Procedures For Students With Diabetes
Students with diabetes may require special accommodations while attending school. Florida Statute 385.203 was amended to include new provisions affecting students with diabetes in Florida public schools. Schools are prohibited from restricting the assignment of a student who has diabetes to a particular school on the basis that the student has diabetes, that the school does not have a full-time nurse, or that the school does not have trained diabetes personnel. Students with diabetes whose parent and physician provide written authorization to the school principal may carry diabetic supplies and equipment on their person and attend to the management and care of their diabetes while at school, participating in school-sponsored activities, or in transit to or from school. Schools are responsible for putting safeguards in place.
The well being of a student with diabetes involves a collaborative relationship among the health care provider, the school and the home. The student’s family and the health care team are responsible for the medical management and should contribute information for the health care plan. The school should be responsible for assuring the services needed to implement the plan of care, are provided by persons specifically trained to provide the needed services while preserving the safety of the student. The school district and its administrator should be familiar with the school issues and responsibilities associated with students with diabetes and assure consistent care through district-wide policies.
ROLES & RESPONSIBILITIES
The Principal/designee should arrange a meeting with all involved school personnel including the student’s teachers, the assigned school nurse (if applicable), school social worker (if applicable) and the student’s parent/guardian the beginning of each school year for known diabetic students or when a student is newly diagnosed with diabetes.
The purpose of this meeting is to discuss how the staff will manage any emergencies, any change in the student’s health status or any health related information necessary to assist the student during the school hours. This discussion may include, self-administration of insulin, glucose monitoring, and emergency care.
All involved teachers, substitutes, specials teachers, teachers assistance, cafeteria staff and bus drivers should be informed of the student’s diagnosis and any physical limitations. It is necessary for all involved staff to receive training regarding diabetes. The principal/designee should develop a plan as to how the health information will be conveyed to substitute teachers.
The school 504 liaison may consider the need for the development of a 504 plan. Assistance is available from the designated health care professional. The principal may contact Psychological Services or Coordinated Student Health Services for assistance with this process.
Principals should also request a “sharps box” from the Risk Management Department. A sharps box is needed to properly dispose of used needless when a diabetic student is testing his/her glucose level or after administering insulin. The principal should arrange an in-service through Risk Management regarding the proper use of the sharp box, its proper storage, and location and pick-up requirements.
School Health Personnel
The Coordinated Student Health Services Department will review the current Diabetes Authorization for Medication/Treatment Authorization form to determine the appropriate level of care and the number of hours per day that a student requires trained personnel to provide/assist in the management of their diabetic needs at school. The school health personnel (on-site nurse, supervising nurse for a health support technician, or on-call nurse) should function under the scope of practice defined by Florida Nurse Practice Act. The school nurse may be the only full or part-time licensed health care professional in the school setting. When the school nurse is assigned to multiple schools, the nurse should recognize the need to set students with diabetes as a high priority whenever part or all of their care is delegated to Trained School Personnel, to insure the safety of the students, the school nurse should:
- Obtain and maintain a current knowledge base and update skills and abilities related to the medical management of diabetes in the school-age population included in this knowledge relating to the current standard of care prevalent in the community.
- Organize and facilitate planning meetings with the student’s parent/guardian and other key school staff to discuss planning and implementation of the student’s individualized health care plan.
- Perform a nursing assessment on the student based on a home or school health room visit to obtain health and psychosocial information.
- Develop an individualized health care plan in cooperation with the student, the parents/guardians, the health care provider, and other school-based staff.
- Regularly review and update the individualized health care plan whenever there is a change in medical management or the student’s response to care.
- If necessary, request the health care provider to re-evaluate the student’s competency level to further enhance the student’s independence or, if necessary, to require closer supervision until the student’s knowledge and skills improve.
- Collaborate with the principal to select and delegate the most appropriate Trained School Personnel for each student. Train and supervise the Trained School Personnel specific procedures for the student with diabetes. It is recommended that two or more back-up persons be trained in each school to assure adequate coverage in an emergency.
