Just a question on diabetic kid

[MrsNurse08]

Good morning to my new found school nurse friends,

I have a 1st grader who has diabetes Type 1. Everyday mom brings in his lunch and she already has his Carbs counted for me. So for example: If he's eating 15 carbs, the doctor order to give 1 unit per 15 carbs. Sometimes mom would say give 1.5 units of insulin, but that's not what the doctor ordered. In her defense, she knows 1 unit will not help and he will run high later. And she is right most of the time. I told her to talk to his doctor and get an updated order, but i just chart per mom to give 1.5 units. So my question to you all, would you give 1.5 units like mom said or what the doctor ordered?

[Guest374845]

I feel for these parents because I've left appointments for my child with a specific plan developed with the endo only to later find it mistyped or copied forward from previous orders.

Trying to call for updated orders, prescriptions, etc to some of the university mega clinics is hellish; you have to work through a phone tree and a litany of ancillary schedulers or MAs who forward your message -hopefully transcribed correctly- to the doc or their RN and hope to hear back in a day... or 10.

Sorry for the random rant, but I can totally see why some of your kids' parents may appear to just be doing their own thing.

[OldDude]

I feel for these parents because I've left appointments for my child with a specific plan developed with the endo only to later find it mistyped or copied forward from previous orders.

Trying to call for updated orders, prescriptions, etc to some of the university mega clinics is hellish; you have to work through a phone tree and a litany of ancillary schedulers or MAs who forward your message -hopefully transcribed correctly- to the doc or their RN and hope to hear back in a day... or 10.

Sorry for the random rant, but I can totally see why some of your kids' parents may appear to just be doing their own thing.

True...true...true. It puts the nurse between a rock and a hard spot. Frequently parent and nurse know what should be done according to the circumstance at the time but the "paper" says to do something different. I have a 5th grader, Type 1, on a pump, that I've had since kindergarten; so this is my 6th year to care for him. As with most elementary schooler type 1s his BG is all over the map. Strict adherence to his DMP would only compound the problem. So I give myself wiggle room - with the faith the parent agrees and will back me up. But such a relationship isn't with all so one has to be more careful otherwise for licensure protection; can be sticky if parents play the blame game.

[JenTheSchoolRN, BSN, RN]

True...true...true. It puts the nurse between a rock and a hard spot. Frequently parent and nurse know what should be done according to the circumstance at the time but the "paper" says to do something different. I have a 5th grader, Type 1, on a pump, that I've had since kindergarten; so this is my 6th year to care for him. As with most elementary schooler type 1s his BG is all over the map. Strict adherence to his DMP would only compound the problem. So I give myself wiggle room - with the faith the parent agrees and will back me up. But such a relationship isn't with all so one has to be more careful otherwise for licensure protection; can be sticky if parents play the blame game.

Same. I have a student that I've been working with for three years and now we are navigating BG and puberty together. Parent and I (parent also a nurse) work together and luckily have orders with some of that wiggle room in them from student's doctor. Orders specifically have wiggle space for the school nurse and parent written into them (the wiggle room states the school nurse may make up to a 20% adjustment in the insulin to carb ratio and/or correction/sensitivity factor with parent communication on okay). It is an amazing thing.

Euro - maybe you can see if such a thing can eventually be added to your child's orders for school?

[AdobeRN]

I have a parent that will email daily insulin dose - she packs his lunch daily, I have no idea what he is eating & don't question it - I just administer the insulin dose requested plus sliding scale dose according to his plan.