For purposes of this TOT program, the "Master Trainer" will be used to define the person providing the TOT presentations. A Master Trainer may be either a school nurse or a certified diabetes educator (CDE) who has received training on this TOT program. A Master Trainer can be sought from school districts, local hospitals with diabetes programs or associations for diabetes educators (refer to Section V, Resources).

The purpose of this TOT Program is for the Master Trainer to train "Qualified Trainers". A Qualified Trainer may also be either a school nurse or a certified diabetes educator (CDE). The Qualified Trainer can then provide trainings to school personnel, parents, health care providers, and diabetes educators in the community based upon relevant information in this curriculum. This program provides continuity in training at schools as well as informs the community regarding school guidelines for care of diabetic students. Appropriate care of the student's diabetes at school enables an optimal educational experience as well as contributes to avoiding the long-term complications of diabetes.

There are two major training components in this curriculum. The first training component involves the Recommendations for Diabetes Care in the Schools. The Recommendations, which are covered in Section I, are integrated into the second training component, Diabetes Basics, but can also be a separate presentation. A Master Trainer or a Qualified Trainer can present to other school nurses, school administrators, teachers, unlicensed assistive personnel, parents, health care providers, and other diabetes educators in the community. The Master and Qualified Trainers use the written Recommendations (Section I) as a script that accompanies the CD-ROM, which can be used as a PowerPoint presentation or to make overhead transparencies.

The second major training component is the Diabetes Basics Training Program, which is covered in Section II. The intended audience is any school staff member (teachers, coaches, health office staff, bus drivers) who may, during the school day, interact with a student who has diabetes. The Diabetes Basics covers all the relevant information they will need to know regarding the care of students with diabetes. The Master or Qualified Trainers use a narrative script that accompanies the CD-ROM, which is used as a PowerPoint presentation or to make overhead transparencies from. Recommended handouts are included in the curriculum as well as notes pages that follow the structured lecture.

The Diabetes Basics Training Program also includes instruction on current diabetes technology. For purposes of this TOT program, stations are set up on the second training day that will include hands on demonstrations for carbohydrate counting, blood glucose testing, treatment of hypoglycemia with glucagon administration, insulin pump therapy, insulin pens, and mixing insulins for administration with a syringe. Assistants will be needed for the demonstration/ return demonstration activities segment of the training. Assistants can be sought from school districts, the parent community, pharmaceutical companies, or other organizations that support diabetes education (refer to Section V, Resources).

Other components of this TOT program include the review of the following:

• Background of the PEDS program
  
  
• Training, Phase I and II
  
  
• Relevant state laws and regulations, the individual state's nurse practice act
  
  
• Manual overview (includes review of all the School Nurse Tools)
  
  
• Individualized School Healthcare Plan

Information on the preceding pages will provide training parameters, content detail, timelines, methods, materials, evaluations and documentation requirements.

All training programs need to be implemented in accordance with applicable state laws, regulations and nurse practice acts.

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The following goal statement and objectives are for the "qualified trainer" receiving the training on PEDS, A Curriculum for Diabetes Care in the Schools.

Goal Statement
School Nurses will be able to provide appropriate management of diabetes at school and school sponsored events.

Objectives
Following the training program on PEDS, A Curriculum for Diabetes Care in the Schools, school nurses will be able to: Understand the written Recommendations for Diabetes Care in the Schools.

Replicate an overhead presentation on the Recommendations to school nurses, school administrators, teachers, unlicensed assistive personnel, parents, health care providers, and diabetes educators in the community.

Understand and be able to replicate and evaluate a PowerPoint or overhead presentation on the Diabetes Basics to other school nurses and school personnel.

The objectives for Diabetes Basics includes the following:

• understand diabetes and how it effects the body.
  
  
• understand the importance of balancing a proper diet in diabetes management.
  
  
• list the benefits of exercise management.
  
  
• understand the consequential effects of hypoglycemia, how to recognize and treat low blood glucose.
  
  
• understand normal and abnormal blood glucose levels.
  
  
• understand the appropriate response for hyperglycemia.
  
  
• understand facts about insulin and injection supplies.
  
  
• describe where a vial of insulin is stored.
  
  
• identify diabetes management when someone is sick or injured.

Understand how to utilize the paperwork needed to:

• initiate the assessment of student needs.
  
  
• formulate a care plan.
  
  
• implement diabetes procedures.
  
  
• prepare for disaster.
  
  
• provide a successful training program for school personnel.
  
  
• Understand the process for 504 accommodation plans and IEP's.
  
  
• Utilize the Parent & Healthcare Provider Guide.
  
  
• Utilize the Resource section of the curriculum.

