Nursing Services for Students with Diabetes Procedure (HEA-P102)

Transcription

1 1.0 SCOPE: 1.1 This procedure describes the process in which Student Health Services implements the provision of nursing services and health management for students with diabetes. 2.0 RESPONSIBILITY: 2.1 Director, Student Health Services Department 3.0 APPROVAL AUTHORITY: The online version of this procedure is official. Therefore, all printed versions of this document are unofficial copies. 3.1 Director, Student Health Services Department or designee. 4.0 DEFINITIONS: 4.1 AHCP Authorized Health Care Provider (Approval signature on file) Signature 4.2 CA Clinical Aide 4.3 EMS Emergency Medical Services 4.4 HCP Health Care Plan 4.5 NAC Nevada Administrative Code 4.6 Non-routine Blood Glucose Correction Insulin prescribed to reduce an unexpectedly high blood glucose level. 4.7 Non-routine Insulin-to-Carbohydrate Coverage - Insulin prescribed for food consumed in addition to the student s daily meal or snack schedule. 4.8 NRS Nevada Revised Statutes 4.9 Nursing Intervention(s) a delegable or non-delegable nursing action or actions prescribed by the physician and implemented to increase an abnormally low or decrease an abnormally high blood glucose level Routine Blood Glucose Correction Insulin prescribed for administration at predetermined meal or snack times, based upon the student s glucose level Routine Insulin-to-Carbohydrate Coverage Insulin prescribed for administration at predetermined meal or snack times, based on the total number of carbohydrates consumed UAP (Unlicensed Assistive Personnel) a WCSD employee whom the Nurse determines is competent and qualified to provide specified nursing services to an individual student WCSD Washoe County District : 06/04/2013, Rev F HEA-P102 Page 1 of 7

2 5.0 PROCEDURE: 5.1 The WCSD Student Health Services Department promotes and facilitates educational opportunities for students who, as a result of health conditions or disabilities such as diabetes, require nursing services and/or health management while attending WCSD schools or while participating in school-sponsored activities. 5.2 Nursing services and health management for the student with diabetes will be provided within established parameters of safe and prudent standards of nursing care, with the objective of having the student fully participate in all educational and school-sponsored activities to the maximum extent possible. 5.3 Students with diabetes will be supported to actively participate in self-care and disease management. 5.4 In providing and managing appropriate nursing and health services for students with diabetes, Nurses, CA s, and all other school personnel will comply with the provisions of the Nevada Nurse Practice Act: NRS 632 & NAC 632; the Nevada Board of Nursing Nurse Regulation and Advisory opinion; Health and Welfare (HEA- P007); Management of Illnesses and Injuries at (HEA-M500); Assisting Students with Medication (HEA-P200), Assisting Students with Diabetes Care, (HEA- W100), and all WCSD policies and procedures Nursing services and/or health management for students with diabetes includes, but is not limited to: carbohydrate calculations; calculation of insulin-tocarbohydrate ratios; insulin verification and/or injection; ketone testing; and glucose testing and/or monitoring. 5.5 The parent/guardian is responsible for providing all required WCSD forms, student medication(s), and equipment/supplies for the student s diabetes care including, but not limited to: carbohydrate-containing snacks; insulin, blood glucose monitors; lancet devices and lancets; testing strips; and syringes In order for any student to receive assistance from school personnel in nonemergency diabetes management or care, there must be on file in the school health office a completed Licensed Health Care Provider Diabetes Orders form (HEA-F121) signed by a physician or AHCP and the student s parent or guardian. 5.6 Parameters for safe and prudent standards of nursing care for students with diabetes include, but are not limited to the following: Blood glucose level will be determined using a glucometer provided and calibrated by the parent/guardian For the purposes of ensuring the health and safety of students with diabetes in the school setting or during school-sponsored activities, a low blood glucose level is defined as a glucometer reading of less than 75 and a high blood glucose level is defined as a glucometer reading of greater than The physician or AHCP may set a more restrictive but not less restrictive range for defining normal blood glucose levels for an individual student. : 06/04/2013, Rev F HEA-P102 Page 2 of 7