- Practice universal precautions and infection control procedures with all student encounters and include information in the training for all Trained School Personnel.
- Trained and supervise Trained School Personnel who can serve as a second adult to verify any dose of insulin administered in the schools.
- Provide or arrange for child-specific training to all school-based personnel who will have direct contact with the student on how to respond in an emergency.
- Maintain appropriate documentation of the training and care provided and monitor the documentation of services provided by Trained School Personnel.
- Act as a resource to the principal and other school-based personnel, providing or arranging for in-service education appropriate to their level of involvement with the students with diabetes and provide diabetes resource materials for use by school personnel.
Teacher/Coaches and Before and After School Program Staff
Teachers and Coaches should provide a supportive learning environment and treat the student with diabetes the same as any other student while at the same time making the required accommodations. Not all teachers or coaches in the school will have direct contact with the student, they should:
- Be aware of which students have diabetes and cooperate with the accommodation listed in the Healthcare plan or 504 Plan.
- Attend the diabetes in-service and be able to recognize the signs and symptoms associated with hyperglycemia/hypoglycemia.
- Be aware of any student-specific emergency actions that might be necessary.
- Provide the student with a safe location to monitor blood glucose or administer insulin in accordance with the students care plan.
- Be sure that blood glucose levels are monitored before exercise or strenuous activity to allow for snacks before and after the physical activity if indicated on the care plan.
- Understand that accommodations may be necessary even during standardized testing periods.
- Respect the student’s rights to confidentiality and privacy.
- With parents/guardians and the student’s permission, the teachers or the school nurse may educate the class about diabetes and use this as an opportunity to educate students regarding nutrition, exercise, and health.
School Counselor/Social Worker
The school counselor and or social worker should be aware of the students in their schools who have diabetes and the potential impact of diabetes and its treatment on the student’s behavior and performance. The social worker should be prepared to work with the school health personnel and to assure that the necessary accommodations are made to comply with state and federal laws.
The school counselors or social worker may be called upon to assist the student with any expressed concerns regarding diabetes and to identify and respond to ineffective coping mechanism demonstrated by the student or the family as they relate to school performance and attendance. The school counsel or/social worker should be familiar with community resources and services available to assist the student and family.
Food and Nutrition Services
It is the parent/guardian’s responsibility to supply the student with the necessary snacks to maintain the appropriate blood glucose levels. It may also be necessary to have emergency snacks available. The nutrition services manager should work with a dietitian to make available to the students, and/or health personnel, the carbohydrate count for the school lunch menu so that parents/guardians can assist with meal planning. This nutritional information can be found on the BCPS Food and Nutrition Services Department website at www.browardschools.com. The nutrition services managers should attend the diabetes in-services.
The bus drivers will have contact with the students at the beginning and end of the school day. They should be aware that morning without breakfast or late afternoons are often the times that low blood glucose episodes occur. The bus drivers should:
- Be aware of which students have diabetes.
- Be aware of the emergency response appropriate to each student to carry the appropriate snacks or equipment for emergency to each student to carry the appropriate snacks or equipment for emergency response. Students may need to eat and/or drink during the bus ride.
- Consider encouraging the student to sit near the front of the bus to allow for closer observation.
- Communication to the school health personnel (if applicable) any concerns regarding the students actions or behavior regarding diabetes management.
- Participate in diabetes in-service to be able to identify signs and symptoms of hypoglycemia and hyperglycemia.
- Respect the students right to confidentiality and privacy.
- Call 911 for diabetic emergencies.
It is the Parent/Guardian’s responsibility to transport, provide and maintain all medications, supplies, equipment, and snacks needed by the student. This can be done on a weekly or monthly basis. Supplies needed are, but not limited, to blood glucose monitor, test strips, lancets, extra batteries, insulin, syringes, ketone strips, extra tubing sets (if using insulin pump) snacks, glucose tablets or gel, and glucagon injection.
