Diabetes in Schools LVN Training By: Cata Ingalls Jan Okimura Nina Withers At the end of this lesson, the learner should be able to: Define Diabetes Type.
Download ReportTranscript Diabetes in Schools LVN Training By: Cata Ingalls Jan Okimura Nina Withers At the end of this lesson, the learner should be able to: Define Diabetes Type.
Diabetes in Schools LVN Training By: Cata Ingalls Jan Okimura Nina Withers At the end of this lesson, the learner should be able to: Define Diabetes Type I and factors affecting blood glucose levels. Apply the laws affecting students with medical conditions and disabilities Classify the Six Rights of Medication Administration. Familiarize and accurately read the new Diabetes Medical Management Plan (DMMP). Objectives continued Differentiate between hypoglycemia and hyperglycemia and its signs and symptoms. Understand and apply Emergency Care Plans, when needed Successfully monitor blood glucose, administer insulin via syringe and pen, deliver glucagon during emergency, calculate carbohydrate, and to determine amount of insulin based on carb:insulin ratio and/or BG correction. Check ketones in urine, if needed. Document accurately using Meal worksheets and Diabetes Monitor Log for Schools. Statistics Diabetes is the 7th leading cause of death in the US 9.3 % of the American Population have diabetes This is up 1% from 2010 From the National Diabetes Statistics June 2014 LAWS Laws affecting students (all students, not just students who have diabetes): • Section 504 of the Rehabilitation Act of 1973 • Americans with Disabilities Act of 1990 • IDEA- Individuals with Disabilities Education Act of 2006 Other Laws affecting students: • FERPA- Family Educational Rights and Privacy Act. This is a federal law that protects the privacy of student educational records • HIPAA- Health Insurance Portability and Accountability. This law assures that individuals’ health information is properly protected while allowing the flow of health information needed to promote high quality health care. Basic Diabetes Information From YouTube Video on Diabetes Made Simple At School we cannot give medications or perform procedures unless we have doctors orders Once we have orders the School Nurse will develop a Health Care Plan You cannot legally deviate from the orders or the Health Care Plan When we have orders AND a Health Care Plan you may administer medication and/or perform a procedure THE NEW DMMP AS OF 5/2014 DIABETES MEDICAL MANAGEMENT PLAN Student’s Name: _____________________________ Date of Birth: ____________ Medical Record #: _____________________ BLOOD GLUCOSE MONITORING Student routinely checks blood glucose prior to insulin administration at meal time. Student may check blood glucose as needed throughout the school day. INSULIN DOSING Type of insulin: Novolog or Humalog or Apidra INSULIN PUMP: FOLLOW INSULIN DOSE PER PUMP DIRECTIONS Meal time insulin dose to be given pre-meal unless alternative checked: post-meal Insulin dosing not to be used for snacks unless this box checked . Before school meal Insulin dose = _____units Insulin dose = _____units/_____grams of carbohydrates either pre- or post-meal Lunch After school meal Insulin dose = _____units Insulin dose = _____units/_____grams of carbohydrates Insulin dose = _____units Insulin dose = _____units/_____grams of carbohydrates Sliding Scale: (DO NOT USE IF WITHIN 3 HOURS OF PREVIOUS INSULIN DOSE). ___units if blood glucose is _______to _______mg/dl ___units if blood glucose is _______to _______mg/dl ___units if blood glucose is _______to _______mg/dl ___units if blood glucose is _______to _______mg/dl ___units if blood glucose is _______to _______mg/dl ___units if blood glucose is _______to _______mg/dl ___units if blood glucose is _______to _______mg/dl ___units if blood glucose is _______to _______mg/dl ___units if blood glucose is _______to _______mg/dl ___units if blood glucose is _______to _______mg/dl ___units if blood glucose is _______to _______mg/dl ___units if blood glucose is _______to _______mg/dl ___units if blood glucose is _______to _______mg/dl ___units if blood glucose is _______to _______mg/dl ___units if blood glucose is _______to _______mg/dl ___units if blood glucose is _______to _______mg/dl ___units if blood glucose is _______to _______mg/dl ___units if blood glucose is _______to _______mg/dl Sliding scale is based on correction factor of ____units/ mg/dl blood sugar. Sliding scale is based on correction factor of ____units/ mg/dl blood sugar. Sliding scale is based on correction factor of ____units/ mg/dl blood sugar. School Nurse (licensed RN) may decrease total insulin dosage. Student’s Level of Independence: Student can perform own blood glucose checks? Student can calculate carbohydrates independently? Student can determine correct amount of insulin? Student can draw correct dose of insulin? Student can give own injections? Student may carry own diabetic supplies (ie pen/glucometer)? Student can bolus correctly (for carbohydrates or for correction of hyperglycemia) Student can troubleshoot alarms and malfunctions? No No No No No No With With With With With Yes No With Supervision No Yes Supervision Supervision Supervision Supervision Supervision Yes Yes Yes Yes Yes Yes NEW DMMP DIABETES MEDICAL MANAGEMENT PLAN Student’s Name: _____________________________ page 2 Date of Birth: ____________ Medical Record #: _____________________ HYPOGLYCEMIA (Low Blood Sugar) If conscious and able to swallow: If blood glucose is < 80 mg/dl, give 15 grams of carbohydrates and recheck blood glucose in 15 minutes. Repeat until blood glucose is > 80mg/dl. If unconscious or having seizure, give Glucagon injection IM: 0.5 mg 1.0 mg If Glucagon is indicated, administer it simultaneously while calling 911 and the parents/guardians. HYPERGLYCEMIA (High Blood Sugar) Check urine