Health Services Policies
The role of the BB&N School Nurses is to facilitate health and wellness so each student has the opportunity for academic success. The following health policies support the educational process by enhancing the health of all children within the BB&N community while also maintaining compliance with all local, state, and federal statutes related to School health services. In order to ensure a safe environment for your child, medical information relevant to the student’s health and safety is communicated to School staff on a “need-to-know” basis as determined by the School Nurses.
- Acute Illness Management
- Communicable Disease Prevention and Control Policy
- Dismissal Due to Illness or Injury
- Head Injury Policy
- Mouth Guard Policy
- HIV/AIDS & Other Debilitating Disease Policy
- Life Threatening Allergies Policy
- Medication Policy
- Medical Leave/Special Re-entry Considerations
- Continual Enrollment in Special Circumstances and Disabilities
- Student Health Records
- Health Communication
The School Nurses realize that there are times when it is in the best interest of your child to keep him/her home from School due to illness. The School Nurses must also provide a healthy environment for all students. Therefore, the goal of the sick day policy is to assist the parent/guardian with the decision of when to keep their child home from School due to an illness or infection. You will note that we do not approve absences that extend vacations and that any unexcused absence will result in penalties.
Students should not attend School if:
- The student has a fever of 100.4 degrees or more; the student may return to School after being fever-free for 24 hours.
- Antibiotics are prescribed for a contagious illness; the student may return to School after taking antibiotics for a minimum of 24 hours and has a normal temperature for 24 hours.
- The student is vomiting; the student may return to School approximately 24 hours after symptoms resolve and is able to tolerate a normal diet.
- The student has diarrhea of frequency and severity that interrupts and affects School performance;
- The student may return to School approximately 24 hours after symptoms resolve and is able to tolerate a normal diet.
- The student has an undiagnosed rash; the student may return to School after seeing their physician and it is deemed not communicable. Documentation from the physician is required.The student has severe cold symptoms.
The student is diagnosed with a communicable disease, i.e.: pertussis, MRSA, and chicken pox. Please contact the School Nurse before sending your child back to School. Documentation from the primary care provider is required for School attendance after treatment for a communicable disease. (Please see communicable disease policy below.)
Ensuring adherence to Massachusetts immunization requirements and monitoring of infections and other diseases are important functions of the School Nurse. In an effort to follow recommendations from Cambridge Public Health Department (CPHD), the Massachusetts Department of Public Health (MDPH) and the Center for Disease Control (CDC) regarding communicable illnesses, BB&N has adopted several measures that focus on prevention, early detection and control of any communicable illness. By taking a proactive stance, we hope to limit exposure and increase protection for all members of the BB&N community.
The spread of communicable diseases can be controlled through good prevention and infection control practices. The Nurses ensure adherence to Massachusetts immunization requirements. They provide the BB&N community with education on hand hygiene, respiratory etiquette, and standard precautions. In addition, they advise students, staff, and families that sick people should stay at home and remain at home until 24 hours following resolution of relevant symptoms. Please view the BB&N Acute Illness Management Policy above. This aids in early identification and treatment of any ill students or staff. The Nurses also work in close collaboration with intra-campus departments such as facilities, dining services & athletics in maintaining strict sanitation procedures that follow MDPH protocol and procedures. These prevention measures support the goal of maintaining a healthful environment.
Any individual diagnosed with a communicable disease, such as pertussis, MRSA, chicken pox, impetigo, lice, conjunctivitis, scabies, ringworm, measles, tuberculosis etc., will be evaluated. BB&N health services will make a recommendation for referral to a health care provider when needed. Treatment for the disease may include sending the student home until non-communicable. To return to School or full activities, the School Nurse must authorize the student as non-communicable. The School Nurse, in collaboration with the School physician consultant, will determine whether the student’s admittance to the BB&N community is appropriate for the School, child, and family.
School Nurses will monitor and track student absenteeism and watch for increased absences and clusters of potential communicable illnesses. They will continue to follow guidelines and recommendations made by CPHD, MDPH and CDC. The School Nurses will encourage all members of the BB&N community to contact their primary care physician for advice about getting vaccinated for seasonal influenza.
