Introduction
This policy should be read and implemented as part of the school Medical Policy.
Objectives
The prime objective of this policy is to ensure that a child’s Diabetes is managed in the school in such a manner as to ensure that she participates fully in the life of the school and benefits fully from the educational opportunities offered.
The policy aims to ensure that clear, safe and medically sound procedures are in place for the child as part of her daily routine.
The policy aims to ensure that clear, safe and medically sound procedures are in place in the event of child entering a state of Hypoglycaemia or a state of Hyperglycaemia.
The policy aims to ensure that all those involved in the management of child’s diabetes are fully aware of this policy and of the procedures contained within it. It further aims to ensure that all of these people are in agreement with these procedures.
This policy aims to clearly delineate the responsibilities of the school and its employees in relation to the administration of insulin to the child and in their response to her entering a state of Hypoglycaemia or Hyperglycaemia.
This policy includes an Indemnity (Appendix C) which indemnifies the Board of Management and school staff in relation to medical procedures or the administration of medicines as they might apply to the child.
Actions for the Board of Management
The Board of Management has responsibility to:
» Develop school guidelines for diabetes management during school and school outings.
» Ensure substitute personnel are aware of the needs of a student with diabetes and the Diabetes Emergency Plan.
» Arrange for diabetes management training for staff members with responsibility for students with diabetes.
» Alert all school related staff members who teach or supervise a student with diabetes. Ensure that they are familiar with emergency procedures.
» Have sufficient knowledge of diabetes to make informed decisions regarding the safety of students.
» Support and implement the Healthcare Plan (policy) and Emergency Diabetes Plan agreed by the school and the student’s parents.
Actions for Teachers
The Teachers have responsibility to:
» Participate in the school meeting with parent(s) and all relevant staff.
» Work with the school team and the parents to develop a written Healthcare Plan (policy) including a specific Diabetes Emergency Plan for the student.
» Be prepared to recognize the triggers, respond to the signs and symptoms of hypoglycaemia and hyperglycaemia and know what to do in an emergency.
» Maintain effective communication with parent/guardians including informing them if their child has been unwell at school through a record book, any changes to regular school day, increased/decreased activities, stress/high anxiety levels. Extra/less food/drink.
» Provide a supportive environment for the student to manage their diabetes effectively and safely at school. This may include unrestricted access to the bathroom, drinking water, snacks, blood glucose monitoring and adequate time/supervision of all necessary food eaten at break times.
» Treat the student with diabetes the same as other students except when meeting medical needs.
» Ensure the hypo kit is stored in a safe place in the staffroom and available to the student in the event of hypoglycaemia. This hypo kit will be provided by the parent.
» Ensure that the student with diabetes has the appropriate medication or food with them during any exercise and are allowed to take it when needed. This also includes blood glucose monitoring when needed during the school day.
» Provide alternative options for unplanned vigorous physical activity by allowing an extra snack provided by the parents to be eaten, for every 30-40 minutes of activity.
» Provide information for substitute teachers that communicate the day-to-day needs of the student with diabetes and the Diabetes Emergency Plan.
» Attend diabetes management training if deemed necessary.
» Send hypo kit home at the end of each term.
Actions for Parents/Guardians
The Parents/guardians of a student with diabetes have responsibility to:
» Inform the Board of Management, school Principal and the teacher that their child has diabetes.
» Attend and participate in the school meeting to develop a written Healthcare Plan (policy) to meet their child’s needs.
» Provide accurate emergency contact details and develop a Diabetes Emergency Plan for their child.
» Inform school staff of any changes in their child’s health status.
» Provide the school with necessary equipment such as a hypo kit* and replenish supplies as needed.
» If their child is having abnormally high BGL over a period of time, it is their responsibility to check the ketone levels and inform the school of these levels.
» Ensure their child’s meter medication is labelled with the child’s full name.
» Ensure medication and all necessary equipment is within the expiry date.
» Bring medication home from school on the last day of each term and return it to the school on the first day of each new term.
» Provide the school with appropriate treats for their child on Fridays (treat day).
» Provide the school with a list of appropriate treats for special events such as parties.
» Ensure child’s name wears a Diabetes ID on school trips.
» If a school trip is between 1hour to 1½ hours away, it is vital that one parent will attend in a separate car.
