DIABETES PROCEDURE Objective: To provide procedure and protocols to ensure a safe environment and the safe delivery of nursing care at school for the student with diabetes by coordinating care with the parent, nurse and unlicensed diabetic care assistant (UDCA). (FFAF Legal; H&S Code 168; HB 984; Texas DSHS Guidelines for Training School Employees who are not Licensed Healthcare Professionals to implement House Bill 984 [79 th Legislative Session] related to the Care of Elementary and Secondary School Students with Diabetes, 2005) Implementation Parent Care of a student with diabetes is dependent on the collaboration of the school and the parents. (H&S 168.002) Informs school nurse that student has diabetes Provides the diabetes management treatment plan(dmtp) from the health care provider Provides and maintains supplies and equipment for care of student at school Completes, signs and returns all forms required for care of the student Provides updated information as appropriate for the student s care Principal The principal s role is to select from school employees, an individual for training to provide the required care for the student with diabetes. This is done with the assistance of the school nurse. (H&S 168.004) At each school in which a student with diabetes is enrolled, the Principal is responsible for making certain that unlicensed, non-healthcare employees are selected and trained to provide appropriate care for the student with diabetes. These trained employees will be referred to as the Unlicensed Diabetes Care Assistant (UDCA). The UDCA will serve under the supervision of the principal. o At least one UDCA is required - if a full-time nurse is assigned to a school o At least three UDCA are required - if a full-time nurse is not assigned to a school 1
School Nurse The Campus Registered Nurse (RN) coordinates care for the student with diabetes between the classroom, clinic and home environments. The campus RN assists the student when needed, with care to ensure safety and a quick return to the learning environment. The ultimate goal of caring for the student with diabetes is to support and teach the student in the move toward self-care as appropriate to the student s developmental level. (H&S 168.005) Identify students with diabetes on campus. Obtain DMTP from parents. Discuss current health status and management of diabetes care with parent. Discuss the supplies/equipment that the parent provides for the student at school Assist Principal with identification of staff for designation as an UDCA. Assure Principal Designees for Unlicensed Diabetes Care Assistants form is completed by the Principal at the beginning of each school year. Discuss the training and the role of the UDCA with the parent. Obtain signed authorization for this supportive care, if not indicated on the student s DMTP Develop Individual Health Plan (IHP) with parents/student (H&S 168.003) Refer the student to the Student Support Team (SST) to evaluate and determine 504 eligibility. Provide education to staff at appropriate information level. Provide supervision and re-training of UDCA during the school year and annually in each year. Unlicensed Diabetes Care Assistant (UDCA) The UDCA is an unlicensed, non-healthcare staff member that has been selected to assist the student with diabetes at the campus when needed. Selection Criteria for the UDCA: Aptitude to learn a technical skill, i.e. injections, insulin pump, glucose testing with glucometer and ketone testing Ability to communicate with parents/teachers/student Ability to think and act calmly in an emergency situation Has a schedule in school that enables them to be readily accessible Generally on the campus during the school day Willing to learn about diabetes Willing to perform tasks associated with the student s DMTP and the IHP TRAINING Qualifications of trainer of UDCA (FFAF Legal) Must be a school nurse (RN) or a healthcare professional with expertise in the care of persons with diabetes. Content of the training must meet the mandates of H&S Code Chapter 168 and HB 984 and provide current knowledge and information. 2
Parameters of the Training Program It is recommended that the training of an UDCA must be at least 2 hours in length. The trained UDCA must be evaluated to show competency to perform the required basic diabetes care skills. Review of didactic information and skills will be performed at least annually. o Competency must be maintained through a review of skills and by the provision of opportunities to care for students with diabetes under the supervision of the campus RN. o The campus RN will periodically review and observe demonstration of skills. Review/return demonstration will be documented on the appropriate District skills/competency verification checklist. o All designation and training documentation will be retained in each campus clinic. o Current UDCA Principal Designation form will be kept on file in the clinic. o Retain previous UDCA Principal Designation forms for a minimum