All BB&N students are expected to adhere to the school immunization requirements established by MDPH. Please click here to download a PDF that describes immunization requirements for all students attending BB&N during the 2017-18 year. Upon recommendation by the School Nurse to administration, students may be excluded from School if immunizations are not up to date or if a student has a communicable disease. In situations when one or more cases of a vaccine-preventable or any other communicable disease are present in school, all susceptible, including those with medical or religious exemptions, are subject to exclusion as described in the Reportable Diseases and Isolation and Quarantine Requirements (105 CMR 300.000).
Public Health Reporting:
School nurses are responsible for reporting communicable diseases to CPHD and/or MDPH. School nurses may hear about a student’s reportable disease from a variety of sources, including a local board of health, a child’s medical provider, a parent/guardian, or an epidemiologist. BB&N has a mechanism in place to report and review any cases/outbreaks of a communicable disease. Please click here for a list of the reportable communicable diseases that are subject to control under general reporting regulations.
In the event of a communicable illness outbreak, the Director of Student Health Services with assistance from the Campus Nurses will collaborate with the CPHD, the BB&N School Physician and the BB&N Administration to implement a communication plan that best serves the entire BB&N community. Phone calls and/or e-mails may be used to notify parents/guardians about a possible exposure to a communicable illness. Our goal is to keep the channels of communication open and alert parents/guardians to a potential health problem and advise them what to do.
Assessment of student illness or injury occurring during School hours is a significant part of the BB&N School Health Services. Care for all students is provided in the Health Office. Parents/guardians are notified of any significant injuries or signs of illness that may require further observation, intervention, or follow-up with the student’s health care provider. The School Nurse or BB&N School staff will contact the parent/guardian or parent designee when dismissal is indicated. The parent/guardian or parent designee is required to make the necessary transportation arrangements in a timely matter. No student will be dismissed without being assessed by the School Nurse and contact has been made with the parent/guardian or parent designee. All students must be signed out upon their pick-up. In the event of an emergency, local EMS services may be activated.
Buckingham Browne & Nichols seeks to provide a safe return to activity for all students after injury, particularly after a head injury. A head injury is a potential brain injury. Head injuries are caused by a bump, blow, or jolt to the head. They can range from mild to severe and can disrupt the way the brain normally works. Due to the potentially serious sequelae of a head injury, BB&N has adopted conservative and proactive guidelines for the management of students with head injuries. These guidelines aid in ensuring that students are identified, managed and referred appropriately, receive appropriate follow-up care during the school day, including academic accommodations as indicated, and are recovered prior to returning to full activity.
- All students in grades 6-12, parents, coaches and health care providers are required to complete an online concussion education training course as required under Massachusetts General Law.
- All students at BB&N in Grades 6-12 are required to take a baseline ImPACT test. ImPACT evaluates multiple aspects of neurocognitive function, including memory, attention, brain processing speed, reaction time, and post-concussion symptoms.
- All students who receive a head injury while at school will be evaluated by the Campus Nurse and/or Athletic Trainer as close to the time of injury as possible. The injury will be assessed using the consensus statement materials developed by the American Academy of Neurology (AAN) and recommendations will be made using their evidence based criteria.
- If the situation appears serious, the student is unconscious or there is suspected neck or back involvement, EMS will be called and the student will be transported to the nearest hospital.
- The Campus Nurse and/or Athletic Trainer will notify parents of ALL head injuries regardless of severity and give follow-up care instructions. ALL students with persistent symptoms will be required to have a medical evaluation in order to be cleared for return to School and activities.
- All students who have sustained a head injury will be removed from any activity and/or sports and are unable to return until evaluated and cleared by the Campus Nurse, Athletic Trainer, and/or their Medical Care Provider.
- The Campus Nurse and/or Athletic Trainer will notify each other of the injury, prior to the next school day, in order to initiate the appropriate follow-up care immediately upon the student’s return to school.
