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PROVISION OF HEALTHCARE SERVICES AT SCHOOL
MEDICATION ISSUES
FORMS/PLANS/PROCEDURES
MISCELLANEOUS
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PROVISION OF HEALTHCARE SERVICES AT SCHOOL
Q:
How do we respond to an administrator who says repeatedly that state standards do not need to be followed unless it’s a law?
A:
Consult with the nursing representative IN THE State Department of Education. Court cases review state standards for consideration. Many health care needs do not have laws that dictate their provision in schools. In these cases, the state standards would prevail as well as the current standard of health care practice in the community.
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Q:
Should a high school student be allowed to keep her blood glucose supplies as well as insulin syringes in her locker at school?
A:
Her blood glucose supplies should be allowed to be with her at all times. With the push for tight diabetes control, checking frequent blood glucoses is part of standard diabetes care. Storing insulin syringes a locker should be addressed in accordance with state law and school policy. She will only need one syringe a day and it would be more appropriate to keep this in her blood glucose kit so the risk of other students getting into a large supply of syringes would not be a risk. The details for this student can be addressed in a written agreement with the student and parent so the student can maintain independence while still maintaining safety precautions.
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Q:
Who monitors the amount of food eaten in school for snack, lunch, and parties and does calculations for the bolus?
A:
Monitoring the amount of food eaten should be delineated in the ISHP. Calculations for the bolus are ordered from the physician as a carb: insulin ratio (this is on the NEW Authorized Health Care Provider Authorization/Parent Consent form). Parents should decide on the number of carbs to be eaten and assign the amount of bolus based on the physician’s order.
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Q:
Can a parent train school staff on diabetes?
A:
Parents usually have a great deal of knowledge regarding diabetes because they have received education when their child was diagnosed and often times seek out additional information such as subscribing to publications, attending seminars and support groups, etc. Problems may arise when parents discuss how things are done at home. Many times what is appropriate for home care may not be appropriate for schools due to laws defining school healthcare services (for example, in a hospital alcohol and retractable needles are used whereas at home they may not use any skin antiseptic and use regular syringes).
State education laws define personnel qualified to do training in schools. In California, the training for providing health care procedures in school are the responsibility of the credentialed school nurse, public health nurse or licensed physician. This training responsibility includes training includes monitoring and supervision of the provisions of healthcare procedures. The school nurse may also use community resources for assistance. It is very appropriate for the nurse to meet with the parent(s) and discuss their child’s individual needs and record this information in the IHSP.
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Q:
If the student is authorized to do their own blood glucose testing in the office and we have parameters in place, are we required to keep a daily log of blood glucose testing results in the office and have school staff monitor?
A:
The school nurse needs to discuss this situation with the parents and determine the student’s competency in performing the test. If the student is competent, demonstrates good management of their diabetes at school, and the parent does not desire any supervision then there is no reason to record the results or have supervision. The school nurse can maintain this information on the School Health Problem List and inform the student of how to obtain assistance if needed. For example, a high school student may not need any supervision but the school nurse can provide periodic progress checks and then document that the student maintains good control throughout the school year. A younger child may need more progress checks to ensure their safety and well-being.
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Q:
What is the standard for supervising unlicensed staff performing healthcare procedures? How often are we required to observe and supervise? What does regular supervision mean?
A:
It is necessary to check with your individual state laws concerning healthcare procedures. In California, education code 49423.5 and CCR Section 3051.12 determine how health care services will be provided in schools. There are no written policies in these statutes regarding a time frame for supervision. The school nurse is responsible for determining safe and adequate supervision. This depends on the individual receiving training and the service being provided. Some individuals may needs monthly reviews whereas others may do fine with quarterly reviews. Supportive documentation must be done to justify the amount of supervision provided. The amount of supervision given will be judged by how it provided appropriate care and safety for the student requiring these services (Nursing supervision of individuals trained is not reliant on what peers are doing. Peers can be used to assist the school nurse in making a determination for her decision-making).