of three years. As per H&S 168.005 and HB 984, Unlicensed Diabetes Care Assistants (UDCA) must receive training to be able to: Recognize the symptoms of hypoglycemia/hyperglycemia Understand the proper action to take if the blood glucose levels of a student with diabetes are outside the target ranges, indicated by the student s individualized health plan Perform finger-sticks to check blood glucose levels and record results Check urine ketone levels and record results Properly administer injections of glucagon or insulin and record the results of the administration Recognize complications that require emergency assistance Understand the recommended schedules and food intake for meals/snacks for a student with diabetes Understand the effects of physical activity on blood glucose levels Understand the proper actions to take if the student s schedule is disrupted Training will be divided into three (3) levels, as follows: Level I- DISTRICT-WIDE INFORMATION Basic information on diabetes can be provided to all personnel within a school district to increase the knowledge level and raise awareness regarding diabetes. Person responsible: Coordinator of Health Services will distribute diabetic education information to the district via the school nurses or District professional development resources 3
(Eduphoria, in-district link to Salus multimedia course, Region 10 ESC, SafeSchools or other District-approved method). School nurse will reinforce general information to staff members on campus. Level II NEED TO KNOW This level of employee is associated with the student with diabetes, but is not designated as the UDCA. These employees will be given Level I information and Level II need to know information about diabetes. Person responsible: School nurse (RN) at individual campuses will identify and educate the staff members at this level. A review of the IHP, The DMTP and a copy of a Level II Emergency Plan will be given to the following staff members: o The regular bus driver will be given Level I information and Level II need to know information about diabetes and is to be provided with a copy of Transportation/Bus Driver Emergency Plan for Students with Diabetes. o A sponsor/supervisor who is supervising a student with diabetes during off-campus activities requires Level I information and Level II need to know information about diabetes and is provided with a one page Off- Campus Activity Sponsor Emergency Plan for Students with Diabetes. This staff member will be provided with a copy of the student s IHP and the DMTP from the physician for the off-campus activity. Level III- UDCA This level of training is provided to one or more employees that have been designated by the principal to serve as the UDCA on the campus. This training may be provided to the principal, assistant principal, office staff, coach, trainer, sponsor, and/or the teacher of the student with diabetes. Training includes the basic and individualized care that will be provided to the identified student with diabetes either by the campus nurse or by a UDCA when the nurse is not available on campus and at school sponsored activities. This training will address nutrition, exercise, blood glucose testing, ketone testing and administration of glucose gel, glucagon and insulin. Persons responsible for training: Coordinator of Health Services District level courses (didactic and basic skills) will be provided by the Coordinator of Health Services. Campus RNs will provide Level III training to their campus who are unable to attend a scheduled district course. Approved training resources are: 4
Diabetes Care at School: Bridging the Gap multimedia course (Salus Education) Diabetes Care Tasks at School: What Key Personnel Need to Know PowerPoint presentation (National Diabetes Education Program) Helping Administer to the Needs of the Student with Diabetes in School (H.A.N.D.S) continuing education for school nurses (NASN) Texas Diabetes Council Tool Kit and Department of State Health Services School Health Manual Basic skills demonstrations will be documented on District skills/competency verification checklists and returned to each campus RN o Blood Glucose Testing o Glucagon Administration o Insulin Administration-Syringe o Insulin Pen o Urine Ketones Testing School Nurse Individualized training for each student s needs as outlined in their DMTP. o Review each student s DMTP and IHP; o Review and provide hands-on training for each student s supplies and equipment Skills/competency verification checklists will be continued or initiated. Periodic review of competency will be performed throughout the school year and will be documented on the appropriate skills/competency verification checklist. o Blood Glucose Testing o Glucagon Administration o Insulin Administration-Syringe o Insulin Pen o Urine Ketones Testing o Insulin Pump Skills are reviewed, demonstrated and return demonstration to school nurse by the Level IIIA staff member. This will be done for each student with diabetes. 5