Diabetic Mom

Specialties School

Published

Hi all,

Wondering if anyone else has ever had this problem. I have a 3rd grade diabetic student whose mother does not want us to follow the doctor's orders for his insulin administration. For example, she wants his BG levels to always stay over 200 (not in his target range of 70-150), wants him to have mid morning snack regardless of BG level, and does not want insulin given for snack carbs. She does not want any SS insulin given at any time except lunch. He consistently runs 300 to 500 all morning but she remains adamant on this. The doctor's orders state that the parent may make changes as to medication dosing as needed. He also consistently has trace ketones in his urine. Thanks for your advice.

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Call that doctor today! Maybe mom saw him go really low once and is scared it may happen again, but you cannot put that much stress on a little body and expect anything good to come of it!

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Yikes! Please get a two way signed and call that Dr.

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Specializes in School Nurse.

Please follow what the doctor has ordered. Double check your orders, mine are written where the parent can only change the insulin by a small percentage, usually equal to 1u. Call the doctor and discuss the situation with them. It makes for a very sticky situation, but you have to be an advocate for the student. And...document, document, document.

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Thanks for your comments! Just wanted to make sure I was doing the right thing. I am the head nurse for my school district and have instructed the building nurse to call the doctor repeatedly, which she does not want to do. I will have to go to the principal now with this and call the doctor myself.

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Specializes in school nursing, ortho, trauma.

agreed - give a call to the doctor. If you don't have permission to freely exchange into, then get it ASAP and send a log of what has been going on to them. This parent needs more education. The diabetes professional they regularly meet with should know that and should know what points they need to hit at the next visit. I wonder what this child's a1c is.

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Specializes in Maternal - Child Health.

Calls to both mom and doctor are needed.

I shake my head when parents provide doctor's orders and then ask us not to follow them. My response is always this: I have a legal and professional obligation to follow a provider's order that is forwarded to me. If I believe the order to be inappropriate, I will clarify it. If parents believe an order to be inappropriate they have 2 choices: they can clarify it, or they can ignore it. I don't have that second option, so if the parents don't want an order followed, they need to assist in getting it changed or they need to come in and provide care to their own child.

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Specializes in orthopedic/trauma, Informatics, diabetes.

That is almost reportable. BG of 500 sustained?? Insane

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I would get the exchange of info signed for sure, however you have the right to call and clarify orders.

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Specializes in school nurse.

This seems borderline "need to file" with CPS (or DCF in my state) But by all means, contact the PCP.

Providers and families often misinterpret HIPAA constraints. Practitioners CAN share info with school nurses without a parental consent under certain circumstances. (See below)

What types of disclosures may a covered entity permissibly make to a school nurse under HIPAA?

A covered provider may permissibly disclose PHI to a school nurse including, but not limited to, the following situations:

  • Immunization records, which may be disclosed to a school nurse without individual authorization pursuant to 45 CFR § 164.512(b) and 105 CMR 300.191 (B).
  • PHI for which there is an individual authorization;
  • PHI necessary for the treatment of the child. The provider may disclose treatment information to a school nurse, regardless of whether the school nurse is also a covered entity. 45 CFR § 164.506 © (1) or (2).

(FERPA also has a provision to allow the nurse to share info with treating healthcare professionals...)

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This seems borderline "need to file" with CPS (or DCF in my state) But by all means, contact the PCP.

Providers and families often misinterpret HIPAA constraints. Practitioners CAN share info with school nurses without a parental consent under certain circumstances. (See below)

What types of disclosures may a covered entity permissibly make to a school nurse under HIPAA?

A covered provider may permissibly disclose PHI to a school nurse including, but not limited to, the following situations:

  • Immunization records, which may be disclosed to a school nurse without individual authorization pursuant to 45 CFR § 164.512(b) and 105 CMR 300.191 (B).
  • PHI for which there is an individual authorization;
  • PHI necessary for the treatment of the child. The provider may disclose treatment information to a school nurse, regardless of whether the school nurse is also a covered entity. 45 CFR § 164.506 © (1) or (2).

(FERPA also has a provision to allow the nurse to share info with treating healthcare professionals...)

I will have to save this information. I had a physician's office argue with me, then hang up on me when I was trying to discuss a student's immunizations with them.

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Specializes in orthopedic/trauma, Informatics, diabetes.

If the parent is telling you what to do, my guess that is what is happening at home and that child's life is in danger. I'd seriously have to think about reporting. Problem is getting someone to understand the gravity of the situation to someone that might not realize it.

Good luck. Sorry you have been placed in this position. Even sorrier for the child.

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