Nursing Support Services Referral

Direct care (in-home respite) referral steps

1. Assessment

   • Referrals for palliative care management must include a completed and signed BC Palliative Care Benefits Registration form (PDF)
   • Children/youth being referred must be stable and ready to be cared for in the community setting (home and school)
   • If the child/youth being referred is currently hospitalized, please ensure you make the referral no more than four weeks before their anticipated discharge
2. Complete a referral form

   The referring doctor or nurse practitioner must complete the referral form (Word) in its entirety and include any supporting documentation as requested in the specific form.

3. Send the referral

   Fax the form and any supporting documentation to: 604-708-2127 or email it to: nssreferrals@cw.bc.ca.

4. Post referral

   Our intake team processes all referrals in order of receipt.

   They review the referral for completion; and assess whether a child/youth meets the requirements for a nursing assessment, and their eligibility for admission to our program.

   Our intake team may reach out to the referring provider if we need additional information to support the referral. If a child/youth is not eligible for service, we will send a letter of notification to the referring provider and the child or youth's family or caregiver.

   If there have been changes to a patient's condition which affect their care needs (e.g. a change to their palliative status) after you have placed a direct care referral, please submit a new referral.

5. Appointment with a nurse coordinator

   If the child/youth needs a nursing assessment to determine eligibility for service, a local NSS coordinator will contact the family/caregiver to arrange it. No further action is required from the doctor or family.

   If the child/youth is not eligible for service after this assessment is completed, we will send a letter to the referring doctor and the family.

Delegated care (in-school care) referral

1. Assessment

   • Children and youth must have orders describing their routinely scheduled tasks related to diabetes care (blood glucose monitoring and insulin administration), tube feed administration or catheterization
   • We are unable to accept referrals for tasks that are not routinely scheduled
   • Children and youth must be medically stable and have predictable responses to the tasks that require support in school
2. Complete a referral form

   The referring doctor or nurse practitioner must complete the delegated care referral form (PDF) or the referral form for children with diabetes (PDF) in its entirety and include physician’s orders.

3. Send the referral

   Fax the form and any supporting documentation to: 604-708-2127 or email to: nssreferrals@cw.bc.ca.

4. Post referral

   Our intake team processes all referrals and requests in order of receipt.

   They check that referrals are complete. Then they assess whether a child/youth meets the requirements for a nursing assessment, and their eligibility for admission to our program.

   Our intake team may reach out to the referring doctor if we need additional information support the referral. If a child/youth is not eligible for service, we will send a letter of notification to the referring physician and the family.

5. Appointment with a nurse coordinator

   If the child/youth is eligible for a nursing assessment to determine eligibility for service, a local NSS coordinator will contact the family/caregiver to arrange an assessment of the child’s medical care needs. No further action is required from the physician or family.

   If the child/youth is not eligible for service after this assessment is completed, we will send a letter to the referring physician and family.

Seizure rescue intervention training request

1. Assessment

   • Students must have a completed Seizure Action Plan and Medical Alert Information (SAP) form available at their school, which includes details of the rescue intervention(s) that have been prescribed by their doctor or nurse practitioner
   • Information about what types of seizure rescue intervention(s) are prescribed is in part four of the SAP. NSS provides training for the following medically ordered seizure rescue interventions:
     • Buccal lorazepam (Ativan)
     • Buccal or intranasal midazolam
     • Vagus nerve stimulation

   Please identify which non-medical school staff require training to provide the student’s seizure rescue intervention(s) at school.

2. Complete a request form

   The school administration (such as the student’s case manager or principal) must complete and submit the training request form (PDF).

3. Send the request form

   Fax the form to: 604-708-2127 or email it to: nssreferrals@cw.bc.ca. Do not include the student’s Seizure Action Plan.

4. Post request

   Our intake team processes all training requests in order of receipt. They may reach out if there is any missing information on the request form.

   Before we can complete training, the school must take three additional steps:

   1. Hold an information-sharing session with the student’s parent/caregiver, the school staff who will be trained, and the school administrator/case manager. During this session, they must review all the information in the student's SAP, including:
      • What the student’s seizures look like, so the school staff can recognize them
      • How long the student’s seizures normally last
      • Any auras (warning signs) that would indicate the student is going to have a seizure
      • Any triggers that may make seizures more likely (e.g. illness, lack of sleep, flashing lights)
      • How the student usually behaves after a seizure
      • The student’s typical seizure patterns, including:
        • Time of day they typically happen
        • How long they typically last (duration)
        • How often they typically occur (frequency)
      • Any student-specific care that is to be provided during and/or after a seizure
      • Any student-specific instructions for seizure first aid (e.g. what school staff should do if the student has a seizure while in a wheelchair)
      • The student’s rescue intervention(s), including:
        • When to provide the rescue intervention (e.g. if seizure lasts longer than x minutes)
        • What intervention to provide (e.g. lorazepam, midazolam, or vagus nerve stimulation)
        • How much of the rescue medication to provide (e.g. one tablet)
        • If the student uses midazolam as their rescue intervention, the parent or caregiver should demonstrate to the school staff how to line up the plunger with the pre-marked line (or tape) on the syringe that they have marked to ensure that the correct dose will be given. They should demonstrate this using the student’s supplies
      • Complete seizure log (i.e. how, what, and where to document any seizures and/or seizure rescue intervention(s) provided to the student)
      • When to call 911
      • When to call the parent/caregiver
   2. Confirm that the appropriate supplies are available at the school (as per the order on the SAP)
      1. Note: a student may either have only one rescue medication (lorazepam or midazolam) as their seizure rescue intervention, or they may have both a medication (lorazepam or midazolam) and a vagus nerve stimulator (VNS) as their rescue interventions. If the student has midazolam as their rescue intervention, they must have either buccal midazolam or intranasal midazolam, but not both
         • Lorazepam (Ativan) sublingual tablet(s): a single dose in a pharmacy-labeled container/package with the student’s name, medication name, dosage, route of administration, indication for use and expiry date
         • Midazolam: in a pharmacy-labeled vial with the student’s name, medication name, dosage, route of administration, indication for use and expiry date, and:
           • A 3 ml luer-lock syringe marked with the appropriate dosage (number of millilitres) prescribed for the student. The dosage must be marked on the syringe by the parent/caregiver either by drawing a line or by marking with a piece of tape
           • A blunt needle to withdraw the medication from the midazolam vial
           • A nasal atomizer (for intranasal administration only)
         • Vagus nerve stimulator (VNS): the student’s magnet may be a wrist band/watch or a pager/belt-clip style
   3. Ensure that all of the staff who will be trained have completed the Seizure Rescue Intervention for Non-Medical School Staff module on LearningHub (sign-up instructions (PDF)).
      1. LearningHub provides a certificate to participants upon completion of the online training module. Participants can provide them to school administration to verify they have completed the training
      2. If you receive an error message stating "This course is not open to your account type" when you try to enroll for the LearningHub course, follow the instructions here: Changing Account Type to Affiliate Instructions (PDF)
5. Appointment with a nurse coordinator

   A local NSS coordinator will contact the person listed on the request form to arrange a training date. No further action from the school is required.

   When training is complete, we will provide the school with a record of who was trained.