School Nurse Procedure Manual - The School District of Philadelphia

SCHOOL DISTRICT OF PHILADELPHIASCHOOL NURSE PROCEDURE MANUAL2. With the student in the erect position, the screener should move to the student’sback and run the index finger on each hand under the scapula and towards themiddle of the back observing for equal height of scapula. This technique shouldbe employed at the waist to observe for equal level of the pelvis.3. Facing the screener, the student will bend over slowly with palms of handstogether and arms hanging relaxed from shoulder, head hanging down. Thescreener will observe the student in this position from both sides and the back,observing for any fullness (rib hump) in the right/ left thoracic area or in theright/left lumbar area.D. Positive findings at initial screening1. Any student who is found to have any positive signs of spinal abnormality will berescreened by the Certified School Nurse and a second screener, who may beanother Certified School Nurse or a School Physician.2. Any student who is scheduled to be rescreened will receive a Report of Visit toHealth Services card (M34) with the appointment for rescreening and a briefexplanation of the purpose of rescreening. In addition an effort to contact theparent/guardian by phone should be made to alleviate any anxiety the rescreeningmay cause.E. Positive findings at second screening1. Students with positive findings following rescreening must be referred to theirprivate health care provider.2. A positive finding for RIB HUMP in any location in the forward bending positionis the major criteria for scoliosis referral. Other observations made by the screenerare merely supportive of the rib hump finding.3. The Certified School Nurse will speak to any student with positive findings toallay fears and encourage cooperation.4. Every effort must be made to notify, by phone, parents/guardians of students withpositive findings and encourage further medical evaluation.5. The “Parent-Physician Letter” form with the findings of both screeners will becompleted and signed by both screeners and sent to parent/guardian.6. The Certified School Nurse will assist parents/guardians needing guidance inmaking arrangements for further evaluation.7. The Certified School Nurse will contact parents/guardians who do not returnevidence of further medical evaluation within four weeks of the initial referral. Thefollowing methods are suggested;a) Telephone call or personal interview.b) Repeat referral letter. Send home by U.S. mail.c) M34 form sent with student or U.S. mail.8. Upon receipt of the completed private health care providers’ report the appropriatedocumentation will be made.9. It is appropriate for the Certified School Nurse to contact the private health careprovider if the form is incomplete or additional information is needed regardingthis student.F. Documentation1. Record all results in the HIS, Main Menu #2, Health Inquiry and Maintenance,screen H11 (where HIS is unavailable, use MEH-3).September 1, 2002 Page 24