- In the event that a student sustains a head injury during an away game, the student will be evaluated by the home team Athletic Trainer and referred for further treatment as deemed necessary. The home Athletic Trainer will notify the BB&N Athletic Trainer(s) as soon as possible, in order to initiate appropriate follow-up care.
- The Campus Nurse and Athletic Trainer will continue to provide coordinated care for the duration of the injury. Any student who exhibits deterioration of neurological function and/or persistent symptoms will be encouraged to seek referral to a concussion specialist.
- The Campus Nurse will monitor the student closely and work collaboratively with his/her Medical Care Provider(s) until the student returns to his/her pre-injury neuro-cognitive and physical status. There will be ongoing communication with the student’s family and advisor regarding the student’s neurocognitive recovery and need(s) for academic support.
- Recommendations for short-term academic accommodations will be made for students with diagnosed concussions. Students requiring long-term academic accommodations must have an evaluation by a concussion specialist and receive a diagnosis consistent with the accommodations requested.
- Final clearance for return to athletic participation is determined by the Athletic Trainer when ALL of the following, criteria is met:
- The student must be symptom free at rest and during exertion.
- The student must be able to participate in a full academic day without any academic accommodations.
- The student’s ImPact Test must return to baseline.
- The student must present a note to the Athletic Trainer and/or Campus Nurse from their Medical Care Provider(s) clearing them to return to participation.
- Students may return to competitive game participation only after completion of a graduated ramp up process of activity. A minimum of 24 hours is needed before progressing to the next stage. Students must also have a minimum of 1 full contact practice (if applicable by sport) before returning to game play.
- After all head injuries, regardless of where they happened, it is expected that the student and his/her family will communicate with the Campus Nurse and/or Athletic Trainer on a regular basis, in order to provide the most effective care for the student.
Mouth guards are a required and mandatory piece of equipment for all students grades 5-12 when participating in Field Hockey, Boys’ & Girls’ Ice Hockey, Boys’ & Girls’ Lacrosse. It will also be mandatory for 5th and 6th Grade Floor Hockey and Free Skate.
Mouth guards are available at the Athletic Center, or at local Sporting Good Stores. They should be properly molded to the individual to ensure proper protection. The “boil and bite” mouth guard would need to be brought home to be molded correctly. For a more individualized fit, it is recommended that students see their dentist/orthodontist for a custom mouth guard, especially for those with braces. These can be worn for multiple sports and have a better fit for the student. There are also companies that provide custom mouth guards such as O-PRO. www.opro.com.
Please note that students will not be allowed to participate in athletics without a properly fitted mouth guard. It is highly recommended that all mouth protection be stored in the student’s locker and placed in a protective/ clean case when not being worn. If a student fails to have/ use his/ her mouth guard, a phone call will be made home.
The following policies and procedures are based upon knowledge about known risk factors of debilitating diseases and modes of transmission of HIV infection and reflect concern for individuals as well as groups within the School Community:
- Guidelines developed by the Centers for Disease Control and Prevention, Massachusetts Department of Public Health, and American Academy of Pediatrics will serve as a basis for discussion and decision-making pertaining to cases of HIV infection and other debilitating diseases. Each case of HIV infection and other debilitating diseases, whether involving a student, faculty member or other School worker, should be identified and decisions will be made on a case-by-case basis.
- Decisions regarding School attendance, alterations in program, and other issues will be made by a defined group which may include the student’s primary care provider, the student’s parents, the Head of School, the BB&N School Physician, and the Director of Student Health Services. In each case, risks and benefits to the student and the community will be weighed.
- Only persons with an absolute need to know will have medical knowledge of a particular case. Such persons will be identified by the above group and notified by the Head of School in a manner to best preserve confidentiality. The number of personnel notified will be kept at the minimum necessary to assure proper care of the student and to detect situations where the potential for transmission might be at risk.
- Individual cases will be reviewed periodically by the Head of School, the BB&N School Physician, the Director of Student Health Services, and may include the student’s personal physician and the student’s parents. This pertains both to students attending School and to those who have been excluded and, because of change in their condition, might be permitted to return. The frequency of such reviews will be determined on an individual basis.
