With school nurses becoming a vanishing breed, virtual nursing care via telemedicine is proving itself to be a viable alternative for cash-strapped school districts.
Attendees of the 2016 American Telemedicine Association annual conference in Minneapolis got some evidence of this Tuesday, courtesy of a case study in South Dakota. There, state regulations did not allow nurses to delegate insulin administration to unlicensed individuals, so children with Type 1 diabetes in Sioux Falls public schools without a dedicated nurse had to be driven to an area nursing home to get their needed medication.
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The situation was even worse in rural areas of the sparsely populated state, and the South Dakota Board of Nursing was fully aware of the problem, said Linda Young, nursing program specialist for nursing board. “When you have no providers out there, you have a public health crisis,” Young said Tuesday.
During the 2007-08 school year, the nursing board called for legislation to allow unlicensed providers to administer insulin, but they realized there would be opposition in the state capitol. “We wanted to bring people together,” not fight battles, Young said.
Instead of going to lawmakers, the Board of Nursing brought together groups of stakeholders and developed a virtual model of nursing practice, linking trained but unlicensed people to a remote nurse to administer insulin shots as necessary. “A research project emerged,” Young said. “It was very crucial for us from a policy perspective to gather evidence.”
After securing funding from the state as well as from the National Council of State Boards of Nursing, Avera eCare Services, the telemedicine division of Avera Health, an integrated delivery network in Sioux Falls, ran a study of 32 South Dakota schoolchildren with Type 1 diabetes from December 2010 to May 2013. None of the kids a school nurse available to administer insulin during the school day.
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Avera eCare outfitted all of the participating children’s schools with identical hardware and software to measure and monitor patient blood-glucose and insulin levels. Each child received a comprehensive diabetes medical management plan, said Mary Oyos, diabetes program manager for Avera McKennan Hospital & University Health Center.
Virtual nurses conducted weekly e-visits, and the unlicensed assistants completed weekly care logs that virtual nurses used for oversight.
After 2½ years, the results were fairly impressive. The unlicensed personnel at the schools responded to hypo- and hyperglycemic events according to each patient’s management plan nearly 100 percent of the time, according to data that Oyos presented. They collected accurate blood-glucose readings more than 90 percent of the time.
The Board of Nursing subsequently approved new rules that took effect in 2014, allowing unlicensed providers to administer insulin to schoolchildren under nurse supervision. The regulations included a standardized protocol as well as training for nurses and the diabetes aides, Oyos said.
With the rule changes and the positive results of the research study, Avera eCare in February 2015 started a wider pilot for remote health services in eight Sioux Falls schools without full-time nurses. Each school got a telemedicine cart outfitted with an HD webcam, an otoscope and a stethoscope. Two half-time nurses at an Avera facility rotate call duty, according to Molly Satter, health services supervisor for the Sioux Falls School District.
The district has but one nurse per 1,190 students, and some school nurses covered two or three buildings each, Satter said.
Local school staff initiates video consultations and provide care under remote nurse supervision. Remote nurses help students with general health needs, including first aid, illnesses and control of chronic conditions like asthma and diabetes. They also supervise and delegate the provision of care, contact parents for case management and refer students to physicians as necessary.
The jury is still out on the success of this expanded program, but Satter offered up some data. In the first 13 months of the pilot, about 7.5 percent of students at participating schools used the Avera eCare service a total of 457 times. More than a third of video visits were related to diabetes.
Students seemed to take well to the service. “Kids are pretty technology-savvy now, so this seemed pretty normal to them,” Satter said.
The presenters showed this video at ATA to illustrate how the system works.
https://www.youtube.com/watch?v=DXn7t8WVhxQ
Photo: YouTube user SiouxFallsSchools