IHI CEO Kedar Mate, MD, shared ways to create a more equitable health system during his keynote address at the virtual IHI Forum.

This article was originally published December 8, 2020 on PSQH by Jay Kumar.

In his keynote address at the Institute for Healthcare Improvement (IHI) Forum, IHI CEO Kedar Mate, MD, urged attendees to look for patient safety solutions that not only help marginalized populations but benefit the public at large.

The conference, which normally takes place in Orlando, is being held virtually this year. Mate, who was named the organization’s CEO in June, said the search for ways to build a better healthcare system should embrace the concept of targeted universalism, which is an inclusive way to implement interventions. A prime example of targeted universalism is the curb cut, which was initially created to provide public streets accessible to wheelchair users, but now benefits a wide variety of people for various reasons.

“Targeted universalism seems ready made for today’s moment and today’s challenges,” Mate said. Other examples include seatbelts, which originally created for children; smoking laws, which were enacted to help flight attendants on airplanes; and closed captioning, which was designed to help the hearing impaired.

“In fact, by focusing on the most marginalized and excluded, we just might create a system that is better for all of us,” he noted.

The spirit of collaboration needs to be encouraged, said Mate.

“Our societies are becoming increasingly polarized, and this polarization is obscuring the value of collaboration, when the present global moment that we are in demands exactly that,” he said. “It has reduced decision making to either/or constructs where someone has to lose instead of seeing the opposite that might be present in both/and solutions…Consider the curb cut as a way of seeing through that polarization.”

An important challenge for the healthcare industry is to create a more equitable health system, Mate said. Organizations should take the following steps to ensure health equity:

• Make health equity a strategic priority
• Build infrastructure to support health equity
• Address the multiple determinants of health
• Eliminate racism and other forms of oppression
• Partner with the community to improve health equity

IHI launched a collaboration called Pursuing Equity that developed a framework called the “4 Ms” to create age-friendly health systems:

• Knowing and understanding what MATTERS to older adults
• Improving MEDICATION use
• Increasing MOBILITY
• Improving MENTATION (i.e., preventing, identifying, treating, and managing dementia, depression, and delirium)

“These interventions have had profound effects on older adults, reductions in polypharmacy, delirium incidents, and length of stay for our oldest adults,” Mate said. “Meaning less time to de-condition and more time at home with family and friends.”

In 2017, the IHI set the goal of having 1,000 health systems adopt age-friendly initiatives. Mate said as of this week, 1,195 care locations are recognized as age-friendly health systems. In addition, Providence Health added a fifth “M,” malnutrition, which had the added benefit of helping all patients, not just the elderly ones, he said.

“In healthcare, ignoring the disadvantaged and the systems that perpetuate these disadvantages will not only in the health of individuals but in the health of entire nations,” Mate noted. “We are living this now with COVID-19.”

Mate listed several “curb cuts for a better world” that he would like to see implemented:

• Address the inequities right from the start.
• Invest in public health.
• Fix our long-term care environments. “Our nursing homes need our support right now, not our mistrust and suspicions.”
• “De-carcerate” by reducing the prison population where possible.
• Expand community health.
• Improve prison health.

To find their own curb cuts, Mate said health organizations need to name their universal goals, pick a measure that’s important to them and stratify their data, and stay physically and psychologically safe.

“We need ‘psychological PPE’ to promote mental health and well-being,” he added.

Any professional who is currently involved in patient safety or quality improvement is welcome to submit a case study application.

This article was originally published December 2, 2020 on PSQH

Patient Safety & Quality Healthcare (PSQH) is seeking to spotlight the best healthcare quality improvement case studies. By imparting their in-the-trenches experiences and lessons learned, the chosen case studies will shed light on an issue, practice, or principle that affects stakeholders across the modern medical staff landscape.

Whether you’re a seasoned educator in search of a broader platform to share your expertise or a yet-to-present professional with big ideas, read on for the ultimate opportunity. Then, click here to apply to the 2021 PSQH Innovation Awards. Deadline to apply is January 15, 2021 and the application is free.

Any professional who is currently involved in patient safety or quality improvement is welcome to submit a case study application. The 2021 PSQH Contest Committee, in conjunction with the PSQH administrative team, will select one case study to highlight on PSQH.

The winning proposal will showcase a creative solution that the presenter(s) have helped implement at their organization. This change can have occurred at any time, as long as it reflects current industry standards and continues to benefit the organization.