Parents/guardians are responsible for having the student’s healthcare provider complete the Diabetes Medication Authorization/Treatment Form. If the student is using an insulin pump there must also be a complete Insulin Pump Medication/Treatment Authorization Form. These forms must be signed by the parent/guardian. All sections need to be completed by the healthcare provider.
Inform the school as soon as possible when a student is newly diagnosed as having diabetes or when a previously diagnosed student enrolls in a new school so that planning and training of personnel can be arrange. Parents should work with the school staff prior to their child’s admittance to ease the student’s transition into the school environment.
- Provide the school with accurate and current emergency contact information.
- Provide the school with the health care provider’s written medical orders (medication authorization treatment form) related to the student’s diabetes management.
- Participate in a care plan planning conference as soon as possible after diagnosis and at the start of each school year.
- Provide the school health personnel with any new written medical orders when there are changes in the medical management that must be implemented in school.
- Provide and transport to the school all medications, equipment, supplies, and snacks associated with the medical management that must be implemented in school.
- Provide and transport to the school all medications, equipment, supplies, and snacks associated with the medical management of the student’s diabetes.
- Assume responsibility for the maintenance and calibration of all medical equipment.
- Assume responsibility for the management of new diabetic devices until appropriate training is provided for school health personnel.
- Sign appropriate written permission for authorization of treatment (medication authorization treatment forms) and sharing of necessary health related information.
- Consider providing student with a medical identification tag or jewelry and encourage the student to wear it in school.
- Work with health care providers, their staff, and the child to promote self-sufficiency in diabetic management.
Health Care Provider
The physician/health care provider manages the medical care of the student with diabetes.
The physician should provide information and guidance to the school health personnel to use in developing the individualized health care plan. The physician should not only be aware of the medical needs of the student but should also take into consideration the resources available in the school. To safeguard student safety, the physician should:
- Provide the school nurse (if applicable) with the required diabetes history information, medication authorization treatment form, and emergency information specific to the needs of the student.
- Provide specific written orders when prescribing a sliding scale dose of insulin.
- Agree to answer student-specific questions relevant to the training and education.
- Be accessible by phone or fax to review or contribute to the individualized health care plan and for emergency orders.
- Determine the level of self-care allowed based on the student’s knowledge, developmental level and abilities.
Medication Authorization/Treatment Form
The healthcare provider should:
- State the specific time frame in which the student should check his/her blood glucose level.
- Identify symptoms of High or Low blood glucose levels specifically demonstrated by the students.
- Specify any physical limitations
- Note food and amount the student may need to consume when the blood glucose level is low. The student may be allowed to keep the specified food in his/her possession al all times.
- State if the student has been trained by healthcare provider and is able to test his/her blood glucose level and administer own insulin.
Other forms to be used for the student with diabetes include: Insulin Pump Medication/
Treatment Form, Diabetic Student Log, And Diabetes Emergency Care Plan. These forms may be obtained from the Coordinated Student Health Services web page. Go to the Broward County Public Schools web site at http://www.browardschools.com, choose departments, Coordinated Student Health Services, then forms. The required forms are available under the forms drop down menu under Diabetes.
Storage of Supplies
Needles and syringes must be kept in a locked cabinet where they are not easily accessible to other students. This area may be in the classroom or the school clinic.
Students who self-administer their insulin may keep insulin and all other supplies with them at all times. The Diabetes Medication Authorization/Treatment Form must state that the student has been trained in order for the student to carry supplies on him/her self and to self-administer.
- The following procedures should be followed when the students is scheduled to go on a field trip:
If the trip extends beyond the regular schools hours, Parents/guardians are responsible to obtain another Diabetes Medication/Treatment Authorization form with specific instructions for the extended hours. If the hours are during regular school hours the Diabetes Medication/Treatment Authorization form on file should be followed.