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Q:
The procedure for providing insulin when the blood glucose is elevated states to check blood glucose 30 minutes after the insulin is given. The parent refuses to let this be done due to “more interruption at school and over-involvement of the school nurse”. What do I do?
A:
Explain to the parent the rationale for this is to ensure the safety of the student; making sure that this extra dose is not exacerbating hypoglycemia. This is not a typical practice for home care but is recommended at schools due to the fact that the child is not under individual supervision. The parent has a right to refuse this service especially if the insulin coverage historically has not caused problems. Document in your IHSP what the parent tells you and it may provide reasonable justification.
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Q:
Please provide information on requirements for field trips for students with diabetes.
A:
The school is responsible for providing all healthcare services on field trips or any other school sponsored events. Provisions for care must be available and easily accessible. This includes treatment for hypoglycemia (glucose sources and gel and Glucagon, if ordered) and hyperglycemia (water, insulin, if ordered, and access to bathroom), blood glucose testing kit and insulin supplies, if needed for the time period involved. Trained staff must accompany the student.
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Q:
Must the blood glucose be tested prior to a student boarding a bus for home?
A:
The details for this should be delineated in an IHSP. What is the history for this student? How long is the bus ride? When was the last meal or snack eaten? The school nurse’s assessment with input from the parent and healthcare provider should determine what is safe for this student. The bus driver should be trained in recognition of and treatment for hypoglycemia.
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Q:
I have a 5th grade student that has orders from doctor to give himself insulin "under adult supervision". Does this supervision require an RN?
A:
The school nurse needs to provide the "assessment" of the situation and determine how much supervision this student requires. The school nurse will determine this by interviewing the parent and observing the student administer the insulin. It may be that an unlicensed person can be designated to observe for "task completion" or it may be that specific details need supervision which may require more advanced skill and knowledge (in California this practice is then restricted to a licensed nurse).
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Q:
What if the parent refuses to sign the physician authorization form?
A:
Schools are obligated to provide emergency first aid. This would include treatment for hypoglycemia and extreme hyperglycemia. If authorization or consent to provide healthcare services is not received the letter should be sent to the parent(s) informing them that the standards for treatment of hypo and hyperglycemia will be implemented if necessary. The school nurse needs to document correspondence and the parents refusal to consent. The school nurse proceeds to train staff according to these approved standards.
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Q:
What is the school nurse role with disaster preparedness? Is it necessary to make sure that all students who take medication at home have an extra supply at school?
A:
Since disaster preparedness is usually a health related issue, the school nurse is critical in planning for safety should a disaster occur. Districts handle disaster preparedness in different ways. Every school should have a plan in place (check with you state laws regarding disaster preparedness) with alternatives for students who have health needs. If the parent chooses NOT to send in extra supplies or medication for a student with diabetes alternatives can be provided. For example, if insulin is not available during a disaster, all efforts to get the student medical attention would be made. In the meantime, the student can be provided sugar-free fluids and foods that have no or little carbohydrate (foods that are high in fat and/or protein like peanut butter, nuts, beef jerky, meat sticks, etc.). Whatever decisions and/or provisions are made for all students with health care needs should be documented in their Individual School Health Care Plan and a copy of this plan included in the school disaster plan.
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Q:
How does a diabetic child receive his/her insulin injection if the school nurse or the parent cannot attend a field trip or other school-sponsored event? Does someone have to be with this student at all times?
A:
It is legally the school’s responsibility to provide this healthcare service to the student. The school cannot deny the right for this student to attend school events. The school can contract with a nursing agency to provide this service if their own staff is not available. Someone who is trained in diabetes emergencies must be accessible to the student at all times.
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Q:
I am a school nurse assigned to cover 12,000 students. Within this population I have 102 students with diabetes. How can I possibly provide these standards of care for all these students?