The winning presentation will elegantly address the following subjects:

• A specific (and widely relatable) challenge or objective that sparked a meaningful change in a key patient safety or quality improvement process
• The steps that the involved parties took to conceive, develop, and implement their solution, including any hurdles they overcame along the way
• The short- and long-term effects of the solution
• The takeaways for the broader professional community

Potential case study subjects include the following:

• Patient safety improvement
• Quality improvement
• Medication safety
• Infection control
• Reduction/elimination of “never events”
• Improving readmission rates
• Patient satisfaction
• Innovative approaches to addressing tricky regulations and accreditation standards

To access the case study application, click here, or paste the following URL into your internet browser’s address bar: https://www.surveymonkey.com/r/8BQFTTK. We recommend that you paste your responses into the application fields from a Word document. The application period closes end of day on Friday, January 15, 2021.

The technology and understanding of how to deal with drug diversion is evolving more quickly than regulations can be rewritten, and facilities are expected to keep abreast of the best practices available.

This article was originally published November 18, 2020 on PSQH by Kimberly New, BSN, JD, RN

Editor’s note: This article is excerpted from the HCPro book Drug Diversion Prevention in Healthcare, Second Edition. For more information and to order, visit https://hcmarketplace.com/drug-diversion-prevention.

Drug diversion in healthcare facilities has been the subject of increasing focus by regulatory authorities in the past several years. In many cases, the expectations of these authorities are not explicit in regulations but come to light in the settlements reached between the Department of Justice/Drug Enforcement Administration (DEA) and facilities where violations or poor practices are identified.

In general, DEA and other authorities expect facilities to adhere to the best available practices for patient safety and drug security, regardless of whether those practices are spelled out in published regulations. Consequently, in terms of expectations by regulatory authorities, there is no real distinction between what is required and what is considered to be best practice.

The technology and understanding of how to deal with drug diversion is evolving more quickly than regulations can be rewritten, and facilities are expected to keep abreast of the best practices available.

Most facilities have a core group of stakeholders that recognize the scope of the problem and risks associated with diversion. Unfortunately, regulation does not explicitly mandate that facilities have a diversion program, so it may be difficult for even committed people to gain support for some of the essential processes. When I visit facilities where administrators are resistant to my recommendations, an argument I hear often is, “Just show me the regulations that require it.” They are not usually content with best-practice guidelines.

Therefore, to support the diversion program effort, refer to the controlled substance- and diversion-related requirements with which facilities must comply. Sources of such requirements include the Centers for Medicare & Medicaid Services (CMS), DEA, the Food and Drug Administration (FDA), the Environmental Protection Agency (EPA), survey agencies, state regulations, and professional boards.

There are numerous best practices and guidelines available to provide direction and support. Sources for guidelines include ASHP, Centers for Disease Control and Prevention (CDC), and the Institute for Safe Medication Practices (ISMP), to name a few.

Several states have developed toolkits and roadmaps to help facilities perform their own gap analyses; many of freely available online, including the Minnesota Hospital Association roadmap, the California Hospital Association roadmap, and the Missouri Bureau of Narcotics and Dangerous Drugs Guide to Preventing and Investigating Diversion Issues in Hospitals, among others (see the URLs at the end of the chapter). Finally, additional guidance and expectations can be gleaned from DEA settlement agreements with healthcare facilities. Some of the universal requirements and expectations are discussed here.

Patient Safety

The pharmacy has ultimate responsibility for medications throughout the hospital. The Interpretive Guidelines for the Medicare Conditions of Participation (CoP) state, “The hospital’s pharmacy service must ensure safe and appropriate procurement, storage, preparation, dispensing, use, tracking and control, and disposal of medications and medication-related devices throughout the hospital, for both inpatient and outpatient services” (Interpretive Guidelines 42 CFR §482.25[a]).

Hospitals generally must provide a safe environment of care for patients—that is, one that is free from the threat of abuse or harm (42 CFR §482.13[c][2]). The hospital must also ensure that the medical staff is accountable to the governing body for the quality of care provided to patients (42 CFR §482.12[a][5] and 482.22[b]).

In order to comply with these patient-safety related requirements, hospitals must keep controlled substances secure so as to prevent tampering and substitution. Nursing and pharmacy staff and anesthesia providers, particularly those in procedural and operative units, who fail to keep controlled substance injections secure pose a substantial risk to patient safety.