*Hypo Kit – contains blood glucose meter, testing strips, finger pricking device with lancets, Lucozade, cereal bar, Actimel (normal, not 0%) kept in fridge,
non-alcoholic wipes, Glucogel and Glucagon injection.
Policy Stakeholders
The following are the current stakeholders in this policy:
The Child
Name of child
Family
Mother’s name
Father’s name
School
- The Board of Management of Name of school
- Principal: Name
- SNA: Name
- Class Teacher: Name
Medical
Dr. Name & Dr. Name, Diabetes & Endocrinology Consultant, Hospital name
Name, Name, Name, Paediatric Diabetes Nurse, Hospital name
Dr. Name, pupil’s G.P.
Note: All Policy Stakeholders will be consulted in the drafting of this Policy and all will agree to be bound by the procedures set down in it.
Conditions under which child’s name is accepted as a pupil in the school
- The Department of Education & Skills (DES) has access to a SNA to meet child’s care needs during the school day.
- The Health Service Executive co-operates with the school in the management of child’s diabetes during school hours by providing training, advice and emergency cover to the school as required.
- Parents are contactable by mobile phone at all times and are available to come to the school in the event that they are required to deal with her treatment, as outlined in this policy.
- The Board of Management is satisfied that the school has the facilities and support to safely monitor and manage child’s Diabetes while she is at school.
- Child’s name parent /guardian will demonstrate the use of medicines/ injections to the relative staff dealing with child, during each term.
- In the event of child’s medical care plan being reviewed or changed, the child’s parent/guardian will attend the school daily for a period of time until:
- The Child and her SNA are comfortable carrying out the procedures outlined in the policy.
- All necessary supports and agreements have been put in place.
Definitions in relation to Child’s name Diabetes
BSL Blood Sugar Level
Normal BSL Range 4 to 10 (4 is the floor)
Mild Hypoglycemia < 4
Severe Hypoglycemia < 2
Mild Hyperglycemia > 10
Severe Hyperglycemia > 14
Insulin Pump No pump
Insulin Type Novorapid (Rapid Acting Insulin)
Insulatard (Long Acting Insulin)
Carb Count The amount of carbohydrates in the child’s snack/lunch
Insulin Dose In the event that the child will need insulin injections during the day, the parents will determine the amount of insulin required to deal with the carbohydrate count in the child’s snack/lunch. Parents will calculate this figure and write it in a diabetes record book each day for the SNA’s guidance. The SNA will record this figure in the record book
Record Book It will be used to record any additional doses of insulin or Actimel (sugary drink) given to the child during the school day. The result of all BSL checks will also be entered into the record chart. If either SNA or Class Teacher is unavailable to record BSL, the Principal will take over this duty.
Symptoms relating to Hypoglycaemia (Specific to name of child)
Authority of these symptoms
The School has been advised by the child’s parents/guardian that the following may be / can be symptoms displayed by her in the event of entering a state ofHypoglycaemia:
- Mild Hypoglycemia
Pale, Hungry, in a quiet mood, lethargy,
- Moderate Hypoglycemia
Pale, very tired
- Severe Hypoglycemia (Emergency)
As above, but BSL will be lower
Symptoms relating to Hyperglycaemia (Specific to Child’s name)
Authority of these symptoms
The School has been advised by the child’s parents/guardians that the following may be / can be symptoms displayed by her in the event of entering a state ofHyperglycaemia:
- Mild Hyperglycemia
There are often no symptoms.
- Moderate Hyperglycemia
Slightly grumpy, lack of concentration, tired, thirsty, going to toilet after drinking water
- Severe Hyperglycemia
Moderate: Increased urine output, increased thirst and drinking, tiredness,
Serious signs needing immediate attention: nausea/vomiting, lethargy, deep and rapid breathing, sweet smell from breath, rapid heartbeat.
Procedure for checking BSL
- The Child’s BSL will normally be checked four times per day – immediately prior to her consuming meals and bed time.
- Further BSL checks will be carried out at the discretion of the SNA, Class Teacher or Principal.
- The BSL check will be carried out by the Child’s SNA. The SNA will communicate these results to the Class Teacher. In the SNA’s absence, the Class teacher will check the BSL. If either SNA or Class Teacher is unavailable to record BSL, the Principal will take over this duty. In the event of the SNA, Principal and Class Teacher not being available on a particular day, the resource teacher will be required to check her BSL. In the unlikely event of all these personnel being unavailable the parent/guardian will have to come to the school to check the BGL.