A:
Address this situation with the administrator and decide how and IF you can safely provide healthcare to students. Provide your administrator the information of the healthcare needs for these students. The Recommendations in the PEDS Program supports the provision of necessary care and this can be shared with the administrator. In accordance with Section 504 of the Rehabilitation Act of 1973, the school must provide reasonable accommodations for ALL students with healthcare needs not just the ones with diabetes.
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Q:
Is a licensed nurse required to observe a student programming the pump?
A:
The interpretation of state laws will determine who can provide this service. At this time, in California, this practice is restricted to a licensed nurse since it is a complex technical task and requires expanded skill and knowledge. PEDS is attempting to form a task force to further look at the pump issues. Anyone verifying that a task was done correctly should have complete knowledge regarding the specific task along with all the ramifications of that task. An alternative suggestion could be that the student would program the pump via directions over the phone with parent (technical staff at pump companies often walk through troubleshooting steps
of programming with customers via phone). The parent would know how to verify what the student is doing over the phone thereby not having to rely on school staff that has limited knowledge regarding the pump. Of course this student would have to be at an age where this is appropriate. The student’s health and safety is the prime concern.
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Q:
A kindergartner recently started on the pump. His mother was coming in each day to do the snack bolus but then gave us a letter from her doctor giving school health aide permission to program and bolus the pump. I explained that the interpretation of the law in California required the skill of a licensed nurse. The mother said she did not want a nurse and she could pre-program a basal rate that would cover the snack and lunch. I explained that this could be unsafe as something may come up where the snack or lunch is delayed or not eaten.
A:
In this situation, the parent desired to pre-program an alternate basal rate that would cover the snack and meals. This is an option that the parent chose and does not require a physician order if the school is not providing the service. This is comparable to a child who is on shots and has to eat on time. All children with diabetes are at risk at any time of needing extra carbs or treatment for hypoglycemia. This is a compromise to a difficult situation. For some reason the parent does not desire assistance from a nurse and it does not sound like you need it if the parent can pre-program everything. Furthermore, a physician does not have the legal authority to order a school aide to perform specific tasks. Delegation of tasks on the school site is determined by Education code, the nurse practice act and individual school policy. School staff will need training on hypoglycemia and hyperglycemia. You can also train staff to look for problems at the pump insertion site if the student is hyperglycemic (refer to the PEDS manual, Section III, Pump procedures).
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Q:
Can a substitute health clerk be designated to perform blood sugar monitoring and general supervision of a child with diabetes in the classroom?
A:
As long as this person has received adequate training and competency has been verified and documented by the school nurse.
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Q:
When do you notify a parent of an increased blood sugar?
A:
This should be delineated in the ISHP. There is also a space on the Physician Authorization/Parent Consent form for when the physician wants to be notified. Parents should minimally be notified when glucose levels are elevated two days in a row as this may warrant an adjustment in dosage. If hyperglycemia is causing symptoms such as nausea then the child should be sent home, as an educational environment is not appropriate at this time.
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Q:
How do you handle a parent that doesn’t want the school nurse to ever check blood sugars on their child in second grade? She would rather just have treatment with juice if necessary.
A:
The parent has some reason for refusing school services and it may be that she perceives the school wanting to take “control” over her child. Provide reassurance when explaining that your role is to advocate for her child and provide for their safety while at school. Provide your administrator with the justifications as to why this student needs this service and they can support you in addressing this situation with the parent. There are some children who don’t check their blood glucose at school but this is becoming the rarity. Consider the symptoms this child displays and the frequency of hypoglycemic episodes. Explain to the parent that waiting for overt signs of hypoglycemia may be putting the child at risk. If early signs are detected and confirmed by a blood glucose reading then more severe symptoms may be avoided with early treatment.
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MEDICATION ISSUES
Q:
Once a vial of insulin is opened, how long is it good?