Regardless of whether the services are provided directly by hospital employees or indirectly by contract, the hospital is responsible for requiring staff to comply with state and federal law (42 CFR §482.12[e]). In other words, even if anesthesia staff are contracted workers, the hospital is responsible for requiring them to comply with state and federal regulations and with relevant patient safety standards (42 CFR §482.12[e][1]).

The hospital is also responsible for ensuring that the care delivered by nonemployed nursing staff meets hospital policies and procedures (42 CFR §482.23[b][6]), including controlled substance handling requirements. Agency nurses are often implicated in drug diversion cases, so in order for the hospital to comply with this requirement, tit must monitor nurses closely. Due to the relatively short duration of their assignments, their controlled substance transactions should be monitored more frequently than those of employed staff.

The CoPs also require that hospitals have ongoing surveillance to identify “infectious risks or communicable disease problems” in any particular location (Interpretive Guidelines 42 CFR §482.42). This CoP requirement is meant, in part, to facilitate early identification of an outbreak. In light of the many reported diversion cases that have resulted in bloodborne pathogen transmission to patients, and in conjunction with this responsibility, infection prevention departments should be apprised of all confirmed drug diversion cases.

Patient Privacy

Hospitals and other institutions are required to protect patient information and prevent unauthorized individuals from accessing private healthcare related data (42 CFR §482.13[c][1] et seq and 42 CFR §164 et seq).

When diversion occurs, often the diverting staff member has inappropriately accessed patient records to locate patient identities under which it would be ideal to divert. It is important to review each diversion case for the possibility of a privacy violation and to work with the institutional privacy officer to ensure that any violations are addressed.

Security and Medication Handling Requirements

The CoPs require that institutions have policies and procedures in place that prevent, to the extent possible, diversion of controlled substances (Interpretive Guidelines 42 CFR §482.25[a][3]). In order to comply with this directive, facilities must have policies and procedures that explicitly address controlled substance handling, and must insist on compliance with expected practices.

For example, staff should be able to review controlled substance handling policies and obtain direction regarding how long they have to administer a controlled substance once it is removed from secure storage, and when and where they are required to waste excess controlled substances. Furthermore, institutions must review diversion-related policies regularly to ensure that they are up to date and consistent with institutional expectations.

The CoPs require that all drugs and biologicals be kept in a secure area and be locked when appropriate (42 CFR §482.25[b][2][i]). This means that controlled substances need to be stored in a way that prevents unauthorized access. Secure areas must be accessible only to authorized individuals (Interpretive Guidelines 42 CFR §482.25[b][2][iii]). Such individuals must be identified by job class in hospital policies and procedures, and those procedures must also indicate how unauthorized access is prevented.

Automated dispensing cabinets (ADC) are recognized in the CoPs as a secure option for controlled substance storage. If you are using ADCs, consider the ISMP guidelines for their use, including password security, unit-specific privileges, biometric access, locking storage in refrigerators, returning unused medications to a designated return bin, and implementing blind counts for controlled substances (ISMP Guidance).

The CoPs state that drugs can’t be administered without a valid order by a physician, and any drugs available on override must be strictly limited to those that might be needed immediately in emergency circumstances (42 CFR §482.23[c][1] et seq and Interpretive Guidelines 42 CFR §482.25[b]).

This requirement is meant to ensure that appropriate safety checks are in place prior to administration, but it is also relevant to the diversion prevention effort. One popular method of diversion is to pull controlled substances via an override transaction. Therefore, hospitals should regularly review their list of overridable controlled substances, and they should keep that list as narrow as possible.

The CoPs require that quantities of medications dispensed be limited to prevent diversion, and that patients must be assessed to ensure that medications have their intended effects (Interpretive Guidelines 42 CFR §482.25[b][1]). Monitoring for the removal of excessively large doses is one way of preventing diversion, but limiting the dosage size available based on the needs of the patient population being served is also an effective measure.

Although hospitals may permit patients to self-administer their own medications, hospitals are required to keep self-administered medications safe and secure. Owing to the increased security requirements for controlled substances, hospitals should only allow self-administration of these drugs in very limited situations. In fact, the CoP interpretive guidelines state, “Hospitals … generally should not include such medications as part of a patient self-administration program” (Interpretive Guidelines 258).

ISMP guidelines suggest that wasting of unneeded controlled substances happens at the time the medication is removed from secure storage (ISMP Guidance, Core Process 2).

