth under 18 year of age to buy and/or use ENDS. ENDS are also included in the indoor clean air act (Indoor Smoking Act, RSA 155:64-77), making it illegal to use them in all the same places as combustible (tobacco) cigarettes. 

Download Flyer from Tobacco Free NH network

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