School-Based Telehealth Program
November 2019 

This issue will feature program updates as well as a
Clinical Focus on the Flu

Have you Heard? 

There has been a Medicaid Facility Fee Reimbursement Increase! The facility fee has increased from $14.96 to $20.92. This is great news for health care and telehealth as a whole!

 I loved every minute of my 31-year nursing career in Cardiology and ER. My introduction to school nursing began when I worked with one of my son's school nurse in a voluntary capacity, and realized the important impact of a school nurse. After moving to Charleston in 2014 I decided to make the switch to school nursing.  I was very intrigued about the opportunity to work in a setting that incorporated school based health. I am currently the nurse at Sanders-Clyde Elementary Elementary School in Charleston, and being able to work with the MUSC team is incredibly rewarding. The services that we we are able to offer the children is outstanding, in addition to acute care, we also coordinate asthma education and the heart health program for our student population.  By combining acute care, preventative care and education, children stay in school, parents don't have to leave work for routine appointments, and ambulance transportation is reduced. This program does so much for children and families. 
I have 3 boys, all in college now.  Nick is a senior at Old Dominion University and twins Clay, at Winthrop University, and Davis, at Lawrence University are freshman.  Swimming has been a huge part of our lives.  Nick and Davis swim for their universities and I have worn many hats as a swim-mom. I currently coach for Swim Charleston, and my free time is spent visiting the boys and doing yoga. 

We would like to thank Mrs. Wukovits for being an outstanding school nurse and a strong advocate for  School-Based Telehealth!

  Currently the amount of flu circulating in the US overall is considered low but we are experiencing moderate influenza like illness with local flu activity here in SC (https://www.cdc.gov/flu/weekly/usmap.htm). The most recent SC flu statistics may be viewed at Flu Watch: South Carolina's Weekly Surveillance Report .  The most effective way to prevent flu is by getting a flu vaccine.  The American Academy of Pediatrics (AAP) recommends flu vaccine for everyone 6 months of age and older. Injectable flu vaccine or nasal flu vaccine (FluMist) may be administered.  This is a change from the recommendations made last year. In 2017 the manufacturer of the nasal spray made changes to the formulation to include a new A/H1N1 strain, and this year infectious disease experts are encouraged by its effectiveness. While Flu vaccine is not 100% effective in preventing the flu, it has also been shown to reduce the severity of flu illness in those who receive it.  Being vaccinated is a win win! 
 
As school nurses it is very important to identify students with flu early to help reduce the spread of illness at your school. For more information about the flu and how to prevent it at school check out the CDC website at https://www.cdc.gov/flu/school/guidance.htm .  
 
Influenza is a respiratory illness caused by various strains of the influenza virus.  Often, people refer to viral gastroenteritis (persistent vomiting and diarrhea) as the flu.  But, true influenza may not include vomiting and diarrhea at all.
 
What are the symptoms of FLU?

• Abrupt onset of Fever (often high, 102-104) lasting 3-5 days
• Cough (usually dry), which may last 2 weeks or longer
• Sore Throat
• Muscle and body aches
• Runny nose or congestion
• Headache
• Fatigue
• Vomiting and diarrhea may be present in children but not always

Do we need rapid flu tests to diagnose flu? Not necessarily!
In some cases, rapid flu tests or cultures are necessary to assist with the diagnosis of flu.  But, because there is a high rate (30-50%) of false negative results on rapid tests they are not always indicated.  In general, once flu is identified in the community, a clinical diagnosis can be made without use of a rapid test.  If the clinician suspects flu, appropriate treatment may be started without a positive test result.

How is Flu treated? 
In most cases, symptomatic treatment is all that is necessary.  This includes rest, fluids, using a humidifier, and depending on the age and symptoms of the child, an over the counter pain reliever and fever reducer, cough suppressant or decongestant may be used.  One safe remedy for cough in children over 1 year of age is to take a teaspoon of honey. This has been shown to be effective in reducing cough especially at night. 

Additional medications such as Tamiflu (antiviral medication) or antibiotics (to treat secondary infections) may be indicated depending on the patient.  Antiviral medications are not recommended for everyone with the flu.  They are indicated for use in patients with higher risk of developing complications or those with severe illness.  According to the CDC, this includes children under the age of 2, those with underlying health conditions such as asthma, sickle cell disease, diabetes, neurologic and neurodevelopmental disorders, kidney and liver disorders, morbidly obese people, those with weakened immune systems and children on long term aspirin therapy, pregnant women, adults aged 65 and older and American Indians and Alaskan Natives.

How is Flu spread?
It is spread generally by droplets made when people with the flu cough, sneeze or talk.  The droplets can land in the noses or mouths of others or onto surfaces.  Some people contract flu by touching a surface with the virus on it and then rubbing their eyes, nose or mouth.  

How long is it contagious?  
Those with flu are thought to be contagious from one day prior to symptom development until 5-7 days after the illness starts.  Young children may be able to spread the virus even longer. 
 
How can School-Based Telehealth help when you suspect flu?
We can:

• Assess children suspected of having flu to help confirm the diagnosis
• Assess children for complications of the flu, such as ear infections or pneumonia
• Prescribe appropriate medications, when indicated, such as Tamiflu and antibiotics
• Help determine if a patient needs to seek in person care and support the nurse in orchestrating the visit

We are happy to evaluate any child that you suspect of having the flu or of having complications of the flu.  By identifying students with flu early, we can help to reduce the spread of illness in your school. 
 

Be sure to read the article below about how school-based telehealth is reducing ED visits for pediatric asthma patients in Williamsburg County!

This would not be possible without the support of the school nurses in Williamsburg:
Niecey Burgess, Lynn Floyd, Jennifer Lamb, Lacey McClary, Ashley Moore, Sharon Rogers, and Jamie Webb. 

Help us make a difference in the lives of children with asthma at  your school too!  Refer all students with asthma who are not receiving ongoing care locally.  Please contact garberk@musc.edu with any questions about managing asthma through telehealth at your school.

The story below truly highlights the great work of the people and this program! Tammy Kizer, the school nurse at Minnie Hughes Elementary School in Hollywood, SC with the help of Katherine Chike-harris, a Nurse Practitioner with MUSC’s School-Based Health Program were able to diagnose a case of strep throat this year. The student presented with a very high fever and complained of a sore throat. By connecting through an on-demand telemedicine visit Tammy and Katherine were able to evaluate the student. The school is located forty-five minutes away from MUSC and the nearest pharmacy is nine miles away. Katherine was able to call in antibiotics for the student to begin a treatment plan. Way to go Tammy and Katherine!

 More Information on the SCTA School Based Health Program and links to the online consent forms can be found by clicking the button below!