As discussed in more detail in a subsequent chapter, the DEA, EPA, and FDA have all identified regulations or expectations regarding controlled substance waste disposal. Local waste treatment regulations may also impact how a facility approaches controlled substance disposal. Because controlled substance waste is a common source for diversion, it is important to have a compliant process for disposal—that is, one that doesn’t facilitate diversion—in place.

Recordkeeping

The CoPs and DEA regulations require that current and accurate records be kept of the receipt and disposition of all scheduled drugs (42 CFR §482.25[a][3] and 21 CFR §1304.04 et seq). This includes having complete records for all controlled substances from the time of procurement to administration, waste, or return via the reverse distributor.

It also includes being able to track all controlled substances that leave the pharmacy and ensure that they are received into stock at the intended location, and it includes being able to track controlled substances that are removed from stock in remote locations to ensure that they are received back into stock in the pharmacy.

All institutions should have a meaningful daily or per-shift reconciliation, by a reviewer who is not involved in the workflow that is being audited, of drugs that leave or are expected to be returned to the pharmacy.

This requirement also applies to situations in which drugs are manually accounted for. For instance, many facilities use manual records to track the administration and wasting of patient-specific controlled substances. In those facilities, nursing documentation may not be sent to pharmacy as it should be, and pharmacy may not follow up to be sure that the documentation is received. Every instance in which administration and waste documentation is incomplete is a discrepancy, subject to a civil monetary penalty of up to $10,000 per violation (21 U.S.C. § 842(c)(1)(8)). In such a situation, complacency is not an option.

The CoPs require that all records demonstrating the movement of controlled drugs within the institution must be readily retrievable (21 CFR §1304.04 et seq). This means that facilities must be able to produce all records relating to controlled substances without delay, not just those that relate to procurement and inventories.

Discrepancies are required to be reconciled “promptly” (21 CFR §1304.04 et seq). The term “prompt” is explained in the CoPs by citing the Merriam-Webster online dictionary, where “prompt” is defined as being performed “readily or immediately” (Interpretive Guidelines 42 CFR §482.24[c][2]). This interpretation supports the policy that most facilities have requiring that discrepancies be resolved by the end of the shift. It also means that discrepancies cannot be left unresolved for extended periods of time.

Such resolution is essential. When I have visited facilities that regularly allowed discrepancies to go unresolved, I have found hundreds or thousands of discrepancies pending resolution across the institution. Any discrepancy, even a surplus, may be a sign of poor controls and lax accounting. The reasons given for discrepancy resolution must be reviewed consistently to ensure that discrepancies are resolved appropriately. For instance, it would not be appropriate to resolve an actual discrepancy of 32 missing tablets by stating that the discrepancy was due to a miscount.

Diversion Investigation and Response

ISMP and ASHP guidelines emphasize the need for regular review of drug usage patterns, wasting practices, and discrepancies (ISMP Guidance, Core Process 2 and ASHP Guidelines). The Interpretive Guidelines for the CoPs require facilities to be capable of readily identifying loss or diversion of all controlled substances so that the time between the loss or diversion and the time of discovery is strictly limited.

Facilities must also be able to quickly ascertain the extent of any controlled substance loss or diversion (Interpretive Guidelines 42 CFR §482.25[a][3]). In order to comply with this requirement, all facilities need to have a robust multidisciplinary diversion surveillance effort. Those required to review transaction data must be identified in policy, and the steps involved in transaction review should be set forth as well.

The CoPs require that hospitals promptly investigate and resolve patient complaints and grievances (42 CFR §482.13[a][2]). This includes complaints about poor pain relief, poor nursing care, and failure to receive documented medication, all of which may relate to diversion. Any complaint that may be related to diversion should be forwarded to the diversion specialist, as well as to the patient advocate, so that the possibility of diversion can be reviewed and addressed.

If there is evidence of tampering or diversion, or if medication security otherwise becomes a problem, the CoPs require that the hospital evaluate its current medication control policies and procedures and implement the necessary systems and processes to ensure that the problem is corrected. The hospital must also ensure that patient health and safety are maintained (Interpretive Guidelines 42 CFR §482.25(b)(2)(i)).

In addition, hospitals must have in place ongoing performance improvement and patient safety initiatives (42 CFR §482.21(a)(1) et seq). These requirements speak to the need to address noncompliance in medication handling via coaching and progressive discipline.