- These general policies will apply to faculty and other employees as well as to students.
- Age-appropriate education about HIV/AIDS, AIDS-related issues and other debilitating diseases will be incorporated into the health curriculum of the School and also be made available to faculty and other School employees.
These guidelines are designed to ensure that the environment of the BB&N School is as safe as reasonably possible for the students who experience life-threatening allergies. The guidelines are designed to manage life-threatening allergies to most common foods, latex products, and insect bites. It is anticipated that as a student moves from the necessarily more restrictive environment of the primary levels to the greater independence of the secondary levels, their needs will change, as will their plan of care. This process will be ongoing and assessed by all involved persons on a regular basis. The guidelines describe measures to promote a safe environment for all students by educating all members of the BB&N School community about life-threatening allergies. These guidelines may be modified to accommodate the individual student’s Emergency Action Plan and the specific BB&N campus.
- Notify the School of their child’s life-threatening allergies.
- Work with the School team to develop an Emergency Action Plan that accommodates their child’s needs throughout the School including in the classroom, in the cafeteria, in after-school programs, and during School-sponsored activities.
- Provide the required BB&N written medical documentation, instructions, and medications as directed by their licensed prescriber following the BB&N medication policy.
- Educate the child in the self-management of their allergy including:
- Strategies for avoiding exposure to allergens such as unsafe foods and insects;
- Symptoms of allergic reactions;
- How and when to tell an adult they may be having an allergy-related problem;
- How to read food labels (age appropriate);
- Review policies/procedures with the School staff, and the child (if age-appropriate) after a reaction has occurred.
- Include allergic students in all School activities. Students should not be excluded from School activities solely based on their life-threatening allergy.
- Identify a core team of, but not limited to, Campus Director, Campus Nurse, Faculty/Staff, Dining Services Director, to work with parents and the student (age appropriate) to establish a prevention plan. Changes to the prevention plan to promote life-threatening allergy management should be made with core team participation.
- Because of the high risk of cross-contamination inherent with peanut and nut products, BB&N no longer serves peanut butter on any campus. We now serve Sun butter in its place. Lower School parents will be asked not to send lunches or snacks that include peanut and nut products to School with their children.
- Provide “nut free zones” as needed on each campus.
- Assure that all staff who interacts with the student on a regular basis understand a life-threatening allergy, can recognize symptoms, know what to do in an emergency, and work with other School staff to eliminate the use of allergens in the allergic student’s meals, educational tools, arts and crafts projects, or incentives.
- Coordinate with the School Nurse to be sure medications are appropriately stored, and be sure that an emergency kit is available that contains a licensed prescriber’s standing order for epinephrine. Students should be allowed to carry their own epinephrine, if age-appropriate after approval from the student’s physician, parent, and School Nurse.
- Designate School personnel to handle a reaction and ensure that there is a staff member available who is properly trained to administer medications in accordance with the State Nursing and Good Samaritan Laws governing the administration of emergency medications.
- Review policies/prevention plan with the core team members, parents/guardians, student (age-appropriate), and physician after a reaction has occurred.
- Discuss field trips with the family of the allergic child to decide appropriate strategies for managing the allergy while on a field trip.
- Follow federal/state laws and regulations regarding the sharing of medical information on a need-to-know basis.
- Should notify an adult immediately if they eat something they believe may contain the food to which they are allergic.
- Should not trade food with others.
- Should not eat anything with unknown ingredients or known to contain any allergen.
- Should be proactive in the care and management of their allergies and reactions based on their developmental level.
The School Nurses recognize that many children are able to attend School because of the effective use of medication in the treatment of illnesses and medical disabilities. They believe that it is more desirable for medication to be administered at home; however, any student who is required to take medication (prescription and non-prescription) during the School day must comply with School regulations. These regulations are based on M.G.L. Chapter 94C, the Controlled Substance Act.
