Orders for the School Nurse

Issued by Regional Health Officers
Public Health Division, New Mexico Department of Health

School nurses face new challenges daily in assuring the health of school children. To assist school nurses in meeting these challenges, Regional Health Officers, in their statutory role of oversight of school health staff, provide these standing orders to direct school nurses in specific treatments and testing.
These standing orders are to be used solely and exclusively by New Mexico schools and school nurses.

Please request current standing orders from your regional School Health Advocate. Contact information for each School Health Advocate is listed on the MAP page of this manual.

These standing orders will be reviewed and revised annually.

Reminder: When giving emergency medication such as Narcan, Epinephrine, or Albuterol, please send your regional School Health Advocate an NMDOH Adverse Event Form for Schools.

Standing Orders Include

• Standing order and guidelines for COVID-19 testing
• Standing order and guidelines for administration of vaccines as part of the VFC program only!
• Standing order and guidelines to administer oxygen
• Guidelines for urine pregnancy testing
• Standing orders and guidelines for Narcan
• Standing orders and guidelines for specific over-the-counter medications in treatment of:
  • Fever
  • Headache
  • Menstrual cramps
  • Minor cough
  • Sore throat
  • Severe pain while waiting for transport
  • Acid reflux
  • Oral pain
  • Insect bites
  • Allergic reaction
  • Minor wounds
  • Lice shampoo

Guidelines for the School Nurse to Administer Oxygen

Introduction

Oxygen use in the school setting is increasing. It is the standard of care for some medically challenged students. Written orders from the medically challenged student’s primary care provider for handling potential emergencies related to that student should be a part of the Individualized Health Plan (IHP). These orders should take into consideration the isolation of the school in relation to emergency medical care and the potential need for immediate intervention in an emergency situation.

In the school setting, there may be times when school staff, volunteers, and visitors will require the use of oxygen. Identify these individuals prior to an emergency situation; this allows opportunity to obtain guidance from the school district’s identified local emergency medical officer or an individual’s primary care provider, should initiation of oxygen administration be required.

Guidelines for School Nurses

• As with any emergency situation, the local Emergency Medical Services (EMS) system should be activated if other-than-routine oxygen is administered to an individual.
• The school district’s identified local emergency medical officer should be requested to provide guidance to the school district about use of oxygen in the school and whether its availability is appropriate for a particular setting.
• Identifying medical conditions of students and staff that might require oxygen administration prior to an emergency situation will assist the medical officer in appropriately assessing potential needs and making recommendations to the district regarding oxygen availability and usage. It also gives the nurse leverage in requesting written primary care orders for potential individual student needs.
• Distance of the school from the nearest EMS should always be considered when developing the school’s policy for oxygen storage, use, and maintenance.
• Schools should document the procedures in place for oxygen use in the school, which must adhere to safety and regulatory measures.

Example Procedure for Oxygen Administration in Schools

Action to be performed by: Personnel as designated in their school.

1. Check to ensure that “oxygen in use” signs are posted on the school campus.
2. Check that the tank has enough oxygen and document on the log.
3. Assemble equipment: oxygen cylinder, tank or canister, mask, and tubing.
4. Wash hands.
5. Attach mask/trach collar and tubing securely to oxygen source.
6. Set liter flow on the flow meter as prescribed. Never change this setting without an order.
7. Check that oxygen flow is coming out of the mask/trach collar.
8. Place mask over student’s nose and mouth. Tighten the elastic band over the student’s head and pinch the mask over the bridge of the nose for a good fit. Place trach collar over tracheostomy and loosely tighten elastic around neck.
9. Wash hands.
10. Monitor student continuously for respiratory distress. Initiate emergency procedures as indicated.
11. Document oxygen administration and any observations.

Action Points of Emphasis

• Most oxygen tanks have oxygen content gauges.
• Use approved hand washing technique.
• Attach humidifier if ordered.
• Hold mask/trach collar up to your cheek to feel for airflow. If no flow is felt, check connections and tubing for obstruction.
• Ensure good infection control technique.
• Emergency procedures: call 911 and continue to resuscitate.
• Use Oxygen Administration Log.

Guidelines for Pregnancy Testing by the School Nurse

Introduction

Pregnancy testing as a laboratory procedure in the school setting should be administered according to CLIA (Clinical Laboratories Improvement Act) regulations. For more information about obtaining a CLIA certificate or waiver, contact the state CLIA Program at (505) 222-8646, (575) 202-8937, or clia.dhi@state.nm.us.

See: New Mexico Department of Health. Clinical Laboratory Improvement Act. Accessed July 21, 2022.

If pregnancy testing is to be performed by the School Nurse, it is essential that the CLIA-certified agency provide training on the test and establish standards of care for all staff regarding performing the test, counseling the patient, and providing results, referral, or follow-up to patients who are pregnancy tested by the school nurse.

School nurse supervision should always be enforced if a home pregnancy kit is made available for a student to self-test, and the same standards of care are expected to be followed as though laboratory testing was being performed.

It should be kept in mind that every laboratory test may yield a false-positive or false-negative result. Therefore, the results of any test should be considered in the clinical context and appropriate action taken, such as repeat testing in two weeks if a false-negative result is suspected.

Guidelines for School Nurses

• Pregnancy testing provides an opportunity for preventive health education and counseling, regardless of the result. Each patient requesting pregnancy testing should be informed of services available in family planning, sexually transmitted disease, mental health counseling, and social services in the community. Young and/or distraught clients may need immediate emotional support and assistance getting services. Any agency unable to provide these essential services and support to every patient should not perform pregnancy testing but should refer the patient to community providers who can provide appropriate support and services.
• Each pregnant patient should be informed of all of their options and offered support and assistance in selecting among options. It is important to explore with the client their current emotional support system, such as family members or other trusted adults, and to offer them help in discussing the pregnancy with identified individuals if they so desire.
• Early referral for medical care and/or other services is essential. Undecided clients should be given information to allow them to access services and support at a later time. Agency staff where pregnancy testing is performed should be knowledgeable about a wide variety of related service providers and funding resources in the community, as well as school assistance and resources for expectant parents. Follow-up with each patient to assure that their physical, emotional, and educational needs have been addressed is likewise essential.