- If a student is incapable of self-administering his/her insulin or checking blood glucose level per the Diabetes Medication/Treatment Administration form a plan of action should be developed by school designee to assist in meeting the needs of the student. The plan of action will specify emergency care and identify trained school personnel/health professional to assist/accompany the student on the field trips. It is always recommended to encourage the parent/guardian to accompany the student on the field trips.
- If the parent/guardian cannot accompany the child on the field trip and the student is receiving nursing services at school then the principal must arrange for nursing services for the student while on the field trip. Please contact Coordinated Student Health Services for assistance at (754) 321-2272.
It is good practice to assign a “buddy” for the diabetic student. A buddy can serve as a runner in times of an emergency. This can be particularly helpful during lunch,
physical education, or outdoor activities. Teachers may wish to rotate buddies. If a student is experiencing hypoglycemia (low blood glucose), help should come to the student. Never send the student who is experiencing hypoglycemia to the office or clinic. Have the appropriate person come to where the student is. This is an emergency situation that requires immediate attention.
Emergency Care Plan/Crisis Management/Health Concerns
The student’s healthcare provider should document any emergency care the student may need on the Diabetes Medication/Treatment Authorization form. The healthcare provider should identify the student’s symptoms of Hypoglycemia (low blood glucose) and or Hypoglycemia (high blood glucose) and methods to treat them also, how to prevent unnecessary emergencies. The healthcare provider should state what time of day the student should test blood glucose levels and administer insulin. The student should be encouraged to wear an identification bracelet for emergency purposes.
Diabetic students blood glucose levels may alter their personalities. The student may exhibit severe mood swings or their energy level may vary drastically. School personnel should be made aware of what they may signs or symptoms they might observe with a high or low blood glucose level, as well as what interventions to take for each specific situation. Coordinated Student Health Services will provide Diabetes in-services upon request.
The Insulin Pump is the size of a beeper. It is a small computer that administers insulin upon request and on a continuous basis. The pump is worn at all times. The parent/guardian is responsible for providing the school with an Insulin Pump Medication /Treatment Authorization form and all supplies needed for the Insulin Pump.
At the initial meeting with the parent/guardian, and all involved school personnel, the plan of action should be discussed. A diabetes in-service education class should be scheduled to teach all necessary school personnel about diabetes. A Health Services Request form, along with a copy of the Diabetes Medication/Treatment Authorization form and Insulin Pump Medication/Treatment Authorization form (if using insulin pump) must be faxed to Coordinated Student Health Services at 754-321-2743 to schedule a diabetes in-service. To obtain a copy of the Health Services Request (HSR) Please go to the Coordinated Student Health Services web site @ www.browardschools.com.
Self Medication Procedures
- Each student must have a completed Diabetes Medication/Treatment Authorization form and Insulin Pump Medication/Treatment Authorization form (if using insulin pump) on file. These forms will state if the student is able to independently monitor blood glucose levels and administer insulin, if the student needs supervision to perform these tasks, or if the tasks must be done for the student.
- The healthcare provider must also indicate the time the blood glucose levels should be tested and the corrective action to be taken.
- The assigned school health nurse (on-site of on-call) should in-service the school staff including food services employees and bus drivers on the signs and symptoms of hyperglycemia and hypoglycemia and the appropriate treatment for each situation. Even is a student is able to self check his/her glucose levels and administer insulin staff need to receive training to assist the student should an emergency arise.
Blood Glucose Monitoring in the Classroom Setting
- The Parent/guardian must have a completed Diabetes Medication/Treatment Authorization form or Insulin Pump Medication/Treatment Authorization form on file.
- Blood glucose monitoring and insulin administration may occur in the clinic or the classroom if the student has been trained as stated on the Diabetes Medication /Treatment Authorization form.
- If the student has not been trained to administer his/her insulin, then the only persons who are able to administer insulin are, a licensed nurse (RN or LPN), trained Health Support Technician (HST) or parent/guardian. School personnel should NEVER administer insulin.
- Documentation of blood glucose levels and insulin administration should be maintained on the student’s Daily Diabetic Log. A copy should be given to parent/guardian upon request.