A:
Always check the date imprinted on the box for expiration date. Write the date the vial is opened on the vial and discard after 1-3 months from the date of opening. Insulin is a hormone that can be denatured when exposed to extremes in temperatures or by movement. The repeated use of an insulin vial can also slowly denature the insulin and potency is decreased. The more often the bottle is used, the more it is predisposed to denaturing. If blood glucose levels are raising without explanation, check the date on the bottle of insulin; it may be that it's not as potent. It may be a good idea to "rotate" vials of insulin that are used infrequently at school. Discuss this with the parent and decide how frequently the vials should be rotated. The vials can then be used at home long before the shelf life has expired. Unopened insulin is usually good for two years.
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Q:
If medications need to be locked, why recommend students carry the m with them?
A:
Authorized health care providers authorize medication to be carried by students who need to have immediate access for life support. Parameters should be established in written agreements with students and parents for safely maintaining medications on person. Medications that are stored for students in school must be under lock and key for the health and safety of all students and staff.
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Q:
Can trained staff verify insulin number on insulin pen?
A:
State laws will vary on tasks that can be designated or delegated to unlicensed assistive personnel. Verifying a number on an insulin pen is a simpler task than verifying a dose on a syringe. Obtaining an insulin dose via pen is most often done by twisting a device or pushing a button (both one step tasks) until a displayed number reveals the desired dose.
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Q:
What if a parent insists that she cannot afford to have an extra bottle of insulin at school and cannot afford to dispose of a needle each time it is used?
A:
The school nurse can write a letter to the insurance company for the need for extra supplies. Also the vial can be sent back and forth from home to school however explain to the parent that this could decrease the potency faster (as the movement from transporting it daily can denature the insulin). OSHA has no jurisdiction over students therefore if they desire to re-use a syringe they may do so if they are independently performing the task.
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Q:
Can we train unlicensed district employees to give glucagon and/or glucose gel to
unconscious?
A:
Check with the laws in your state to determine who can provide health services. In California, glucagon injections can be given by "trained", competent (as determined by the school nurse) school staff because it is considered a life-saving medication, (like epi-pens for allergic reactions) and although it is an injection, the medication dose is pre-determined, pre-measured, and ready for use. The student’s physician must authorize giving glucose gel to an unconscious student with written consent from the parent. In California, designated trained school staff can administer glucose gel in accordance with the authorized health care provider’s authorization. The school nurse must explain the risk for aspiration to the parent and document the parent’s acceptance of this risk. The school nurse must provide specific instruction to designated school staff on the administration of glucose gel to help prevent aspiration from occurring (i.e. 15 gms only, turn victim to side, rub gel in cheek pouch closest to ground) as well as the potential risk for aspiration.
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Q:
A secondary student can draw up his or her own insulin. The parent wants a health clerk (UAP) to check the dose. Is this appropriate?
A:
The sight administrator is the authorized school staff responsible for designating school staff to perform health care procedures and functions in school. A parent cannot designate school personnel to provide the care. The school nurse assessment of the student’s skills can identify specifically procedure performance needs and design training of designated staff to provide the services needed by the student to improve and promote independent skills. However, as explained in Question # 1, Medications, dose verification and injection via an insulin syringe is usually a complex and technical task therefore this task may need to be restricted to a licensed nurse.
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Q:
Does insulin need to be refrigerated at all times?
A:
Check with the recommendations of the specific manufacture. Insulin is a hormone that can be denatured with extremes in temperatures. Keeping the insulin in a SAFE temperature range is what’s most important. If it is not refrigerated make sure there are no heat waves or power outages that can affect the potency.
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Q:
What is a successful method of documenting self-administered meds?
