Less restrictions for DM I kids

[arlingtonnurse]

I've been discussing the care plans for T1D students with my medical director and she was expressing to me that many of the traditional restrictions (specifically here we were talking about the need for a nurse to accompany field trips and the inability to delegate glucagon) she felt were outdated with the new advances in technology (specifically the ability to monitor sugars constantly and without fingerstick as well as the ease of administering baqsimi).  The wheels of change spin slowly here in Massachusetts but I'm wondering if other states have been able to do away with these restrictions (or never had them to begin with).

[k1p1ssk, BSN, RN]

The thing I worry about here is the willingness of a staff member to take on learning about the ins and outs of T1DM... I know for a fact that most of the teachers/staff in my school would be unwilling to take on that responsibility, and I would feel unsafe sending a student with T1DM on a field trip without a nurse, even one on a pump or with a CGM. I agree that Baqsimi should be delegable, however...  

[JenTheSchoolRN, BSN, RN]

OK, so I'm in MA. I don't send a nurse on a field trip with a student that is well managed and can give their own insulin (via pump or pen). I do set up that student with a check-in adult and they call me in the office to check in if they are eating on the field trip. I'm also linked to that student's CGM if they have one. But I have some amazing teachers that are willing to learn here about T1DM student care. 

But, this is for older kids (grades 7 & up). I did just accompany one of my T1DM kids (in HS) on a field trip recently. This student has autism, has to do the carb ratio math, AND I have to pull the insulin from a vial (no pump or pen here). I will never delegate that degree of care, even if MA let me eventually.

 

[CommunityRNBSN, BSN, RN]

I can see this type of thinking. I sub in all the schools in my district. We have one early-elementary who is so brittle that, even with pump and CGM, she definitely needs a nurse or a parent or somebody who really knows what they’re doing. But at the middle and high school, we have kids who come twice a day to flash us their CGMs and that’s about all the contact with have with them. The likelihood of them needing intervention is so low, and if they did, the intervention would be “give Baqsimi and call 911,” which any staff could do if they were trained and confident. 

[StudentRN56, BSN, RN]

I'm in Oregon and we have to have a delegated UAP - trained to administer insulin and glucagon - attend field trips with DM1 kiddos but often the parents will go on the field trip with them. I have 4 schools, so it is not practical (or maybe even possible) to necessarily attend each DM1 student's field trip. Each DM1 student has to have 3 staff members trained to administer insulin (count the carbs - check blood sugar - and properly calculate how much insulin to administer) to them. Those staff are trained on glucagon as well as their classroom teachers.

[arlingtonnurse]

10 hours ago, StudentRN56 said:

it is not practical (or maybe even possible) to necessarily attend each DM1 student's field trip

I am not the one that goes on the field trips-- the district has to hire a sub nurse to go with them.  Requires a lot of time and coordination to get the sub but I am not allowed to leave the school.