Specialties School
Published Sep 17
tlessman
6 Posts
We have a 6th grader in our district who's parent wants to REQUIRE the school nurse to change his site when it falls off. It falls off all of the time. He pulls it off (sometimes on purpose) or when he goes to the restroom or just playing. It is not on his IEP or diabetic orders from the Dr. that the nurse has to replace it. The nurse is new this year and mom is upset that she has to leave work to go to his school and put a new one on so wants the nurse to do it. I'm not seeing anywhere on boards that the nurse is required to do this and in the past we have all just kept an insulin pen or a vial of insulin at school in case of pump failure or if it comes out. Any thoughts on this? Thank you!
FolksBtrippin, BSN, RN
2,237 Posts
My thoughts:
The child is in 6th grade which means he is 11-12. An 11-12 year old should be more responsible for his own insulin pump. He should not be purposely removing it. He should be taught and empowered to put it back on himself. If he needs assistance in putting it back on, or if he needs a private space or supplies, he should be supported at school in this way, by the school nurse. The school nurse should know how to put the pump back on or should learn how to put the pump back on, but only to support the child in taking responsibility. This should be in the IEP and care plan. The eventual goal should be independence in management of insulin pump.
This student is in the EBD program and cannot be trusted with his cares at this point so the parent has always done it. In my 14 years I have never had a diabetic that was so irresponsible and non-compliant with his cares. Usually by the time my diabetics are in 5th grade, they rarely come to see me because they do their own cares. It's definitely a situation I haven't been in yet so just trying to navigate his cares now that he is in the middle school
The behavior needs to be addressed. You said EBD, but not sure exactly what's going on here. It could be a way to self harm. It could be oppositional. This needs to be explored, an interdisciplinary approach applied. Can you ask for an interdisciplinary meeting for the child or is one due soon? You need a plan to address the non adherence.
We are. We have been having meetings since he was in 2nd grade about this. Mom worked in the same building so did everything for him and he was never held accountable. Now that they are in different schools it's a bigger issue. Having another meeting today. I am just trying to see if anyone has any legal statues on requiring a nurse to change his pump site.
NRSKarenRN, BSN, RN
10 Articles; 18,804 Posts
Modern diabetes devices in the school setting: Perspectives from school nurses
Quote Currently, there are no unifying clinical guidelines for the use of modern diabetes devices in schools, and little is known about how these technologies translate from the home to the school setting.
Currently, there are no unifying clinical guidelines for the use of modern diabetes devices in schools, and little is known about how these technologies translate from the home to the school setting.
Diabetes Care Tasks at School
Quote These modules focus specifically on how diabetes care should be done in the school setting and may also be used to train caregivers in the child care, camp, and other settings.
These modules focus specifically on how diabetes care should be done in the school setting and may also be used to train caregivers in the child care, camp, and other settings.
Check your states nursing practice act and state education regulations-- unaware of any requirement for the school nurse to be required to change continuous glucose monitoring sensor, especially since not part of an IEP.
Webinar for School Nurses Free CEU School Nurse On-Demand Webinars Offered
Quote Safe at School® recently concluded its seven-part live webinar series attended by hundreds of school nurses from across the country covering topics such as core diabetes concepts, CGM and insulin pump use, nutrition, and legal protections. These recorded one-hour webinars are now available from the ADA's Institute of Learning offering one free CEU for each webinar completed. Continuous Glucose Monitors (CGMs) in the School Setting
Safe at School® recently concluded its seven-part live webinar series attended by hundreds of school nurses from across the country covering topics such as core diabetes concepts, CGM and insulin pump use, nutrition, and legal protections. These recorded one-hour webinars are now available from the ADA's Institute of Learning offering one free CEU for each webinar completed.
Continuous Glucose Monitors (CGMs) in the School Setting
Hope our school nurses can chime in.
Thank you! Just to clarify, this is for an insulin pump, not a CGM sensor
k1p1ssk, BSN, RN
812 Posts
Mom/Admin can't just throw pump maintenance into an IEP or 504 - Nurses follow orders from Doctors, not parents. If you do not have orders to perform the change (it may be referred to as pump "maintenance"), then I think you legally can't change the pump. It is a medical device, which would require orders from the prescribing doctor to have. So unless the mom gets an order dictating the nurse can do that maintenance (not to mention has received specific training on that device), she shouldn't feel obligated.
I also agree that at this point, the student should be working towards independence. The diabetic I had was still a bit nervous to change his pump site without me when he was in 6th grade, but he ran the show - I just stood by for encouragement and reinforcement of clean technique, placement etc. I would document that this care was done by the student with my assistance.
For reference, in my area, a typical diabetic order set for a pump includes the type of insulin, the basal rate and whatever carb correction ratio for boluses. It would include instructions to call the Pedi Endo if the pump failed and no replacement was available, or whatever - they would then give us specific verbal orders for the SC insulin injections (sometimes these would be included, but with how fancy pumps have become, I think there's more to it, especially if the basal rate is variable). The order set also typically gives authorization for the school nurse to perform pump & CGM sensor maintenance, dictates when to do a fingerstick instead of relying on the CGM, when to check ketones, and what to do with all of that information. They also include an emergency direct phone number for us (and families) to call the Pedi Endo provider office and get to speak with a nurse without going through the call center.
So, with that last bit in mind, if the nurse has contact info for this student's endocrinologist, I might bring these issues to their attention. Continue to call in Mom to do the change every time until the orders come through, and maybe even call the Pedi Endo every time. They might get so annoyed by the lack of compliance/independence that they call the family in for a meeting to discuss.
I agree thank you so much! We are asking for a release to talk with endo today at this next meeting.
k1p1ssk said: Mom/Admin can't just throw pump maintenance into an IEP or 504 - Nurses follow orders from Doctors, not parents. If you do not have orders to perform the change (it may be referred to as pump "maintenance"), then I think you legally can't change the pump. It is a medical device, which would require orders from the prescribing doctor to have. So unless the mom gets an order dictating the nurse can do that maintenance (not to mention has received specific training on that device), she shouldn't feel obligated
Mom/Admin can't just throw pump maintenance into an IEP or 504 - Nurses follow orders from Doctors, not parents. If you do not have orders to perform the change (it may be referred to as pump "maintenance"), then I think you legally can't change the pump. It is a medical device, which would require orders from the prescribing doctor to have. So unless the mom gets an order dictating the nurse can do that maintenance (not to mention has received specific training on that device), she shouldn't feel obligated
Agree 100%. As camp RN, I had NO orders for insulin pump mgmt or diabetic mgmt for the 3 campers + staff-- everything handled by Camp Director who was IDDM since childhood and camp Pediatrician -their mom at their "diabetic porch". So when an issue occurred, that's who I called.