They also underscore the need for institutions to perform a review of every diversion case and identify any performance improvement measures that can be implemented to help prevent similar events. This is a process that ASHP supports as part of the institution’s quality improvement initiative (ASHP Guidelines).

The CoPs state that diversion and loss of controlled substances must be reported to the individual responsible for the pharmaceutical service and to the chief executive officer, as appropriate (42 CFR §482.25(b)(7)). This requirement includes ensuring that all reporting required by state and federal law is accomplished. Many hospitals fail to report diversion to the DEA on a form 106, as required by law (21 CFR §1301.76(b)), but failure to do so not only violates DEA regulations but also violates the Medicare CoPs for hospitals.

CEO and Board Communication

Hospitals are required to be in compliance with the federal requirements set forth in the CoPs to receive Medicare/Medicaid payment (Interpretive Guidelines 3). The CoPs require that hospitals be in compliance with all applicable federal, state, and local laws. They also require facilities to have an effective governing body that is legally responsible for the hospital’s conduct.

Surveyors assess compliance with these CoPs in part by interviewing the facility’s CEO and reviewing Board of Director meeting minutes. A common theme with diversion cases and other crises within hospitals is that full disclosure to executive leadership doesn’t always occur in a timely fashion. There was an allegation of this type of gap in communication in a diversion case in Florida that involved allegations of patient harm (Eiselle, 2016).

With diversion, it is essential that the CEO and Board of Directors be kept abreast of suspected diversion cases as well as confirmed cases. The CEO must be familiar with the institutional diversion program components and should fully understand what diversion response entails. The Board of Directors must be kept abreast of confirmed diversion cases and any potential patient harm that may have resulted.

Facilities should also ensure that they keep up to date with State Board of Pharmacy and State Board of Nursing regulations as they apply to diversion and controlled substance handling. Both boards typically require reporting of diversion or actionable poor practice that may suggest diversion.

At Children's Health in Dallas, our partnership with over 225 schools across the Dallas metro area provides vital access to specialty support for children and teens and guidance around infection control.

This article was originally published November 12, 2020 on PSQH by Karen Kaighan and Jason Isham

As schools face heart-wrenching decisions around how to educate kids during the COVID-19 health crisis while keeping students and staff safe, school nurses are perhaps feeling the most strain.

These days, school nurses are often responsible for assessing children and faculty presenting with COVID-19 symptoms. And with the health crisis putting a pause on access to some regular healthcare services, many children are not getting the care they need. This puts an even bigger responsibility on school nurses, some of whom were busier than ever when schools shut down last spring.

Telehealth increasingly is helping school nurses meet students’ physical and mental health needs, both in school and virtually—and lawmakers are recognizing its importance. At Children’s Health in Dallas, our partnership with over 225 schools across the Dallas metro area provides vital access to specialty support for children and teens and guidance around infection control.

A back-to-school approach to telehealth

Even before COVID-19 was a blip on the radar screen, we saw the benefits of using telehealth in school settings. In 2014, the health system began partnering with schools to bring virtual primary and specialty care into the building, such as by providing one-on-one virtual education and support for asthma management. The impact: 72% of parents whose children have relied on our school-based telehealth services say the initiative helped their children avoid an emergency department visit.

However, when COVID-19 struck, we quickly realized that a broader virtual approach would be critical.

In mid-March, when schools closed their doors to in-person learning, our technology team brought school-based telehealth equipment and devices back into the hospital, where they could be sanitized and used. Team members provided urgent care and behavioral health services virtually for students who ordinarily received these services in a school environment.

Staff also offered free assessments of COVID-19 symptoms in students via telehealth and directed students to in-person treatment, where needed. From March through September, we recorded a 500% increase in telehealth urgent care visits among students compared with the same period in 2019. As school start dates approached, the health system distributed 150,000 masks to students to help limit exposure to the virus.

Then, as the 2020–2021 school year approached, we partnered with school nurses to ensure children and faculty were kept safe as they returned to the classroom. We started by launching a “Back-to-School COVID Conference,” bringing together more than 900 school nurses throughout the Dallas metro area to discuss what school-based care delivery should look like during a pandemic and how nurses could most effectively protect themselves.

Collaborating with UT Southwestern, we shared best practices that would help ensure nurses felt comfortable providing complex as well as routine care. We also supported school nurses by providing fit testing for them as well as for essential school and college personnel. And we offered school districts a daily quick-screen COVID-19 symptom checker for staff, student, and teachers before entering school.

