District Nursing Services / Protocols

Protocols

Each Specialized Physical Healthcare Service (SPHCS) or protocol has specific authorization form posted under the protocol guidelines.

Protocol Training Video Links and Related Forms

A. Specialized Health Care Services:

(1) Form

D. For a protocol or SPHCS that is not listed on the standardized specialized physical health care services, please download the Generic Authorization Form (English/Spanish)

E. General Guidelines for Orientation of Pupil

F. Licensed Nursing Provider

G. Nursing Protocol Log

H. Protocol and Medication Training & Supervision Checklist Form- for Licensed and Unlicensed

Assistive Personnel

I. Review of Support Services Due to Health Needs - Complete for Student with Protocol Before the IEP Meeting

Adrenal Insufficiency

Guidelines

Solu-Cortef Protocol Guidelines

Authorization Forms:

English/Spanish Other languages are not available

E mergency Medication Authorization

Related Forms and Information:

Emergency Care Plan for School

Adrenal Insufficiency - Power Point

Anaphylaxis

Protocols Guidelines:

Anaphylaxis Protocol Emergency Treatment of Anaphylaxis (03/2019)

Bulletin: BUL-5628.1: Management of Food/Other Severe Allergies and Epinephrine Auto-Injector Use

Attachments: Attachment A - Printer Friendly Version - Authorization Form February 2023

Attachment B - Anaphylaxis Guidelines

Attachment C - Letter Template

Attachment D - Special Diet Form. For the most recent version of the Special Diet form, click here.

Forms:

1. Emergency Care Plan

2. Confidential Health Info - Severe Allergies

3. Request for Medication to be taken During School Hours

4. Special Diet Form

Training:

Guidelines

Training Video

FOR SCHOOL BASED CLINIC USE ONLY: Anaphylactic Reaction Clinic Emergency Protocol - August 2022

Autonomic Dysreflexia

Autonomic Dysreflexia: Emergency Care Guidelines

Authorization Form:English/Spanish (2/2023)

Catheterization

a. Clean Catheterization Guidelines (3/2019)

Authorization Form for Clean Catheterization (2/2023): English/Spanish

b. Clean Self-Catheterization with Assistance Guidelines (3/2019)

Authorization Form for Clean Self-Catheterization with Assistance (2/2023) English/Spanish

c. Clean Self-Catheterization Guidelines (3/2019)

Authorization Form for Clean Self-Catherization (2/2023) English/Spanish

d. Sterile Catheterization Guidelines (3/2019)

Authorization Form for Sterile Catheterization (2/2023) English/Spanish

e. Training Videos Link

(1) Male Catheterization

(2) Female Catherization

Diabetic Protocols

Guidelines:

1. Blood Glucose Testing (3/2019)

2. Baqsimi(Glucagon Nasal Spray/Severe Hypoglycemia) (12/2021)

3. Glucagon Injection(Severe Hypoglycemia) (3/2019)

4. Treatment of Hypoglycemia(3/2019)

5. Ketone Testing (Hyperglycemia) (3/2019)

Authorization Forms:

1. Blood Glucose Testing(3/2023)

2. Hypoglycemic Reaction(3/2023)

3. Glucagon Injection(3/2023)

4. Hyperglycemia (Ketone Testing)(3/2023)

Other Related Forms and Information:

a. Confidential Health Information-Diabetes

b. Diabetes Management Information for Trained School Personnel

c. Student with Diabetes

d. Training for Glucagon | Training Video

e. Insulin Pump

For LAUSD Food Services Web Page for Menu click here; for carbohydrate count click here .

Epinephrine for Schools (SB1266)

Epinephrine for Schools Resource Page

Gastrostomy and Jejunostomy

Gastrostomy

a. Gastrostomy Tube Feeding: Bolus Method (3/2019)

Authorization Form (2/2023): English/Spanish

b. Gastrostomy Tube Feedings: Slow Drip Method or Pump(3/2019)

Authorization Form (2/2023): English/Spanish

c. Gastrostomy Tube Replacement (3/2019)

Authorization Form (2/2023): English/Spanish

d. Training Videos Link

(1) Gastrostomy Tube Feeding Bolus Method

(2) Gastrostomy Tube Replacement

Jejunostomy

Jejunostomy Tube Feeding: Slow Drip Method or Pump (3/2019)