3 The parent will always be contacted if the student s blood sugar is high or low, or if the student is symptomatic A student s blood glucose level must be checked prior to administration of insulin, prior to breakfast/lunch/dinner diabetes care, and/or anytime the student is symptomatic Blood or urine ketones must be checked for any student with a high blood glucose level Insulin may be administered as a routine or non-routine blood glucose correction or as routine or non-routine insulin-to-carbohydrate coverage Insulin doses administered for blood glucose correction must be spaced at least two hours apart If a blood glucose correction is administered less than two hours before mealtime, insulin is to be administered as ordered to cover mealtime carbohydrates; the blood glucose correction dose of insulin is to be postponed until at least 2 hours after the non-routine dose was administered Insulin doses administered for routine or non-routine carbohydrate coverage may be spaced less than 2 hours apart In cases where the calculated injectable (non-pump) insulin dose is a fraction of the units measurable in the syringe, the insulin dose will always be rounded down to nearest measurable dose If student has an insulin pump, fractions of a unit may be indicated and administered accordingly It is solely within the purview of the physician or AHCP to direct and prescribe specific medication(s) or treatment(s) appropriate to stabilizing and maintaining acceptable blood glucose levels It is solely within the purview of the school nurse to establish a safe plan of diabetes care and to authorize the exclusion of a student for health and safety reasons on a case-by-case basis when the student s nursing services or health management cannot be safely carried out in the school environment or during school-sponsored activities A student who is excluded by the school nurse for health and safety reasons will require immediate parent/guardian pick-up and may not return for the remainder of the day If upon the arrival of the parent, the student s blood glucose has returned to normal levels, the student will be excluded for the remainder of the school day A student who is excluded by the nurse for health and safety reasons may attend school the following day based on a parent report that the : 06/04/2013, Rev F HEA-P102 Page 3 of 7

4 student has been asymptomatic and that his/her blood glucose levels have remained within the normal range EMS will be called for any student who, in the professional judgment of the school nurse, is experiencing a potentially life-threatening diabetes emergency The parent/guardian will be called for immediate pick up if the student s glucometer reads high, low, or error with two consecutive checks of the blood glucose level With specific doctor s orders, insulin may be given if the glucometer reads HI on two consecutive glucometer readings, provided the student is asymptomatic and the parent or guardian is en route The student who does not have a glucometer, test strips, ketone strips, or other equipment/supplies necessary to provide diabetes management will require immediate parent/guardian pick up. 5.7 The student who requires more than one unscheduled dose of insulin during the school day to correct high blood glucose levels will require immediate parent/guardian pick up. 5.8 A student with a high glucose level AND moderate or severe symptoms will require immediate parent/guardian pick up. 5.9 A student with a high blood glucose level AND moderate or large urine ketones/blood ketones 0.6 or greater, will require immediate parent/guardian pick up EMS will be called for a student who is symptomatic AND has a high blood glucose level AND large urine ketones/blood ketones above A student who continues to have a low glucose level after two nursing interventions will require immediate parent/guardian pick up Routine Blood Glucose Correction and Insulin-to-Carbohydrate Coverage will be delayed for the student with low blood glucose until prescribed interventions are successful at raising the student s blood glucose to a normal level Once the student s blood glucose level has increased to normal, Routine Blood Glucose Correction and Routine Insulin-to-carbohydrate Coverage will be implemented With a physician s order, units of insulin administered for carbohydrate coverage may be subtracted in situations where the student has experienced a low blood glucose level Administration of insulin or other diabetes medications prescribed by the student s physician or AHCP must be managed and administered by school personnel in accordance with policies and procedures noted on Assisting Students with Medication (HEA-P200) and Assisting Students with Diabetes Care (HEA- W100) The Nurse is responsible for developing a written diabetes HCP and, if appropriate, a Diabetes Delegation Plan (HEA-F133) for the student with diabetes. : 06/04/2013, Rev F HEA-P102 Page 4 of 7