ketones if blood glucose > 350 mg/dl. Give insulin per sliding scale orders (DO NOT USE WITHIN 3 HOURS OF PREVIOUS INSULIN DOSE). IF KETONES are MODERATE or LARGE and student has symptoms, student will be sent home. PHYSICIAN’S AUTHORIZATION & PARENT CONSENT FOR DIABETES MEDICAL MANAGEMENT PLAN My signature below provides authorization for this Diabetes Medical Management Plan. I understand that in some school districts specialized health care services may be observed by unlicensed designated school personnel under the training provided by a school nurse or RN. This authorization is for the current school year. If changes are indicated, I will provide new written authorization. Physician’s Name (Print): ___________________________________________ Physician’s Signature: ______________________________________________ Date: __________________ Kaiser (Roseville) Sutter Physician’s Telephone: ( UCDavis Other: ____________________ ) _____-____________ Physician’s Fax: ( ) ____-__________ My signature below provides consent for designated school personnel to assist my child with the above medication. Parent’s Name (Print): __________________________________ Telephone: ( ) ____-___________ Parent/Guardian Signature: _________________________________ Date: ______________________ This form was created in collaboration with Sutter Center of Excellence in Diabetes and Endocrinology, UC Davis Children’s Hospital, Kaiser Pediatric Endocrinology, San Juan USD, Natomas USD, Sac City USD, Twin Rivers USD, Elk Grove USD, Rocklin USD, Vallejo USD, Vacaville USD, Folsom Cordova USD, Sacramento County Office of Education, Placer County Office of Education, California School Nurses Organization, Sac State Division of Nursing. A Balancing Act Emergency Care Plan Treatment at School Hypoglycemia YouTube Video Hypoglycemia Safe at School Hyperglycemia YouTube Video Hyperglycemia Safe at School Treatment at school Six Rights of Medication Administration • Right Patient • Right Dose • Right Medication • Right Time • Right Route • Right Documentation New Diabetes Medical Management Plan – Doctor’s Orders developed in collaboration with Kaiser, Sutter & UCDMC LVN Scope of Practice • Business & Professions code, Section 2859, LVN’s work under the direction of a RN • must report data to RN • Title 16, Section 2518.5, LVN does not initiate, evaluate or change the student’s treatment/nursing care plan • No Rx changes from parents/verbal orders • Any problem, call your school nurse. If not available, call Health programs. Jan R. will be able to connect you with another nurse • RN’s must decide if student can be independent • Document/log results (BG, amount of insulin, amount of carbohydrates, ketones, site, etc.) appropriately Review of Procedures • Using skills checklist •Blood glucose check (cannot share glucometers & strips) • If child has no strips, he/she will be sent home • Insulin administration • Syringe • Pen • Pump • Glucagon Administration • Carbohydrate/Insulin ratio calculation • Urine ketone check DOCUMENTATION • Each student you are providing care to should have an individual binder which should include the following: • DMMP • Emergency Care Plan • Monitor Log • Meal Worksheets (breakfast & lunch) • Documentation must be done right after each intervention, before leaving the premise. • NOT DOCUMENTED = NOT DONE Example of Meal Worksheet: Meal Worksheet- Name ___________________________________________ Date _______________________ TIME___________________ Blood Glucose _______________ BLOOD GLUCOSE CORRECTION- BREAKFAST 0 units if BG is 100 to 150 mg/dl 2 units if BG is 301 to 350 mg/dl ½ unit if BG is 151 to 200 mg/dl 2.5 units if BG is 351 to 400 mg/dl 1 units if BG is 201 to 250 mg/dl Call parent if Blood Glucose is OVER 350 1.5 units if BG is 251 to 300 mg A. _____________ Correction for Blood Glucose reading: CARB COUNT-BREAKFAST- 1 TO 15 RATIO FOOD CARBS __________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ TOTAL CARBS: ____________________/15 A.___________ + B.__________ = C. _________ = TOTAL INSULIN DOSE Calculate/Verified by: ___________________________/________________________ Insulin drawn up/Verified by_____________________/________________________ B. ______________ Meal Worksheet cont. • Meal Worksheets will be provided by your school nurse, reflecting Doctor’s orders • One worksheet per meal • Breakfast meal worksheet (if applicable) is different from Lunch meal worksheet (make sure you use the correct form) • Calculation/amount of insulin drawn must be verified & initialed by nurse AND student Diabetes Monitor Log for School • Monitor Log student information should include the following: • Student’s name • Date of birth • Grade/Teacher • Parent/Guardian • Phone #’s • School Nurse & cell # Example of Diabetes Monitor Log REFERENCES American Diabetes Association http://www.diabetes.org Americans with Disabilities Act of 1990 http://www.ada.gov/2010_regs.htm Center for Disease Control and Prevention http://www.cdc.gov Diabetes Made Simple YouTube Video https://www.youtube.com/watch?v=MGL6km1NBWE Family Educational Rights & Privacy Act http://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html Health Insurance Portability and Accountability http://www.hhs.gov/ocr/privacy/ Hyperglycemia Safe at School YouTube Video https://www.youtube.com/watch?v=i26P860R1AU Hypoglycemia Safe at School YouTube Video https://www.youtube.com/watch?v=dH9Y_rby-jQ Individuals with Disabilities Education Act http://www.ideapractices.org LVN Scope of Practice www.cphs.ca.gov/docs/imspp/imspp-vos-ch05.pdf References National Diabetes Educational Program http://ndep.nih.gov Sacramento City Unified School district Health e-training courses http://www.scusd.edu/diabetes-training Section 504 of Rehabilitation Act of 1973 http://www.hhs.gov/ocr/civilrights/resources/