On July 28, 2014, new South Dakota Administrative Regulations (ARSD) will become effective. These new regulations allow school employees (other than school nurses) to be trained in the subcutaneous (under the skin) administration of insulin and allows trained school employees to administer insulin to diabetic students (students with diabetes are usually on a 504 Plan or IEP).
Prior to these new regulations, only RN’s could administer insulin to students.
ASBSD has a new sample policy: Diabetes/Insulin Policy, NEPN Code JHDC. The policy can be found below.
Included in the sample policy is a policy provision that states employees who provide diabetes care shall be provided liability insurance through the school’s insurance coverage for incidental medical malpractice liability, and the school shall defend and indemnify the employee for any and all costs for which the employee may be liable, provided the UAP’s actions were consistent with the training received.
This provision is based on the coverage provided to members of the ASBSD Protective Trust that have liability coverage. The coverage includes incidental medical malpractice insurance for services performed by school employees such as insulin administration.
Schools should check with their own school attorney and liability carrier prior to adopting any policy related to the administration of insulin to ensure coverage for employees who are not RN’s and who administer insulin.
The new regulations can be found in ARSD Chapter 20:48:04.01, specifically 20:48:04.01:16 and 20:48:04.01:17.
NEPN Code: JHDC
The purpose of this policy is to establish procedures in the District for the administration of health care services for each student with diabetes as prescribed by that student’s personal physician. The goal of this care is to maintain blood glucose levels within a student’s target range and to enable a student with diabetes to safely and fully participate in the educational program.
Policy JHCD, Administration of Medications to Students, shall also apply to the administration of health care services for students with diabetes to the extent Policy JHCD is consistent with and not contradictory to this policy.
II. CARE TO BE PROVIDED
A. Diabetes care may be provided by a school nurse, if available, or by an Unlicensed Assistive Personnel (UAP) who volunteers to provide diabetes care and who has been trained pursuant to ARSD Ch. 20:48:04.01.
B. The delegation of insulin administration to an Unlicensed Assistive Personnel (UAP) is authorized by the South Dakota Board of Nursing rules, ARSD 20:48:04.01. A registered nurse (RN), holding an active South Dakota or multi-state compact RN license, currently practicing and employed as a certified diabetes educator (CDE) or RN currently-employed as a school nurse must be identified to be the delegating nurse to train, test competency, and oversee the process. In many cases, the delegating nurse will communicate with the student and UAP during the school day via video conferencing. The delegating nurse will be referred to as the “virtual nurse” in this policy.
- If a student with diabetes needs assistance with care for that condition at school or school-related events, and the services of a UAP is needed, the school shall seek school employees to volunteer to provide that care. The employee must be willing to accept the delegated task of insulin administration. No employee shall be required to be a UAP as a condition of employment. The employee must meet the South Dakota Board of Nursing’s Medication Administration training requirements as set forth in ARSD Ch. 20:48:04.01, which training shall be provided at school expense.
- Employees who provide diabetes care as a UAP shall be provided liability insurance through the school’s insurance coverage for incidental medical malpractice liability, and the school shall defend and indemnify the employee for any and all costs for which the employee may be liable, provided the UAP’s actions were consistent with the training received.
C. If the school provides diabetes care through a UAP, the school shall decide, after consulting with the parents/guardians, what agency (e.g., Avera, Rapid City Regional, Sanford, or a school nurse) will provide the virtual nurse support should the school utilize a UAP to provide the necessary care. The school shall then work with that agency to provide video conference calls to the virtual nurse. A secure internet connection shall be used to dial into the virtual nurse and which shall provide sufficient clarity so the virtual nurse can see the glucose meter and insulin pump screen, insulin pen doses, and insulin syringe lines. A dedicated tablet, laptop, or desktop with video capacity to support calls used to provide services pursuant to this policy shall be securely stored when not in use by the student and UAP.
D. If diabetes care is to be provided by a UAP, the virtual nurse must be available during school hours and must initiate a weekly interaction with UAP and student(s). The virtual nurse will maintain appropriate documentation related to interactions and weekly logs.