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A. Qualifications of instructional personnel. The Master Trainer is:

1. A school nurse who has received training on this program.

2. A certified diabetes educator (CDE) who has been trained in relevant sections of school policy, OSHA laws, and IDEA regulations. (Note: The school nurse maintains responsibility for supervising the training program on school site).

B. Qualifications of training assistants

1. Competency in skills, as determined by the Master Trainer, needed for:

a. carbohydrate counting- typically a registered dietician or CDE

b. blood glucose testing- various manufacture representatives or CDE

c. treatment of hypoglycemia with glucagon administration- CDE

d. ketone testing and mixing insulins for administration with a syringe- CDE

e. insulin pump therapy, insulin pens - various manufacture representatives or CDE

C. Number of participants

1. Due to the demonstration/ return demonstration segment of this program, a ratio of one assistant for every 6-7 participants is recommended

2. Class size should be limited to approximately 50 participants

D. Length of program

1. The TOT program for A Curriculum for Diabetes Care in the Schools is two full days.

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A. The following lecture content will be covered on Day One: Timeframe

1. History of the PEDS program (prepare a script from "About the Author" and the "Acknowledgements" pages)

2. Introduction to Training of the Trainers program (prepare a script from "Introduction to the TOT Program")

Phase I
- Master Trainer trains Qualified Trainers

Phase II Qualified Trainers train:
-other nurses (Recommendations & Basics)
-School Administrators (Recommendations)
-UAP's, other school staff (Basics)
-Parents (Recommendations)
-Healthcare providers (Recommendations)

3. Laws that support the provision of Healthcare Services in Schools for students with diabetes (prepare a script using applicable federal laws as well as individual state laws, regulatins and nurse practice acts:

-ADA-1990
-IDEA '97
-Section 504 of the Rehabilitation Act of 1973
-Case Law
-Applicable state laws, regulations and individual state's nurse practice acts

4. The Recommendations for Diabetes Care in the Schools (use written Recommendations in Section I for script)

5. Overview of the Manual

6. The NEW Individualized School Healthcare Plan (provide explanation on how to use this form, Section III)

7. Diabetes Basics (use narrative script on Diabetes Basics in Section II)

8. Questions & Answers

B. Training stations for Day Two:

1. Set up 9-10 separate tables. Divide entire group into 9-10 small groups (the number will depend on the number of product vendors who are represented. Label participant's name tags with a station number, having equal numbers represented; this will be the participant's station starting point. The following content will be covered:

a. Discussion of carbohydrate counting and display of food groups.

b. Discussion of treatment for hypoglycemia, demonstration of glucagon injection, & discussion of tools to use for glucagon trainings.

c. Discussion, demonstration & return demonstration of insulins, mixing insulins, and insulin administration

d. Demonstration & return demonstration of various tools for insulin delivery in a syringe.

e. Discussion, demonstration & hands on practice with insulin pumps

f. Discussion, demonstration & hands on practice with insulin pens

g. Demonstration and return demonstration of blood glucose testing using various blood glucose monitors

h. Discussion of urine & blood ketone testing

i. Question and answer table

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A. PEDS Manuals for all participants

B. CD-ROM (PowerPoint presentation or overheads) with accompanying scripts

C. Handouts for Day One

1. Handouts on relevant laws in state where training is held

2. Sample ISHP

D. Handouts for Day Two

1. Handouts specific to each training station

E. Equipment for each training station

1. Food models

2. Biohazard disposal.

3. Glucagon kit

a. Expired single vial kit of glucagon (preferred over two vial kit)

b. Empty insulin vials with metal top removed-fill with a pinch of powdered milk to simulate glucagon powder and label "DEMO, glucagon powder"

c. 1cc syringes filled with water to simulate glucagon syringe with diluent

4. Samples of products to treat hypoglycemia (Insta Glucose, Nite Bite, glucose tablets, etc)

5. Insulin syringes & vials of short and long acting insulins

6. Insulin delivery tools (EZ-ject, Autoject II, etc.)

7. Insulin pumps, mock ups

8. Insulin pens

9. Various blood glucose monitors

10. Ketone testing kit- blood and/or urine

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A. Participants will complete:

1. Pre & Post Diabetes Knowledge test

2. PEDS, A Curriculum for Diabetes Care in the Schools, Class evaluation

3. A Course Completion Roster for any subsequent trainings given

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A. Master Trainers will provide participants with a Certificate of completion on A Curriculum for Diabetes Care in the Schools that will include the participant's name, the Master Trainer's name, with title, and date of training (certificate included with each manual)

B. Trainers will keep a record of attendance (this typically includes the participant's name, title, phone numbers, address and e-mail).

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