Lopez-Baca Wadwa Patrick

8/8/2019 Lopez-Baca Wadwa Patrick

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Schools, Rules and Diabetes

Benita Lopez-Baca, RN, BSN, CDEKathleen Patrick, RN, MA, NCSN

R. Paul Wadwa, MD


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The ADA Position Statement

Defines federal laws

protecting children with

diabetes

Provides guidelines forchildren in school and day

care settings

The ADA advocates and

supports the rights ofchildren and families with

diabetes


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What are other states doing?

Safe at School in Virginia

In 1999 Virginia passed a state law

requiring non-medical personnel toassist students at school with their

diabetes management.

Hellems, M and Clarke, W. Safe at School: The Virginia Experience.

Diabetes Care. 2007.


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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 highschool students

92% of parents were satisfied with the childs diabetes careat school

Hellems, M and Clarke, W. Safe at School: The Virginia Experience.


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What is Happening

with Diabetes Care inColorado Schools?


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Diabetes Care in

Colorado Schools Collaborative Stakeholders began meeting in 2005

Members included Schools, Parents,

Healthcare Providers, Communityagencies

Four Task Forces:

Guiding Principals

School Nurse Forms & Tools

Parent Toolkit

Diabetes Resource Nurse Program


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Accomplishment #1

Guiding Principles: Standards and

guidelines for safe management

of children with diabetes in

schools


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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


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Accomplishment #2

School Nurse Toolkit: Standardization

of forms to ensure consistencythroughout the state and between

healthcare providers


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School Nurse ChecklistTraining & Delegation

#500 Diabetes Management inSchools and Child Care Instructor Guide

#501 Glucose Monitoring SkillsChecklist

#502 Urine Ketone Monitoring SkillsChecklist

#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


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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


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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

FAQs

Glossary

Resources

Parent &

School Toolkit


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Accomplishment #4

Diabetes Resource NurseProgram


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ColoradoDiabetes Resource Nurse

Nurse Consultants with expertise indiabetes, staff development andproblem solving who serve as

resources for schools throughoutColorado


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PURPOSE

Assure the safety of Colorados

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.


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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


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Board of Nursing

to protect the people of this state from the

unauthorized, unqualified, and improper

application of services by individuals in thepractice of nursing

Role of BON is to determine if the practicemeets the standards established by the

Nurse Practice Act


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Nurse Practice Act

State law that licenses and

regulates the practice of nursing


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Delegation

The transfer of responsibility for theperformance of an activity to another,

with the former retaining accountability

for the outcome.

ANA, 1994


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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


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Bottom line

The health, safety and welfare

of the student is the primary

consideration in any decision

to delegate


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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


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New DiabetesW

ebsite

www.coloradokidswithdiabetes.org


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Discussion and

Case Studies


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Teddy

10 years old and

diagnosed last week

with Diabetes Mellitus

probably Type 1


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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?


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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


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The school nurse does not have

any experience with glucagon and

is hesitant to delegate what shouldshe/he do?

Discussion


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Billy 9 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


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Discussion

What steps can be

taken to address this

issue?

Can the School Nurserequest a 504?

What safety measures

for Billy can be put in

place until theconcerns are

resolved?

Dad has a

change of heartabout obtaining

Medical Orders


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DiscussionCan 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 placeuntil the concerns are resolved?


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Opie 6 years old

Diagnosed with type 1

DM at 27 months old

Started using insulinpump at beginning of

this school year

Can do own finger

pokes Needs help with other

care tasks


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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?


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NDEP - Helping the Student with

Diabetes Succeed

Section 1 Diabetes Primer for School Personnel


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Diabetes Care Tasks at School:Diabetes Care Tasks at School:What Key PersonnelWhat Key Personnel

Need to KnowNeed to Know

Diabetes Care Tasks at School:Diabetes Care Tasks at School:What Key PersonnelWhat Key Personnel

Need to KnowNeed to KnowDIABETES BASICSDIABETES BASICS

BLOOD GLUCOSE MONITORINGBLOOD GLUCOSE MONITORING

LEGAL CONSIDERATIONSLEGAL CONSIDERATIONS

HYPOGLYCEMIA/HYPERGLYCEMIAHYPOGLYCEMIA/HYPERGLYCEMIA

KETONE MONITORINGKETONE MONITORING NUTRITION & EXERCISENUTRITION & EXERCISE

INSULININSULIN

GLUCAGON ADMINISTRATIONGLUCAGON ADMINISTRATION


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Contact information:

Kathleen Patrick RN, MA, NCSN

Principal Consultant, School Health Services

Colorado Department of Education

303-866-6779

[email protected]

Benita Lopez-Baca, RN, BSN, CDE

Barbara Davis Center

[email protected]

R. Paul Wadwa, MD

Barbara Davis Center

303-724-2323

paul.wadwa uchsc.edu


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Self CareShould be a team decision

Must be determined that the student is capable

Insulin Pump

Can delegate routine meal bolusesNon-routine doses require verification by

nurse or parent according to IHP


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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.


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Requirements for DRN

Minimum five years experience as a

school nurse or public health nurse.

Evidence of experience providing care toindividuals with diabetes.

Bachelor of Science degree preferably in

Nursing.

Lopez-Baca Wadwa Patrick

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