Conversion of School Nurse Policy and Procedure Manual to Electronic Format

INTRODUCTION

School nurse policy and procedure manuals are essential components in establishing standards of practice to help ensure quality service to customers (National Association of School Nurses & American Nurses Association, 2005). In the realm of school nursing, our customers are students and their families. Policies and procedures define the scope of nursing practice and provide a reliable source of direction, thereby decreasing the risk of errors resulting in harm to students or litigation. Agency policies hold employees to a specified standard of behavior (Schwab, Hootman, & Gelfman, 2001). It is critical that school nurses know and follow the policies and procedures in their school district. Establishing a framework for nursing and health care within school districts is important for sharing information about nursing activities with school administrators and boards of education, demonstrating outcomes of practice, and generating substantiation for nursing positions and activities in schools (Proctor, 2006).

Electronic filing is commonplace in today’s world. Soon after the birth of the Internet, it became apparent that access to the Internet and the endless amount of information it could contain would be invaluable. Using the Internet to store electronic files in a coherent, organized way was one of its first practical uses (Griffith, 2000). Most businesses have moved to computer storage of records and information, replacing rows of file cabinets and shelves containing files, records, and manuals. A few years ago, the Olathe District Schools’ Information Technology Department created a Virtual File Cabinet (VFC) to provide online access to district policies, forms, general information, and directories. A VFC provides an avenue for administrators to promote a consistent service delivery model.

Computers are commonplace in the majority of school health offices (Schwab et al., 2001) and used in a variety of ways, including storing student data and health information and assisting school nurses in accessing the latest information on various health issues. As the VFC became a familiar tool to all employees in the Olathe District Schools, the nursing department decided to use the available technology to create an electronic version of the school health manual, which includes health policies, procedures, protocols, and forms. The district’s VFC can be accessed by all employees using password-protected networked computers. More recently the technology department created a password-protected computer portal available to employees using nonnetworked computers, such as home personal computers and laptops, thereby allowing access to information at all times.

The Olathe school nurses kept nursing policies, procedures, protocols, and forms on hard copy that filled two large three-ring binders located in each health room. The original school nurse manual was divided into four major areas: (a) national, state, and professional overview of school nursing and coordinated school health; (b) state laws and local policy and procedures related to school health services; (c) health education curriculum and resources; and (d) documentation procedures, including a complete set of departmental forms.

As access to information via the Internet became readily available to school nurses, the following became very apparent:

The amount of information that could be included in the manual was overwhelming.

Therefore, school nurses referred to the original manuals less and less. Local procedures call for the manuals to be reviewed and revised minimally every 5 years. Converting this information to an electronic format would result in a more efficient and cost-effective way to update the manual in a timely manner. A search for other school district health/nursing information online did not identify a comparable system. For example, the Philadelphia Public School District’s Website (2002) has a bookmarked school nurse manual with a table of contents combined in a 162-page Portable Document Format (PDF) document. The bookmarks assist in reaching desired sections. However, this system does not allow for separate files for forms that could be printed nor does it provide a way to add to or update only parts of the manual.

PROJECT GOALS AND DEVELOPMENT

Three school nurses with elementary, secondary, early childhood, special education, and alternative education backgrounds agreed to complete the task of revising the school nurse manual as part of a summer stipend project. The goals were:

To provide standardized, high-quality care to students and staff through the provision of a comprehensive school health services manual.

Initially, the task force met with a staff member of the Information Technology (IT) department to become familiar with the fundamentals of the VFC. Discussion included goals of the project, desired outcomes, and instruction on data entry procedures. A Web designer or systems programmer would assist in establishing an electronic data storage system. Because the Olathe District Schools IT Department had a virtual storage system in place that was used by many other departments, the nursing department was able to develop their own section and add it to the existing system.