E. To the extent that the student is not able to perform this care independently, diabetes care provided by the school UAP shall be under the supervision of a school nurse or Virtual Nurse, and may include:
i. Checking blood glucose level at the times and under the circumstances specified;
ii. Responding to blood glucose monitoring results;
iii. Administering insulin through the insulin delivery system the student uses;
iv Administering oral diabetes medication;
v. Administering glucagon and taking the additional actions set out in the DMMP
vi. Checking for ketones;
vii. Recording blood glucose monitoring results and medication dosages and frequency in the weekly log; and
viii. Following instructions regarding meals, snacks, and physical activity.
F. If a student becomes unconscious or unresponsive due to severe hypoglycemia, school employees shall take actions as specified in the student’s DMMP and contact 911. No student experiencing hypoglycemia shall be left unattended or shall be sent alone to another location to receive care.
G. All school employees who have primary responsibility for a student with diabetes at any time during the school day or during school-sponsored activities may receive training covering basic information about diabetes and its management, how to recognize symptoms of hypoglycemia and hyperglycemia, and which school employees should be contacted for assistance in providing diabetes care.
H. Notwithstanding the other provisions in this section, a parent or guardian may elect to perform diabetes care for his or her child at school or during school-sponsored activities. The election should be made in writing and shall specify the circumstances under which the parent or guardian will provide care and the circumstances, if any, under which school personnel will provide care.
III. DIABETES MEDICAL MANAGEMENT PLAN (DMMP)
A. The parent of a student with diabetes who requests services from the school must provide written physician’s orders (Diabetes Medical Management Plan, or“DMMP”), signed by the student’s physician. The DMMP identifies the health care needs of, and services to be provided to, a student with diabetes. If the DMMP changes, the parents/guardians shall provide a copy of the changed DMMP, signed by the student’s physician, to the principal or principal’s designee, and to the UAP. The parents/guardians shall authorize the principal or the principal’s designee authorization to speak directly with the student’s physician related to the DMMP. The DMMP must contain:
- A list of the equipment and supplies, if any, that the student is permitted to carry during the school day;
- A statement that the student has been trained on the proper and safe use of medication and supplies needed at school, such as syringes and needles, if the child is to carry such supplies at school;
- A statement as to which, if any, diabetes care tasks the student is capable of performing without assistance, which of these tasks require assistance from school personnel, and which of these tasks the student is unable to perform;
- If the student requires assistance from the UAP with blood glucose or ketone monitoring;
- If the student requires assistance from the UAP with insulin, glucagon or other medication administration at school, the medication to be taken, the timing of medication administration, and instructions for calculating the proper dose;
- Instructions regarding activity monitoring and exercise plan;
- A chart with hypoglycemic recognition and treatment;
- A chart with hyperglycemic recognition and treatment; and
- Instructions for emergency Glucagon administration.
B. Once the school receives a copy of the DMMP, the school shall develop and implement a Student Health Plan (SHP) for the student with diabetes, that incorporates the provisions of the DMMP. The plan shall specify which school personnel or unlicensed assistive personnel (UAP) will provide diabetes care to the student, if needed. The school may use an individualized Student Health Plan, or include the DMMP in a student’s Rehabilitation Act Section 504 Plan (504 Plan), or include the DMMP in a student’s Individualized Education Program (IEP).
C. All supplies and equipment needed by the school to provide diabetes care, including insulin, glucagon, blood glucose meters, and test strips, shall be provided by the student’s parent or guardian.
D. The school may consult with a physician of its own choosing related to any DMMP.
IV. SELF-MONITORING AND TREATMENT
Where a student’s DMMP indicates that the student is able to perform specific diabetes care tasks independently, the student shall be permitted to perform these tasks independently while in school and while participating in school-sponsored activities. If specified in the student’s DMMP, the student shall be permitted to possess on his or her person all supplies and equipment needed to perform diabetes care.
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