- Los Angeles Unified School District
- Protocols
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Protocols
Each Specialized Physical Healthcare Service (SPHCS) or protocol has a specific authorization form posted under the protocol guidelines.
- Other Protocol Forms, Generic Authorization Forms and Protocol Training Video Links
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A. Specialized Health Care Services:(1) SPHCS Form 2024/2025(2) GuidelinesB. Authorization FormsE. For a protocol or SPHCS that is not listed on the standardized specialized physical health care services, please download the Generic Authorization Form (English)I. Protocol and Medication Training & Supervision Checklist Form- for Licensed and UnlicensedAssistive PersonnelJ. Training Log: (1) Student Specific Training Log (2) Training Log
- DNS Training Logs are submitted at: Submit Training Logs
- All submitted training logs (Student Specific, General, and Supervisor Checklist) are housed on SharePoint: Access Submitted Training Logs
JOB AID: Downloading Training Records from SharePoint
Contact your Nursing Coordinator if:
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You can’t access the Training Log SharePoint Link
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A training log needs to be marked as an error (provide explanation)
K. Review of Support Services Due to Health Needs - Complete for Student with Protocol Before the IEP Meeting - Adrenal Insufficiency
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Guidelines
Solu-Cortef Protocol Guidelines (1/2024)
Authorization Form for Emergency Medication for Adrenal Insufficiency and Student Emergency Care Plan
Related Forms and Information:
Solu-Cortef Checklist (1/2024)
- Anaphylaxis
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Protocols Guidelines:Anaphylaxis Protocol Emergency Treatment of Anaphylaxis (08/2021), Attachment B of the BUL 5628.1Attachment B - Anaphylaxis GuidelinesAttachment C - Letter TemplateAttachment D - Special Diet Form.*****For the most recent version of the Special Diet form, click here.Forms:Training:FOR SCHOOL BASED CLINIC USE ONLY: Anaphylactic Reaction Clinic Emergency Protocol - August 2022
- Autonomic Dysreflexia
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Autonomic Dysreflexia: Emergency Care GuidelinesAuthorization Form:English/Spanish (7/2024)
- Catheterization
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a. Clean Catheterization Guidelines (3/2019)Authorization Form for Clean Catheterization (7/2024): English/Spanishb. Clean Self-Catheterization with Assistance Guidelines (3/2019)Authorization Form for Clean Self-Catheterization with Assistance (7/2024) English/Spanishc. Clean Self-Catheterization Guidelines (3/2019)Authorization Form for Clean Self-Catherization (7/2024) English/Spanishd. Sterile Catheterization Guidelines (3/2019)Authorization Form for Sterile Catheterization (7/2024) English/Spanishe. Training Videos Link
- Diabetes Protocols
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Guidelines:1. Blood Glucose Testing (3/2019)2. Baqsimi(Glucagon Nasal Spray/Severe Hypoglycemia) (12/2021)3. Glucagon Injection(Severe Hypoglycemia) (3/2019)Glucagon Training Video4. Treatment of Hypoglycemia(3/2019)5. Ketone Testing (Hyperglycemia) (3/2019)Authorization Forms:b. Parents’/Guardians’ Authorization & Student Contract: Diabetes Independent Care/Self-Care, 6/2024Non-Diabetes Protocol Authorization Forms:Other Related Forms and Information:
For LAUSD Food Services Web Page for Menu click here; for carbohydrate count click here.
- Epinephrine for Schools (SB1266)
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- Gastrostomy and Jejunostomy
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Gastrostomya. Gastrostomy Feeding: Bolus Method (3/2019)Authorization Form (7/2024): English/SpanishAuthorization Form (7/2024): English/Spanishc. Gastrostomy Tube Replacement (3/2019)Authorization Form (7/2024): English/Spanishd. Training Videos LinkJejunostomyAuthorization Form (7/2024): English/SpanishProtocol Related Form: Special Diet Form
- LifeVac Protocol
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LifeVac Protocol, March 2023
Authorization Form: Emergency Treatment of Choking Lifevac® Device
- Mechanical Nebulizer
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Mechanical Nebulizer Guidelines (3/2019)Authorization Form with the Parent Section (8/2024): English-Spanish
- Mechanical Ventilation
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Mechanical Ventilation Guidelines (3/2019)Authorization Form for Mechanical Ventilation (2/2023): English/SpanishOther Related Forms/Information2. Daily Mechanical Ventilator Checklist (Rev. 6/2015)
- Ostomy Care
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Ostomy Care (3/2019)
Authorization Form (8/2024): English/Spanish - Oxygen Therapy + Pulse Oximetry
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Oxygen Therapy - Guidelines (3/2019)
Pulse Oximetry - Guidelines (1/2024)
Authorization Form for Pulse Oximetry and/or Oxygen (1/2024): - Seizure Care
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Protocols:2. Diastat - Diastat Guidelines (3/2019)Authorization Form (8/2024): English/Spanish3. Vagus Nerve Stimulation (VNS) - VNS Guidelines (3/2019)Authorization Form (3/2023): English/SpanishRelated Forms and Informationb. Seizure Action Plan: English/Spanishd. Parent Questionnaire for Students with Seizures: English/Spanish | English/Korean
- Suctioning
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Protocols1. Oral Nasal Suctioning (3/2019)Authorization Form for Oral/Nasal Suctioning (8/2024): English/SpanishAuthorization Form: (3/2023): English/Spanish3. Tracheostomy Suctioning(3/2019)Authorization Form: (3/2023): English/Spanish4. Tracheostomy Tube Replacement(3/2019)Authorization Form (3/2023): English/SpanishTraining Videos Link and Related Forms:
- Oral Nasal Suctioning
- Tracheostomy Suctioning
- Tracheostomy Tube Replacement
- Daily Suctioning Checklist
- Careplan: Student with Tracheostomy
- Oral Nasal Suctioning
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Reporting
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Contact Info 121 N. Beaudry Ave.,
Los Angeles, CA 90012
P: (213) 202-7580
F: (213) 580-6557
E: DistrictNursing@lausd.netDirector:
Sosse Bedrossian, MSN, MA, RN, FNP-C
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Quick Links
