Some students require specialized health procedures during the school day to safely access their education. These procedures may include, but are not limited to:

• Gastrostomy tube (G-tube) feedings and care

• Urinary catheterization

• Tracheostomy care

• Ventilator care

Hays CISD nursing staff must have current healthcare provider orders before any specialized procedure can be performed at school. Depending on the student's needs and applicable regulations, certain procedures may be delegated by the school nurse to the principal's designee after appropriate training has been completed.

All healthcare provider orders and required authorization forms must be submitted annually at the beginning of the school year and whenever there is a change in the student’s medical condition, treatment plan, equipment, or healthcare provider orders during the current school year.

Urinary catheterization, tracheostomy care, and ventilator care are highly individualized based on each student's medical needs. Because of this, Hays CISD does not use a standardized physician order form for these procedures.

Instead, the student's healthcare provider must submit written orders on the provider's letterhead that clearly outline the required care and any necessary instructions. If the school nurse determines that the orders are incomplete or require clarification, the nurse will work with both the healthcare provider and the student's parent or guardian to obtain updated orders before services are provided.

Before gastrostomy tube feedings or related care can be provided on any Hays CISD campus, the following forms must be completed and submitted:

Enteral Tube Feeding and Reinsertion Authorization Form

• Serves as the healthcare provider's order for enteral feedings and G-tube care.

• Includes parent/guardian consent for trained school nursing staff to reinsert the gastrostomy button if it becomes dislodged during the school day, when appropriate.

Gastrostomy Button Reinsertion Trained Emergency Contacts Form

• Identifies trained emergency contacts designated by the parent or guardian to verify placement of the gastrostomy button after reinsertion.

• Provides parent/guardian consent for those designated individuals to perform placement verification.

Important: If a gastrostomy button becomes dislodged during the school day and is reinserted by trained school personnel, Hays CISD staff, including school nurses, are not permitted to verify placement of the button. Before the tube can be used for feedings, medications, or fluids, one of the parent-designated trained emergency contacts must verify correct placement.

If a student requires medications to be administered via the gastrostomy tube during the school day, the Hays CISD Medication Authorization must be completed and signed by the healthcare provider before medication can be administered at school.