Diabetes Summit 2013

1. Diabetes Summit 2013 Marilyn L. Hudson, RN, MSN, CNS, FRE

2. Teaching • Teaching for the purpose of Division 047 means providing instructions for the proper way to administer non-injectable medications and/or perform a task of nursing care. Teaching may include: • Presentation of information in a classroom setting or informally to a group. • Discussion of written material and/or demonstration of a technique/procedure.

3. Teaching Documentation • As with any documentation, needs to be retrievable evidence of action/s you have taken. Include: • General information, elements, steps, processes or procedures you have taught. • How you have determined competency of individual/s you have taught. • If there is demonstration component, describe demonstration or process to be followed. • Hand-outs and/or teaching aids used.

4. Delegation • Delegation means that a registered nurse authorizes an unlicensed person to perform a task of nursing care is selected situations and indicates that authorization in writing. It includes: • Nursing assessment of a client in a specific situation. • Evaluation of the ability of the unlicensed person/s. • Teaching the task. • Ensuring supervision of the unlicensed persons. • Re-evaluating the task at regular intervals.

5. Delegation Documentation • A nursing assessment of the client with identification of the client’s condition. • The RN’s rationale for delegating the task. • The skills, willingness and ability of the caregiver. • The safety of caregiver to perform the task.

6. Delegation Documentation • Written instructions for performance of the task that include: • risks, • side effects, and • appropriate response by the caregiver. • That the caregiver is knowledgeable of the risk factors and side effects and knows to whom to report the same. • Evidence that the caregiver was instructed that task is client specific and not transferable to other clients or caregivers.

7. Delegation Documentation The frequency that s/he will be reassessing the client’s condition to determine if the delegation remains appropriate. This documentation includes the RN’s rationale for choosing the frequency based on the client’s needs. The frequency the RN will supervise the caregiver in their performance of the task. This documentation includes the RN’s rationale for choosing the frequency based on the caregiver’s competency.

8. Delegation Documentation A statement that the s/he takes responsibility for the delegation of the task to the caregiver and will ensure that supervision will occur for as long as the RN is supervising the caregiver's performance of the delegated task.

9. Using the Glucometer • No hard and fast rule regarding whether task is simply taught or if it needs to be delegated. • As with any determination about delegation consider all the factors gained from your client assessment. Decision whether or not to delegate based on conditions for delegation, complexity of task, risks, caregiver skills, etc. • If blood sugars are being collected as data, but no insulin is required, may want to teach only. • Usually, with complex child requiring insulin will want to include teaching as part of the delegation.

10. Counting Carbs • May teach carb counting, but would want to include teaching as part of delegation when it is part of insulin management of child. • Follow guidance for teaching documentation and for delegation documentation it is part of a delegation.

11. Insulin Pumps • Usually will want to delegate. • Response to pump problems: • Plan intervention you will use ahead of time (e.g. Notify RN, call parent or other interventions specific to problems you have experienced with particular child) • Accountability/liability (in relationship to nursing license) would not differ generally from injectable insulin. • Document delegation following delegation rules. • Document pump problems following standard nursing documentation guidance.

12. Teaching for an Anticipated Emergency • Historically, interpreted that all emergency medications would fall into this category. • Current interpretation - limit to meds referenced in ORS 433.800-433.830, Programs to Treat Allergens and Hypoglycemia (epinephrine, glucagon). • Other medications (e.g. rectal Diastat, nasal Versed) may be taught following rules in Division 47, Teaching Administration of Non-injectable Medications and Periodic Inspection.