Authorization Form (3/2023): English/Spanish

Protocol Related Form: Special Diet Form

Mechanical Nebulizer

Mechanical Nebulizer Guidelines (3/2019)

Authorization Form with the Parent Section (2/2023): English/Spanish

Mechanical Ventilation

Mechanical Ventilation Guidelines (3/2019)

Authorization Form for Mechanical Ventilation (2/2023): English/Spanish

Other Related Forms/Information

1. Agency Agreement

2. Daily Mechanical Ventilator Checklist (Rev. 6/2015)

3. General Guidelines for Orientation of Pupil

4. Licensed Nursing Provider

5. Manual Resuscitation Bag

6. Mechanical Ventilator Definitions

7. Mechanical Ventilation Prescription Form

Ostomy Care

Ostomy Care (3/2019)

Authorization Form (2/2023): English/Spanish

Oxygen Therapy

Oxygen Therapy - Guidelines (3/2019)

1. BUL 2356.0: Oxygen in Schools

2. Oxygen Checklist

Authorization Form (3/2023): English/Spanish

Seizure Care

Protocols:

1. Seizure Care: Nasal Benzodiazepine 8/2021

Authorization Form: English/Spanish

2. Diastat - Diastat Guidelines (3/2019)

Authorization Form (3/2023): English/Spanish

3. Vagus Nerve Stimulation (VNS) - VNS Guidelines (3/2019)

Authorization Form (3/2023): English/Spanish

Related Forms and Information

a. Confidential Health Information for Student with Seizures

b. Seizure Action Plan: English/Spanish

c. Seizure Record

d. Parent Questionnaire for Students with Seizures: English/Spanish

e.Request for Medication to be taken During School Hours

Training Materials

(1) Training Video

(2) Guidelines for Administration of Rectal Gel in Schools(11/15)

(3) Training Video: Valtoco 5 mg - 10 mg

(4) Training Video: Valtoco 15 mg - 20 mg

Suctioning

Protocols

1. Oral Nasal Suctioning (3/2019)

Authorization Form for Oral/Nasal Suctioning (3/2023): English/Spanish

2. Oropharyngeal and Nasopharyngeal Suctioning (3/2019)

Authorization Form: (3/2023): English/Spanish

3. Tracheostomy Suctioning(3/2019)

Authorization Form: (3/2023): English/Spanish

4. Tracheostomy Tube Replacement(3/2019)

Authorization Form (3/2023): English/Spanish

Training Videos Link and Related Forms:

(1) Oral/Nasal Suctioning Training Video

(2) Tracheostomy Suctioning Training Video

(3) Tracheostomy Tube Replacement Training Video

(4) Daily Suctioning Checklist (6/15)

(5) Care Plan for a Student with Tracheostomy (5/15)

School-site Crisis Team Training Recorded Webinar Series 2021

ALL 14 WEBINARS ARE NOW AVAILABLE FOR VIEWING ON MyPLN

Search Keyword: RECORDED WEBINARS 2021

School-site Crisis Team Training Recorded Webinar Series 2021 FLYER

COVID-19 Employee Resources

Link to the Division of District Operations > Emergency Services

COVID-19 Employee Resources

Nursing E-Library

Forms

Protocols

References

District Policies Regarding Critical Issues

Immunizations and Enrollment

Immunizations Guidelines and School Based Clinics

Immunization Toolkit for Schools

Important Health Information

Measles

Pertussis

Health Brochures

Local District Nursing Services

Types of Services and Supervisor Contact Information

Special Education Services

Infant and Preschool Special Education

Special Education Resource Nurse

Pre-school Transition School Nurse

Visually Impaired Program

Specialized Physical Healthcare Services

Specialized Nursing Programs

Audiometric Testing Program

Carlson Home Hospital

CPR/Automated External Defibrillators

Communicable Disease

Condom Availability

Nurse Family Partnership

Oral Health Programs

Queens Care

DNS Parent Resources Page

https://achieve.lausd.net/parent-resources

DNS RETIREMENT SHOW (22-23)

...for general access or to download the file, click here

Contact

Director:
Sosse Bedrossian, MSN, MA, RN, FNP-C

Address:
121 N. Beaudry Ave.,
Los Angeles, CA 90012
P: (213) 202-7580

F: (213) 580-6557

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