Diabetes Care and Delegation in The School Setting 101

1. Diabetes Care and Delegation in The School Setting101 Information for Building Administrators

2. WHAT IS DIABETES? • A lifelong disease • Affects the way the body uses food • Sugar (glucose) builds up in the blood stream instead of entering the cells

3. Insulin is a hormone • Produced in the pancreas • Allows glucose to go into the cells to be used for energy

4. Type 1 and Type 2 • Type 1: Children and young adults are most affected • Type 2: Mostly adults (increasing in our youth) • Today we will focus on Type 1

5. TREATMENTS • A daily and life long balance: • INSULIN • FOOD (CARBOHYDRATE COUNTING) • PHYSICAL ACTIVITY • PHYSICAL/EMOTIONAL STRESS, ILLNESS

6. COMMON SYMPTOMS • Increased thirst Frequent urination • Increased hunger Wt. Loss • Irritability Flushed skin • Nausea/Vomiting Weakness • Fatigue Dry skin

7. LONGTERM AFFECTS • High glucose levels cause: • Blindness • Kidney disease • Heart disease • Nerve damage

8. DAILY TASKSFOLLOWING M.D. DIRECTION • Blood glucose checks • Carbohydrate counting • Insulin delivery • Keytone testing • Glucagon for emergency

9. EQUIPMENT • Glucose testing supplies • Keytone strips • Insulin delivery: syringe, pen, pump • Glucagon • Snacks for mid morning-afternoon and for low blood sugar response

10. HYPOGLYCEMIA • hunger sweaty shaky • nervous headache behavior • vision crabby confused • drowsiness weakness • difficulty talking • unable to take oral treatments • unresponsive • loss of consciousness seizures

11. TREATMENTS • 4-8 oz. juice or 6 oz. soda • 3 packs or 1 tablespoon of sugar • 3-4 chewable glucose tabs • 1 tablespoon of honey • 2-4 oz. sugar candy • IF UNSURE IF LOW OR HIGH-ALWAYS TREAT FOR LOW

12. RN Role • Complete assessment of student needs • Physician orders • Parent permission • Development of health plan • Procedures • Health Management Plan (RN requirement) • Staff training • Ongoing review and assessment

13. SCHOOL RESPONSIBILITIES • Assign appropriate delegated caregivers • Adequate training time for staff and RN • Accommodations including staff available during the day • Field trips • Looks Simple, Right?

14. DELEGATION-WHAT IS IT? • Falls under OAR 851-047-000 set for safe community practice • State Board on Nursing is the governing body • Definition: One nursing task delegated to one unlicensed caregiver for one client. (NON-TRANSFERRABLE)

15. CONTINUED • Tasks follow physician orders • Parents cannot legally direct care/school staff cannot follow parent direction • Changes can only be done by RN • Delegated caregivers cannot teach others

16. CONDITIONS OF DELEGATION • Stable client • Safety of the environment • Caregivers must be taught and determined competent • RN has the responsibility to refuse if unsafe

17. PROCESS • Time intensive at the onset • Requires periodic review of client and caregiver every 60 days (can be less) • Provide written guidelines for performance of tasks

18. IMPACT ON SCHOOL • Diabetes care in school requires delegation • Delegation of care is not limited to the task • RN must follow OSBN & agency • Each student is individual with different needs; each plan will differ

19. POSSIBLE ACCOMODATIONS • Place for testing, supplies • Allow BG check before testing, PE, field trip, etc. • Recommend 3 caregivers • Increased adult support for some students When is a student independent?

20. Access to the bathroom • Carrying water and snacks • Longer lunchtimes • Extra support for off campus activities

21. TASKS FOR DELEGATION • Blood glucose testing • Keytone testing • Carbohydrate counting • Insulin administration • Pump • Syringe and vial • Pen

22. Monitoring for high/low blood sugar • Low blood sugar treatments • Administration of Glucagon • Documentation of tasks, time and treatments

23. Questions?