Expanded Provision of Health Care by MMSD School Nurses

Currently, medication can only be given at school with a written doctor's order and written parent permission. We have expanded our services in some schools. School nurses in these schools may give acetaminophen (Tylenol®) or ibuprofen (Advil®) with written parent permission for headache, discomfort or menstrual cramps. The services will be available only when the school nurse is physically present in the school building.

Currently, school staff responds to undiagnosed serious allergic reactions and asthma problems by calling 911. In some schools, we have begun to use "standing orders" to treat undiagnosed serious allergic reactions (such as to food or insect stings) and serious asthma problems until paramedics arrive. Permission for treatment will not be requested. These standing orders allow treatment to be started before emergency personnel arrive at the school. The standing orders were written by the district and reviewed and signed by the medical consultant, Greg DeMuri, M.D. Students with diagnosed serious allergic reactions should continue to provide emergency medication and written parent and physician orders for treatment.

In some schools, we will offer diagnosis and treatment by advanced practice nurses for the following health problems: conjunctivitis (pinkeye), impetigo (skin infection), minor localized skin infection, otitis externa (swimmer's ear), otitis media (middle ear infection), head lice, scabies (skin infestation), streptococcal pharyngitis (strep throat), and tinea corporis (ringworm of body).

The idea of nurse practitioners (NPs) diagnosing and treating acute illnesses is well accepted. Since 1995 Wisconsin NPs have been able to be licensed as advanced practice nurse prescribers (APNPs) after appropriate education and certification. MMSD school nurses who are licensed as APNPs will be permitted to prescribe medication in some schools for the above conditions. In all situations, the APNP would only prescribe according to directions written by district APNPs and reviewed and approved by Greg DeMuri, M.D.

In some situations the APNP would write a prescription that could be filled at the local pharmacy. The school district has worked with Health Maintenance Organizations (HMOs) in Madison to ensure that prescriptions written by school district APNPs are accepted by the HMO in the same way that prescriptions written by "in-house" providers are accepted. If an HMO is unwilling to accept a prescription written by a school district APNP, it will not be possible to fill the prescription as a covered HMO benefit. When a prescription is written, notice will be provided to the primary health care provider.

In other situations, the APNP may recommend buying an over the counter medication if it is called for in the specific protocol (i.e. special shampoo for the treatment of head lice).

The school district's primary mission is education not health care. However, the two are strongly linked because students who are not healthy are not able to learn. The goal of this plan is to make sure that students get care for untreated health problems so that they do not miss school. We intend to improve student's access to health care. All school district nurses are committed to the concept of "children having a primary health care home" in a medical center and we will continue to link children and families to medical centers. We believe that students who do not have health care providers or those who have serious problems getting health care will benefit by using the above prescriptive services. We view this as one more way to ensure that healthy students are at school and able to learn.

Health Information

For more information, contact:
Freddi Adelson, Health Supervisor
Madison Metropolitan School District
545 W. Dayton St.
Madison, WI 53703