5 5.14 The Nurse is responsible for distributing the Diabetes Delegation Plan (HEA- F133) and the Diabetes HCP to the CA, UAP s and other appropriate school personnel and for ensuring their competence in carrying out the provisions of the plans In cases where the parent/guardian has not submitted the completed Licensed Health Care Provider Diabetes Orders form (HEA-F121), the Nurse may not perform or delegate diabetes procedures or management The parent/guardian of a student who requires diabetes care during school hours, but who has not submitted orders from a physician or AHCP for the student s nursing care or management may, in accordance with the provisions of the Nevada Board of Nursing Nurse Regulation and Advisory Opinion, provide or designate a non-schoolemployee to provide the student s diabetes care routine diabetes care and/or medication assistance for their child until orders are received Diabetes management or care provided to the student by his or her parent or guardian does not preclude the exclusion of the student by the school nurse if the student s health status meets the established criteria for exclusion In the absence of the required forms the Nurse will develop and train appropriate school staff in an emergency only diabetes HCP which directs appropriate emergency actions and rescue efforts, as outlined in Code Blue Response on Sites (HEA- P301); Health and Welfare Procedure (HEA-P007); and Management of Illnesses and Injuries at (HEA-M500) As stated in the Nevada Nurse Practice Act, NRS and NAC 632, it is solely within the purview of the Nurse to determine what, if any, aspects of the student s diabetes care and/or management can be delegated to the clinical aide or other UAP Parents/guardians may not delegate or train school personnel in the provision of diabetes care CA s and other school personnel must at all times follow the Nurse s written HCP in providing diabetes care to students In accordance with NRS and NAC 632, the Nevada Nurse Practice Act, only school personnel trained and assigned or delegated to do so by the Nurse may provide nursing services to a student with diabetes or assist a student with diabetes care While UAP s, including the CA, may perform tasks as directed and delegated by the Nurse, they are not qualified to carry out assessments of students with diabetes; make complex decisions regarding the student s nursing management; or deviate from the Nurse s written plan of care The CA or UAP must contact the Nurse for all parent/guardian requests for changes to the established HCP or Diabetes Delegation Plan (HEA-F133) In situations where the student exhibits unexpected symptoms that are outside of the parameters and actions identified by the Nurse in the student s diabetes HCP or the Diabetes Delegation Plan (HEA-F133), the CA or UAP is to immediately contact the Nurse or the Student Health Services Department for further instructions As stated in Health and Welfare, (HEA-P007, 5.7.3), Parent(s) or guardian(s) are primarily responsible for the transport and welfare of their student. If, in the professional : 06/04/2013, Rev F HEA-P102 Page 5 of 7

6 judgment of the Nurse, the student s medical or health condition is not lifethreatening but is unpredictable or unstable, the student will remain under close, continual supervision of school personnel and only be released to the parent, guardian, or designee In cases where a physician s or AHCP s orders for nursing services and/or health management of the student are not in compliance with WCSD policies or best practice standards of nursing care, the Nurse will notify the student s parent/guardian, prescribing physician/ahcp, and the Director, Student Health Services or designee that the orders cannot be implemented After informing the student s parent/guardian, prescribing physician or AHCP, and the Director, Student Health Services or designee that the orders cannot be implemented, the Nurse will document his/her nursing actions on the Student Permanent Health Record (HEA-F300) In situations where, for safety reasons noted above, the Nurse cannot implement a physician s or AHCP s orders, she/he will develop a safe, alternative HCP for the student. 6.0 ASSOCIATED DOCUMENTS: 6.1 Assisting Students with Diabetes Care (HEA-W100) 6.2 Assisting Students with Medication (HEA-P200) 6.3 Code Blue Response on Sites (HEA-P301) 6.4 Consent & Request for Medication Assistance During Hours (HEA-F205) 6.5 Diabetes Delegation Plan (HEA-F133) 6.6 Health and Welfare (HEA-P007) 6.7 Licensed Health Care Provider Diabetes Orders (HEA-F121) 6.8 The Management of Illness and Injuries at (HEA-M500). 6.9 Nevada Nurse Practice Act: NAC & NRS Nevada Nurse Regulation and Advisory Opinion 20opinion.htm 6.11 Student Permanent Health Record (HEA-F300) : 06/04/2013, Rev F HEA-P102 Page 6 of 7

7 7.0 RECORD RETENTION TABLE: Nursing Services for Students with Diabetes Identification Storage Retention Disposition Protection Consent & Request for Medication Assistance During Hours Student Diabetes Delegation Plan Student Licensed Health Care Provider Diabetes Orders Student Permanent Health Record Name of Record Student Student Where is it stored? How long do you keep it? Discard as desired How the document is protected from loss or damage. 8.0 REVISION HISTORY: : Rev. Description of Revision: 7/15/2009 A Initial Release 6/10/2010 B Procedure was completely re-written and revised 5/9/2011 C Re-word prescribed for administration in 4.3, 4.4, 4.9 and /6/2012 D Corrected spelling 4/22/2013 E removed non-routine, 5.11 replaced with with who continues to have symptoms & removed who has symptoms 6/04/2013 F Alphabetized 4.0, added dinner, added ***End of procedure*** : 06/04/2013, Rev F HEA-P102 Page 7 of 7