A:
Make sure that self-administration of medication is in accordance with state laws governing health care at school. One suggestion is to use the Self-Administration of Medication Contract in the PEDS manual (refer to “Contracts”, Section III) or design your own agreement that would assure the students safety. (Please note: the CDE uses the term “Agreement” instead of “Contract”). A written Contract can state how, when, and where the meds are going to be administered. The written Contract can state just how much supervision or task completion assurance is warranted. For example: A 12 year old student can administer their own insulin but the parents and school nurse want to make sure it’s done. Trained staff can observe that the task was completed and document this on a school log. A student kept record may be comparable to a Contract where the student has “agreed” to take the medication specific to physician orders. The nurse and parent may need to decide what is most appropriate and safe for the particular student
If the student is independent in their care then documentation may not be necessary, as the school is not providing the service. Nursing notes should document the student’s competency in independent care. In California, when a student is allowed to self-administer his or her own medication, the parent relieving the district of providing this service should sign a waiver.
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Q:
Can unlicensed school personnel give insulin?
A:
In California, the credential school nurse to determine the needs of that student in school and the level of care that is needed to provide those services in school assesses each individual student with diabetes. Tasks that require a substantial amount of scientific knowledge (nursing assessment) and technical skill (complicated procedures and monitoring and nursing evaluation) may not be assigned to unlicensed school personnel. If a grave error is made in determining the dose of insulin and an excess amount is given, it can be fatal therefore the administration of the correct insulin dose is critical. Verifying accurate insulin dosage involves ensuring that the correct insulin is used, making sure the appropriate syringe is used, determining which line is considered to be the line for measurement on the syringe, checking for air bubbles, and ensuring that the dose being given is in accordance with the authorized health care provider’s authorization. Injecting insulin also requires technical skill and knowledge regarding the appropriate areas for injecting; the technique used for this specific child and the general procedure for insulin administration. Dose verification and injection via an insulin syringe is usually a complex and technical task therefore this task should be restricted to a licensed nurse.
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Q:
Why is the use of Glucagon at school such a problem?
A:
The issue of trained unlicensed school staff to giving an injection makes many people nervous.
Some schools do not have credentialed school nurses to provide training for school staff.
Many as a licensed health care professional function perceive the provision of injections.
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Q:
If a student's medication, Glucagon, has expired, can another student's medication be used?
A:
There are no laws that are written to approve this however this should only occur in a true emergency. A monitoring system should be in place in school to avoid this from happening with replacement of medication before expiration dates occur.
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Q:
Do we have to follow an MD's order for a child (third grade) to be independent with insulin administration in school even if we think it's unsafe?
A:
Physician’s orders are prescriptive health care services needed in school. Orders do not determine the level of care needed in school to provide the service. The school nurse must observe the student’s competency in self-performance of their care in school, determine their needs (if any) and document their findings. If the student is not competent in performing their skills, the school nurse should identify the incompetence’s to the parents and physician in writing. The school nurse can then complete an Individualized School Healthcare Plan (ISHP) with the parent that would work towards specific goals for independent care.
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Q:
Can a parent give an insulin order?
A:
Parents are provided thorough education so that they can successfully adjust insulin doses for their child with diabetes. However, because schools are bound by laws just as hospitals, clinics, and other businesses are, orders can only be authorized by a physician. The physician can provide the school with an order for a sliding scale, insulin sensitivity factor and/or carb: insulin ratio that the parent also uses at home. If the student is independent in insulin administration but needs help in determining dosage, he/she can call the parent directly for dosage but if the school is providing the service, dosage can only be authorized by a physician.
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Q:
Who authorizes the person being trained to give Glucagon?
A:
In most states school administration designates the personnel to be trained and the credentialed school nurse trains designated personnel and must assure that they are competent
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Q:
Who trains UAPs to give Glucagon?
A:
State laws will vary in training unlicensed assistive personnel to give Glucagon. In California, the credentialed school nurse, public health nurse or licensed physician can train UAPs to give glucagons in school. This training must include supervision, monitoring and periodic review of the procedure. Outside agencies can be used as resources for this training.
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Q:
Does a refrigerator with medication in it have to be locked?
A:
Check with your individual state's laws regulating schools. Federal regulations require all medications in school be centrally store and kept under lock and key. This includes medications that need refrigeration.
