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Schools, Rules and Diabetes Benita Lopez-Baca, RN, BSN, CDE Kathleen Patrick, RN, MA, NCSN R. Paul Wadwa, MD The ADA Position Statement • Defines federal laws protecting children with diabetes • Provides guidelines for children in school and day care settings • The ADA advocates and supports the rights of children and families with diabetes What are other states doing? Safe at School in Virginia In 1999 Virginia passed a state law requiring non-medical personnel to assist students at school with their diabetes management. Hellems, M and Clarke, W. Safe at School: The Virginia Experience. Diabetes Care. 2007. Who trains the school personnel? • 63% by school nurse • 35% by a parent • 15% by a diabetes specialist Where does the child do blood testing? • 49% tested in the classroom -41% of elementary, 28% middle school, and 74% of high school students 92% of parents were satisfied with the child’s diabetes care at school Hellems, M and Clarke, W. Safe at School: The Virginia Experience. What is Happening with Diabetes Care in Colorado Schools? Diabetes Care in Colorado Schools Collaborative • Stakeholders began meeting in 2005 • Members included Schools, Parents, Healthcare Providers, Community agencies • Four Task Forces: – Guiding Principals – School Nurse Forms & Tools – Parent Toolkit – Diabetes Resource Nurse Program Accomplishment #1 Guiding Principles: Standards and guidelines for safe management of children with diabetes in schools Guiding Principles • Recognizes all students with chronic health conditions • Essential collaboration of student, school, healthcare provider and home • Schools need to provide sufficient resources • School nurse plans and implements care Accomplishment #2 School Nurse Toolkit: Standardization of forms to ensure consistency throughout the state and between healthcare providers School Nurse Checklist Training & Delegation #500 – Diabetes Management in Schools and Child Care Instructor Guide #501 – Glucose Monitoring Skills Checklist #502 – Urine Ketone Monitoring Skills Checklist #503 – Hypoglycemia Skills Checklist #504 – Glucagon Skills Checklist #505 – Hyperglycemia Skills Checklist #506 – Insulin Pen Skills Checklist #507 - Insulin Pump Skills Checklist #508 – Insulin Syringe Skills Checklist #509 – Insulin Syringe Combination Skills Checklist #510 – Continuous Glucose Monitoring in the Schools Instructions for #600 Delegation & Supervision of Diabetes Care Tasks #600 – Delegation Agreement & Supervision for Diabetes Care Tasks Accomplishment #3 Parent and School Toolkit – Clarify roles and responsibilities of school and parent – Provide quick reference guide for teachers, bus drivers, and other school personnel who are responsible for student with diabetes Parent & School Toolkit Help a Child! Know the Symptoms! Before You Begin a New School Year Parent Letter to Teacher with Photo Low Blood Sugar Lunchbox Card Low/High Blood Sugar Hand Information to help TEACH my Child – Impact to Learning Field Trip Considerations Parties and Snacks Psycho-Social Aspects Developmental Stages and Diabetes Management FAQ’s Glossary Resources Accomplishment #4 Diabetes Resource Nurse Program Colorado Diabetes Resource Nurse Nurse Consultants with expertise in diabetes, staff development and problem solving who serve as resources for schools throughout Colorado PURPOSE • Assure the safety of Colorado’s children with type 1 diabetes within the school community. • Create a standard of best practice in the state in the management of children with diabetes in the school. Responsibilities of Diabetes Resource Nurse • Consult with district school nurses, administrators, & other staff • Assist with development of healthcare plans & 504 plans • Provide resources & evidence based training • Troubleshoot individual problems • Collaborate to ensure standardized care and best practice • Note: does not provide individual care Board of Nursing “to protect the people of this state from the unauthorized, unqualified, and improper application of services by individuals in the practice of nursing” Role of BON is to determine if the practice meets the standards established by the Nurse Practice Act Nurse Practice Act State law that licenses and regulates the practice of nursing Delegation “The transfer of responsibility for the performance of an activity to another, with the former retaining accountability for the outcome.” ANA, 1994 Delegation • Only a registered nurse can delegate • Only activities that do not require nursing assessment and/or judgment • Delegation limited to: – to a specific delegatee – for a specific task – for a specific student – within a specific time frame Bottom line… The health, safety and welfare of the student is the primary consideration in any decision to delegate New Rules to Chapter XIII • Section 8: Delegation of insulin and glucagon in the school setting and childcare • IHP must be developed by the school nurse • Routine injections may be delegated according to IHP & after appropriate training • Non-routine dosages must be verified by school nurse or parent according to IHP New Diabetes Website www.coloradokidswithdiabetes.org Discussion and Case Studies Teddy • 10 years old and diagnosed last week with Diabetes Mellitus probably Type 1 Discussion • Is it appropriate to delegate a correction insulin dose based on blood glucose? • Is it appropriate to delegate the calculation of a carb/insulin ratio insulin dose? Luis • 12 years old • Diagnosed with Autism Spectrum Disorder at 4 years of age • Diagnosed with type 1 diabetes at 9 years of age • Poor verbal communication skills Discussion • The school nurse does not have any experience with glucagon and is hesitant to delegate what should she/he do? Billy • 9 ½ years old • Diagnosed with diabetes more than a year ago • Re-enrolled in school after living with mother out of state for a year • Can do pokes and shots on his own Discussion What steps can be taken to address this issue? Dad has a Can the School Nurse change of heart request a 504? about obtaining What safety measures Medical Orders for Billy can be put in place until the concerns are resolved? Discussion Can a CO RN delegate a nursing task from medical orders from another state? What nursing care tasks can be provided in the absence of current medical orders? What steps can be taken to address this issue? Can the School Nurse request a 504? What safety measures for Billy can be put in place until the concerns are resolved? Opie • 6 years old • Diagnosed with type 1 DM at 27 months old • Started using insulin pump at beginning of this school year • Can do own finger pokes • Needs help with other care tasks Discussion • Describe nursing actions in the supervision of the teacher and the school secretary. • Is it necessary for the nurse to document the supervision? • How often would the nurse need to supervise the delegated tasks? NDEP - Helping the Student with Diabetes Succeed Section 1 Diabetes Primer for School Personnel Diabetes Care Tasks at School: What Key Personnel Need to Know DIABETES BASICS BLOOD GLUCOSE MONITORING HYPOGLYCEMIA/HYPERGLYCEMIA INSULIN KETONE MONITORING NUTRITION & EXERCISE LEGAL CONSIDERATIONS GLUCAGON ADMINISTRATION Contact information: Kathleen Patrick RN, MA, NCSN Principal Consultant, School Health Services Colorado Department of Education 303-866-6779 firstname.lastname@example.org Benita Lopez-Baca, RN, BSN, CDE Barbara Davis Center email@example.com R. Paul Wadwa, MD Barbara Davis Center 303-724-2323 paul.wadwa uchsc.edu Self Care •Should be a team decision •Must be determined that the student is capable Insulin Pump •Can delegate routine meal boluses •Non-routine doses require verification by nurse or parent according to IHP Diabetes Resource Nurses – Currently 26 nurses – 16 District DRN • Metro-area or larger districts. – 10 Regional DRN • Serves several counties or districts. • Rural and small districts. Requirements for DRN • Minimum five years experience as a school nurse or public health nurse. • Evidence of experience providing care to individuals with diabetes. • Bachelor of Science degree – preferably in Nursing.
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