Impact of School-based Blood Lead Surveillance on the Identification, Screening, and Referral Rates of at-Risk Children
childhood blood lead screening
childhood lead exposure
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Publisher:The Ohio State University
Series/Report no.:The Ohio State University. College of Nursing Doctor of Nursing Practice Final Document Projects
Background: Elevated blood lead levels in young children (ages 1 to 6 years) continues to be a public health priority. Blood lead levels that to exceed public health recommendations (5 µ/dL), and those as low as 1 to 2 µ/dL, have negative effects on a child’s neurological development and subsequent achievement in school. School nurses are experts in public health and improve the health and academic outcomes of children in at-risk geographical areas. Improving screening, evaluation, and referral of elevated blood lead levels at the school level is essential in protecting the development of children. Objectives: The purpose of this project was to evaluate and improve on the effectiveness of blood lead level monitoring and student referral using an evidence-based school nurse approach to improve the identification and referral of school-aged children with lead exposure. Through the implementation of an evidence-based public health surveillance tool (Impact SIIS), school nurses may improve health and academic outcomes of children in at-risk geographical areas. Methods: The CDC’s “Decision Chart for Students Affected by Lead” was modified to guide school nursing practice in two Ohio schools located in high-risk areas for elevated lead levels. The nurse from each school completed a baseline audit of school health records to determine if blood lead levels were routinely reported in school health physicals, immunization reports previously printed from Impact SIIS, or communicated with the school by other means. Results: Results of the baseline audit indicated blood lead screening results were not routinely available in school health records. Baseline results indicated that 0-2.4% of student health records contained blood lead screening results for students in grades Kindergarten to 3. The results of the intervention audit indicated school-based blood lead surveillance, utilizing Impact SIIS, increased the identification of blood lead screening results, for students in grades Kindergarten to 3, to 59% in School B and 100% for School A. The students in School B who did not have a blood lead result were referred for screening. Conclusion: Impact SIIS was an effective tool for performing school-based blood lead surveillance in schools. The Modified Decision Chart guided school nurses through the referral of students, according to the blood lead screening results identified. Students were referred for screening, monitoring, or Child Find and Health Department. The Modified Decision Chart was effective in guiding the identification and referral of students with elevated lead levels and screening for those without lead level results.
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