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FORMS/PLANS/PROCEDURES
Q:
If the family's insurance changes and the physician who signed the school forms is no longer the current provider, are current orders still valid?
A:
Technically physician's orders are good for one year. The concern with this situation is ongoing appropriate medical care for the student. Some physicians may differ in management philosophy and may choose to alter current orders. The current orders can simply be faxed to the new physician and "re-approved" or adjusted as desired.
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Q:
Can students without an ISHP attend school?
A:
ISHPs are not mandatory for school attendance however, it is the school’s responsibility to provide for the student’s safety while they are at school. An ISHP assists in the safe and accurate delivery of health care services. If an ISHP is not in place when the student with health care needs attends school, the school is obliged to provide standard emergency care (e.g. treatment for hypo and hyperglycemia). Many students that function independently do not need an ISHP. The nursing diagnosis can be documented on a school health list. It is prudent to have the parent sign a waiver releasing the school of providing health care services and/or supervision.
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Q:
Where are confidential pages of ISHP kept?
A:
Where other confidential nursing documentation files are kept. Some nurses keep these in their own desk files, some nurse keep these directly in the cumulative records. Both should be under lock and key.
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Q:
Is work with a student who has an ISHP reimbursed as it is with a student who has an IEP?
A:
The Individualized Education Plan (IEP) falls under the Individuals with Disabilities Education Act that provides federal funding to schools for students who have IEPs. The Individualized School Healthcare Plan (IHSP) is specifically a nursing care plan, initiated as a standard of nursing practice but is not mandated for individuals who have disabilities that may affect their education. The ISHP is used to identify the current health status, health care needs in school and who will do what, when and how. It also serves to provide quality nursing care and health care in school. The completed ISHP is attached to the IEP and becomes a part of the IEP to ensure proper healthcare services at school. The Individualized School Healthcare Plan as a document has no funding attached.
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Q:
Shouldn’t all diabetics have 504s to guarantee accountability for all staff interfacing with student and family?
A:
Each student is assessed individually. Some parents prefer the simplicity of just having a care plan and feel their child’s needs are adequately met this way. Some parents prefer having the procedural safeguards of a 504 plan.
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Q:
Are all the forms etc. going to be on line so they can be completed on computer?
A:
The ISHP is in a word program and formatted for school district adaptations to be typed directly on the form downloaded into individual computers. Information and spaces can be added or deleted as needed. The remaining forms and procedures will be in a PDF format that cannot be altered.
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Q:
What is the law to site to do an ISHP?
A:
(California) CEC Section 49426 identifies the services a school nurse may perform. One of the services is to design and implement a health maintenance plan CEC49426 (d). We refer to this plan as an Individual School Healthcare Plan (ISHP). However, Section 1443.5 of the Nursing Practice Act includes “formulating a plan” in the Standards of Competent Performance. Therefore developing a care plan is a standard of nursing practice and in school, that plan is called an ISHP.
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Q:
Where does the ISHP fit in when documenting "targeted case management" for Medi-Cal (California) billing?
A:
Targeted Case Management for Med-Cal billing requires an IEP with an appropriate case management plan for the student that is reviewed at least every 6 months. Any nursing care plan should fulfill this requirement if documentation is done at least every 6 months and Medi-Cal TCM requirements are met. The ISHP can be attached to the IEP and it becomes part of this IEP as the case management plan for nursing.
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MISCELLANEOUS
Q:
Can medical I.D. tags for diabetes be purchased “free of cost” for indigent families?
A:
Low cost I.D. tags can be purchased at pharmacies for under $10.00. PTA funds or Medi-Cal (California) billing funds can underwrite these costs or perhaps a sponsorship from a local diabetes manufacture representative. Diabetes Research and Wellness Foundation is currently offering free medical I.D. tags. Call (202) 298-9211 or send a request to “FREE DIABETES ALERT NECKLACE, Diabetes Research and Wellness Foundation, P.O. Box 96046, Washington, DC 20090-6046”.