It is the policy of BB&N that School Nurses will administer all medication, be responsible for all medication in the Schools, and maintain accurate medication records. No other individuals, except where stated, will be allowed to administer medications.
Exceptions to the Policy
- Life-threatening allergic reactions
- When the School Nurse is not immediately available, and the child has an order from a licensed provider for the administration of emergency epinephrine by auto injector, School personnel trained by the School Nurse are authorized to administer epinephrine by an auto-injector. The School personnel must also be tested for competency in compliance with the statute.
- In the event of a life-threatening allergic reaction, for students who do not have such an order, the School Nurse will follow protocols written by the BB&N School physician.
- Field Trips
- In the event that a student’s parent or a School Nurse is unable to attend a field trip, and a child is in need of medication, the School Nurse may delegate the administration of said medication to a trained, responsible adult.
- Students who have an order for emergency epinephrine must be accompanied on field trips by an individual who has been trained in its administration and has passed a competency test.
- Students who may need other injectable medication, i.e. insulin, must be accompanied on field trips by a parent/guardian or School Nurse unless it is deemed appropriate by the student’s Licensed Care Provider, the School Nurse and parent/guardian in writing that a student can self-administer.
Guidelines for Prescription and Non-Prescription Medications
Written Orders from a Licensed Health Care Provider:
- Child’s name;
- Name of drug, dosage, frequency, time, route of administration, specific instructions;
- Date of order and discontinue date (must be renewed at the beginning of each academic year);
- For short-term prescriptions (10 days or less), a pharmacy-labeled container may be used in lieu of a written order;
- Plan for monitoring effects, positive/negative, of medication.
Written Authorization from Parent/Guardian:
- Emergency telephone numbers;
- Emergency contact person;
- Lists of all medications student is currently receiving;
- Known allergies to food or medication;
- Plans, if any, for self-administration.
School Nurse Safeguards:
- Procedure to ensure the positive identification of the student who will receive medication, i.e. photographs or teacher assistance;
- System for documenting and record-keeping;
- Procedure for responding to medical emergencies;
- Procedure for communicating significant observations relating to the medication’s effectiveness, adverse reactions to the parent/guardian and licensed prescriber;
- Procedure for documenting and reporting medication errors.
- Must be delivered to the School Nurse by a parent/guardian, or other responsible adult;
- Must be in container properly labeled by the pharmacy or manufacturer and in such manner as to render it safe and effective;
- Will be stored in the health office in a locked cabinet or refrigerator with the exception to emergency medications i.e. emergency epinephrine auto-injector, inhalers;
- Will be administered in the Health Office, unless otherwise noted;
- May not be carried on a student’s person with the exception of emergency epinephrine auto-injector, inhalers, or insulin pumps;
- No more than a 30-School-day supply of prescription medication shall be stored in the Health Office;
- May be retrieved from the School by a parent/guardian at any time;
- Suspected tampering of drugs shall be reported to the Department of Public Health, Division of Food and Drugs.
- Investigational medications may be administered at School as long as all other conditions have been met.
Potentially Harmful Administration:
- In accordance with standard nursing practice, the School Nurse may refuse to administer any medication which based on her assessment and professional judgment, has the potential to be harmful, dangerous, or inappropriate;
- In these cases, the parent/guardian and licensed prescriber shall be notified immediately by the School Nurse;
- The School Nurse can request that the BB&N School physician confer with the licensed prescriber as a stipulation of continuing a medication or procedure in question.
- Based on the Massachusetts Board of Registration in Nursing’s policy governing the administration of over-the-counter medications and protocols developed by the BB&N School Nurses, with approval of the School physician, specific over-the-counter medications may be administered with signed parental permission;
The following is a list of over-the-counter medications that the School nurse may administer/utilize for students: acetaminophen (Tylenol), ibuprofen (Advil), Tums, bacitracin ointment, diphenhydramine (Benadryl), hydrocortisone cream .5%.