The programmer instructed the task force members about organizing folders and files, creating links to Board of Education policies relating to health, such as immunizations and physical examination requirements, and interfacing the nursing information with applicable sections of the VFC. Some of the original manual pages were already in electronic form and were uploaded easily to the VFC. Other information needed updating and reformatting into Microsoft Word before transfer. Forms were converted to PDF files to ensure quality and standardization. The health coordinator assumed the ongoing responsibility of maintaining the information in the nursing section of the VFC, including making sure the most recent versions of forms were online. As school board policies and procedures from all district departments are updated in the VFC, they are automatically linked to the school health manual without additional data entry on the part of the nursing department. VFCs also have the capability to mark a single file as recently updated, alerting the user to a change.

CONTENT

The development of a table of contents for the VFC manual was integral to beginning the process. The manual was organized into 19 sections, as shown in Table 1. The first section covers the scope of school nursing practice, including job descriptions, professional growth objectives, and reference materials. The Policies and Protocols section contains departmental protocols and a link to local school board policies that are of specific interest to school nurses, such as student health and safety. Figure 1 shows the electronic appearance of the opening page of Section B—Policies and Protocols. The contents of each section are arranged alphabetically. A search feature is located at the bottom of the screen to assist in locating files. Related files are placed in applicable folders and are accessed by clicking on the desired folder. When opened, details of the folder are displayed, including a date indicating the latest revision (Figure 2).

Section BB contains forms used by the nursing department, enabling the nurse to locate a form, download it to the health room computer and print the number of copies needed. The immunization section contains the latest information concerning state and local regulations and parent notification letters in both English and Spanish, including kindergarten boosters and 10-year tetanus boosters.

The medication section covers medication policies, procedures, and forms for receiving physician orders. Another section contains frequently used standardized care plans and instructions for individualizing as needed. Remaining sections cover the Individuals with Disabilities Education Act (IDEA), confidentiality, the district’s blood-borne pathogen exposure control plan, health curriculum, new nurse and substitute nurse information, and other sections relevant to school district practices.

IMPLEMENTATION

The school nurses were very familiar with the existing, three-ring binder version of the school nurse policy and procedure manual, because it had been used for many years and was seen as the primary quality assurance tool for the department. The new format was presented to the school nurses at the first department meeting in August 2004. Because the school nurses were familiar with the VFC for accessing other employee information, the training of the nursing department was accomplished with relative ease. After using the new feature for 7 months, the school nurses were surveyed in February 2005. Use of the VFC school nurse manual at least monthly was reported by 88% of the school nurses, although many were still using the hard-copy version occasionally. One year later, the same nurses reported using the electronic version exclusively. Use of sections, in order of frequency, was forms, policies, protocols, and standardized care plans. Nurses reported there was increased use of information from other departments on the VFC. In addition, the health coordinator has added new information and revises forms on a regular basis. Finally, ongoing coordination with the district’s IT Department has been integral to the success of the project.

COST SAVINGS

Funds were allocated to allow this work to be done during the summer months on a stipend basis. Three school nurses were paid a stipend of $400 each to work 32 hours to organize, update, and enter the information into the VFC for a total cost of $1,200.00. The estimated cost, as illustrated in Table 2, to revise and reproduce paper manuals was $4,608.00. Thus, the approximate initial savings to the district for converting to an electronic manual was $3,408.00. Further, the savings are ongoing, because the VFC is updated several times per year as state laws, local policies, protocols, procedures, and forms are changed.

CONCLUSION

National, state, and local policies and procedures help to establish standards of care. Standards of care are incorporated most frequently into policy and procedure manuals, and, as such, become an indispensable resource to school nurses. Conversion of policy and procedure manuals to electronic format provides several advantages over hard copies. Assurance of up-to-date information and the ability to independently access the information are benefits of a VFC for school nurses that promote confidence and independence in practice. Search features, print-ready forms, and links to applicable files are additional advantages. The Olathe school nurses have found the electronic school nurse manual to be a useful tool in providing the best care to students and families. It also frees space in small health rooms and makes accessing up-to-date information instantaneous. We encourage other school nurses to go paperless by converting their school nurse manuals to electronic files and placing them in VFCs.