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Q:
Should a dietitian be part of a diabetic child's IEP?
A:
If meals are an issue for the child than a goal on the IEP may be
appropriate. A dietician MAY be appropriate, depending on the age of the
child, goals desired, and the amount of content based on nutrition. A
school nurse could certainly consult with a dietician prior to a meeting to
obtain the needed info.
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Q:
What if there is no physician’s authorization and the student is carrying supplies to school?
A:
Students may self-administer medications at school. Any student self-administration of medication at school must have a written authorization from their physician and written consent from their parent/guardian. In addition, the school nurse or school physician shall observe the pupil and determine whether the pupil is competent to self-administer the medication according to the physician’s authorization. If the student is deemed competent to self administer their medication, parameters for safe behavior should be delineated by the school nurse and administrator as well as a waiver signed by the parent/guardian releasing the school of providing this service. An identification card of sort that states the student has permission to self-administer a specific medication in school should be kept on their person. A record of all students who self-administer medications should be maintained in the health office. If the pupil subsequently acts in an inappropriate manner with regard to their self-administration of medication, such as sharing medications with peers, the school administrator may revoke the privilege of self-administration.
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Q:
Are blood lancet devices to be used by one person because of the possibilities of passing blood borne pathogens to another person?
A:
Please check www.osha.gov for the latest requirements on lancing devices and needles. If the student is checking their own blood glucose then they can use their own personal device and change the lancet according to instructions from their health care provider (some may not change it every day - they have the option of changing the lancet at home if they choose). If school personnel are providing this service for the student then a disposable lancing device (sold by companies such as Owen-Mumford or B-D) must be used.
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Q:
Can a trainer receive continuing education hours for training UAP’s?
A:
No. Continuing education hours are for receiving education, not providing it.
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Q:
Is there a potential for diabetes affecting a child’s cognitive ability at some point?
A:
Hypoglycemia can affect a student’s cognitive ability for up to several hours after an episode. Some studies have demonstrated an increase in learning disabilities for students who have suffered several hypoglycemic seizures.
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Q:
Are exchange lists for students with diabetes still being used?
A:
Most dieticians are using the carbohydrate counting method.
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Q:
What about bloodless glucose tests? Are they accurate and recommended for school?
A:
FDA approval for the use of Glucowatch (this is a device that uses interstitial fluid to measure blood glucose levels and intermittently displays them on a “watch”) did not include usage in children. Continuous Glucose sensors are also currently being used but results are downloaded at the physician’s office. Specific manufacture information should provide efficacy rates with potential problems and solutions. Back up meter equipment is always a good idea. If in doubt about blood glucose results, check the glucose on a blood glucose meter.
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Q:
Are there nutritional guidelines for specific foods at school?
A:
Cafeterias providing school lunches must abide by government standards for nutrition. Nutritional guidelines for diabetes may vary from these standards but basically follow guidelines that would be appropriate for any student without diabetes. A dietician usually provides a meal plan to the families of children with diabetes. Nutrition resources can be found under the PEDS website Resource button or in the back of the PEDS manual.
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Q:
Is medical ID jewelry necessary for school attendance?
A:
Medical I.D. tags are not mandatory but are highly recommended for safety reasons. Wallet or pocket I.D. cards can also be used if a student does not wish to wear a medical I.D.
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Q:
How can I keep current with constantly changing technology?
A:
Check the PEDS website resource button.
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Q:
If a student qualifies for an IEP under Other Health Impaired, can the funding be used to purchase a pager for the parent and licensed professionals to assist in giving insulin for a student with diabetes?
A:
This is an IEP Team decision.
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Q:
Is there a list of protein snacks available?
A:
Many companies have a pocket size reference: Accu-Chek, Mini-med, Disetronic. Nutrition resources can be found under the PEDS website Resource button or in the back of the PEDS manual.
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