There are rare occasions when BB&N must respond to a serious health-threatening condition or life-threatening behavior on the part of a student. This includes but is not limited to: acute or chronic illness—physical or mental, depression, suicide gestures or attempts, self-injury, episode(s) of alcohol or drug overuse/abuse, eating disorders, incidents of violence, threats of violence toward others, and possession of weapons. Events such as these may require absence from School while the student is actively participating in an appropriate treatment program. Safeguarding our students’ lives, health, and safety is the most important underlying goal of any procedures or expectations from BB&N.
Prior to a student’s return to school, the counselor and/or nurse must receive documentation from the student’s health care provider(s). Such documentation from the provider(s) must address the following:
● The student is deemed to be physically and emotionally well enough to return to School full-time.
● The risk of the student’s relapse or repeating the harmful behavior is judged to be substantially reduced.
● The Health Care Provider(s) must outline any specific recommendations and/or limitations in the student’s School program.
Additionally, the School requires the following:
● A signed Release of Information Form that allows for adequate communication with the student, family, and Health Care Provider(s) regarding the student’s ability to continue in school safely and productively.
● Confirmation that the student is receiving ongoing attention to the problem(s) as deemed appropriate.
Finally, upon receipt of all documentation, the school will act quickly to schedule a re-entry meeting to review the student’s current academic, behavioral and physical/emotional health status. Attendance at the re-entry meeting may include the Campus Director, counselor/psychologist, nurse, advisor or dean, parent(s) and any outside supports as appropriate. Based on the information shared at this meeting, the team will then develop a re-entry plan and determine the most appropriate time for the student to return to school. Even if a student has been cleared by outside provider(s) to return to school, the school team may require additional time to ensure that the student and his/her school community are prepared for the student’s return.
When there is cause for concern over a student's physical or emotional health or safety, even if there will be no interruption in the student’s attending classes, the School may, at its discretion, require documentation of an evaluation from an outside clinician. This assessment of the student’s present circumstances, and plans for ongoing health services, along with permission for the outside professional to be in communication with the School, are necessary for the student’s continued enrollment at BB&N. When a student has a documented qualifiable disability, BB&N will provide reasonable accommodation, absent any undue hardship to the School or where a necessary modification would fundamentally alter the nature of the School’s academic program.
An individual health record is maintained for each student throughout his/her school career. The student health record is considered confidential and access is restricted to the School Nurse and the School Physician. Parents/guardians may also have access to this record upon request. The Massachusetts Department of Public Health (MDPH) mandates that all student health records must include verification of a physical exam and an up-to-date immunization record unless the student meets the requirement of a medical or religious exemption as defined by Massachusetts Law 105 CMR 220.000 and M.G.L.c.76,ss.15, 15C and 15D. This applies to ALL BB&N students as well as any visiting student including international students, regardless of the length of their visit. Physical exams are valid for one year from the date of the previous exam. BB&N does not conduct these physical exams. The School recommends that parents consult with their child’s primary care provider to ensure that these exams are scheduled and performed in a timely manner. Due to insurance restrictions, all students will be granted a one month grace period.
In addition, parents must complete an online health history form on an annual basis. This information must be must be submitted electronically by June 16th. BB&N students including ALL visiting students with incomplete health records will not be allowed to participate in any BB&N activity including: orientation activities, academic classes, extracurricular activities and sports.
Health forms contain important information that the School needs in order to ensure a safe environment for your child. In the event of a medical emergency, School personnel will call 911. The School will then try to contact the parents as listed on the health information form, next the person designated as emergency back-up and next the student’s doctor as listed on the health information form. Please update this information whenever it changes by calling the Registrar (617-800-2716).
Parents are required to communicate all student health concerns, medical reports, and issues on the electronic health history form. It is essential that parents report to the School Nurse any acute episodic illness and/or injury that may affect the educational process during the School year. This may include interventions such as hospitalizations, surgeries, medical procedures, and/or testing. Ongoing communication between the School Nurse and parents enables the School to make reasonable accommodations in a timely manner. Medical information relevant to the student’s health and safety is communicated to School staff on a “need-to-know” basis as determined by the School Nurse.