Education was a key pillar of our strategy, thus we also expanded on our programming for Children’s Health℠ LIVE, an accredited, web-based continuing education series. Our “The Nurse Is In” and “Teacher Talk” series give nurses and school staff the clinical educational support they need to provide care in school. While we originally kicked off the program in 2015, we knew we had to keep creating new education to help bridge the gap between the presentation of symptoms, diagnosis, and referral.

Team members coached nurses on how to provide virtual care, as many school nurses were doing so for the first time.

The team also supplied devices that could work in tandem with the telehealth platform, such as a digital otoscope that sends virtual images of the inside of a child’s ears to an online physician or a scope that captures images of a child’s throat.

These devices will be particularly important as cold and flu season ramps up, as they can help nurses evaluate children who present with ear, nose, and throat complaints.

Our health system also reached out to parents to help guide them in the decision to send children with a medical condition back to an in-person school setting.

By examining the health history of high-risk kids and teens, physicians and nurses could provide the right guidance for families on whether face-to-face instruction or e-learning would best meet a child’s needs.

To maintain continuity in care for in-person and e-learning students alike, our “School Telehealth at Home” program provides families with in-home school telehealth support.

By downloading the Children’s Health Virtual Visit app, parents can schedule a virtual health visit for their children. The health system also offers a 24-hour nurse hotline that families can call for answers to health questions.

Behavioral health services

The need for school-based behavioral health services rapidly expanded during the pandemic as children and families increasingly struggled with mental health. In fact, a study from the American Academy of Pediatrics found that one in seven parents reported worsening behavioral health for their children since coronavirus began to spread in March.

We have long offered behavioral health services virtually in school settings, such as our Teen Recovery Program, which assists students who are recovering from substance use disorder or facing mental health challenges.

Because school-based telebehavioral services could easily be conducted in home settings, team members were able to continue offering virtual behavioral health support to students while schools were closed.

Through June 2020, our health system conducted 963 telebehavioral health visits with students in the Dallas area, ensuring continuity in care for students in need.

During the 2020–2021 school year, we will offer both school-based and at-home telebehavioral health services to eliminate gaps in care for vulnerable populations.

Families can access a behavioral health provider by scheduling an appointment via the Children’s Health app. When prescriptions are needed, our team works directly with parents to meet the child’s needs and provide assistance around medication adherence.

The program has demonstrated strong results among Dallas-area students. Children and teens experience a 32% improvement in their clinical goals for treatment based on self-ratings conducted before and during treatment.

As the program continues to expand during the pandemic, we will offer telebehavioral health in nearly 180 campuses this fall, with continued availability in students’ homes as well.

Measuring the impact

Today, school-based telehealth is our fastest-growing telehealth program—and it continues to expand.

Since January 1, we have conducted more than 14,000 telehealth encounters with children and teens—from rapid strep and flu testing to asthma treatment, behavioral health, and sports medicine. We worked with 93 schools in 2018, then grew to partner with 145 schools in 23 school districts across the Dallas metro area in 2019.

Currently, for 2020, we’re working with over 225 schools in 27 districts. That’s a 64% increase since 2018, demonstrating the rising need for telehealth support for schools and students during the pandemic.

Our efforts at Children’s Health in Dallas point to some important lessons learned:

Work with school nurses in building out your organization’s telehealth platform. 

These professionals’ familiarity with families in your community can point to the services that are needed most, giving you the insight to develop a high-value approach.

Our experience with schools in the Dallas metro area indicates that some schools had been looking for a health system partner; however, they could not find a healthcare provider willing to take the leap.

Focus on continuity in care. Establish a dedicated panel of providers to supply telehealth services for e-learners and in-person students, and ensure that follow-up visits can be performed in the same setting as the initial visit, where possible.

Provide a hotline for students and their families to ask questions about their medications or care after hours, and enable parents to contact providers directly, if needed.

Make sure your telehealth workflow model matches that of the school-based offering. For instance, the way in which students and families connect with your telehealth team during school hours should match the process for receiving support after hours.

By collaborating with school health professionals to design the right platform of services and approach, healthcare providers can help ensure children receive the right care in the right setting during COVID-19 and beyond.

Karen Kaighan is director of school health programs and Jason Isham is director of integrated behavioral healthcare at Children’s Health in Dallas.