- If none of the above people are available to check the child’s BSL, the Deputy Principal, or Acting Deputy Principal, will contact (Dr Name, Address) to arrange for the child’s BSL to be checked. If he/she is not available the Principal or Deputy Principal will ring CUH in advance, an ambulance will be called and the child will be sent to Hospital. The Child will be accompanied by her record book and a staff member.
- The result of each BSL check will be recorded on the record book and sent home each evening.
- All equipment used to check the child BSL will be stored in a marked box in the staffroom. It will be the responsibility of the SNA/Class Teacher to ensure that all equipment used is returned to the box immediately after use. It will be the responsibility of the SNA/Class Teacher to ensure that the box is then stored in a manner which will ensure that no child in the class has access to the box.
Procedure for the administration of food and insulin bolus under normal conditions
- When the class teacher announces that it is time for the children to eat their lunch
- Child’s name will wash his/her hands
The SNA will:
- Discreetly check and supervise child’s name BSL
- Allow child’s name to have his food immediately after BSL check
- Adequate time allowed for all of above and discreet observation of all snack/lunch consumed.
- The SNA and Class Teacher will periodically monitor child’s name during the school day for symptoms which might indicate the onset of Hypoglycemia or Hyperglycemia.
Procedure to be carried out in the event of the SNA becoming aware that child’s name is entering a Mild State of Hypoglycemia – (BSL < 4) 4 is the floor
This procedure will be carried out in accordance with hospital guidelines i.e. hospital staffs agree that the following procedures are in accordance with hospital guidelines:
The Child may not feel the warning symptoms of a Hypo.
Never leave the Child without adult supervision during a Hypo event.
- Step 1: In the event of a BSL of < 4, the SNA will immediately give the Child 90ml of Lucozade to raise the BSL.
- Wait 15 minutes, check BSL.
- If BSL has returned to normal, child’s Christian name must have a snack accordingly to the parent’s/guardian’s guidelines and can continue with her normal activities.
- Step 2: If BSL is still <4, the SNA will give the Child another 90ml of Lucozade to raise the BSL.
- Inform the Child’s parent(s)/guardians.
- Wait 15 minutes, recheck BSL.
- If BSL has returned to normal, the Child must have a snack and continue with her normal activities. Inform the Child’s parents/guardians.
- Step 3: If BSL is still <4, the SNA / Class Teacher will give the Child another 90ml of Lucozade to raise the BSL. The Child G. P. should be informed. At this stage, the Child’s parents/guardians should be on the way to the school to collect the Child. If parents/guardiand cannot be contacted, use the phone policy.
NOTES:
- This Lucozade will be stored with the Child’s medical kit. It is the responsibility the parents/guardians to ensure that there is always a bottle of Lucozade in case of emergency. It is the responsibility of parents/guardians to ensure that the bottle of Lucozade is replaced once it is opened. They must ensure that the Lucozade is within its sell-by date.
- A measuring vessel and glass will be kept with the Child’s Medical Kit, in order to measure out 90ml of Lucozade accurately. The glass will be used by the Child to drink the Lucozade.
Procedure to be carried out in the event of the SNA becoming aware that the Child entering a Moderate state of Hypoglycaemia – (BSL < 4 even after 3 doses of Lucozade has been administered)
This procedure will be carried out in accordance with hospital guidelines i.e. hospital staffs agree that the following procedures are in accordance with hospital guidelines:
- In the event of a BSL of < 4, the SNA will immediately squirt Glucogel down into the sides of the Child cheeks and rub the outside of her cheeks. The capillaries in her cheeks will absorb the glucose which is necessary to raise her BSL.
- The Child’s parents/guardians should be on their way or in the school at this stage. Follow phone policy if either cannot be contacted.
- Watch the Child continuously for the symptoms of continued Hypoglycaemia, as advised by parents.
- Re-check BSL after 15 mins.
- If the BSL is normal, inform parents/guardians of the result and the Child will be sent home.
- If the BSL is abnormal, follow next procedure of severe state of Hypoglycaemia.
Procedure to be carried out in the event of the SNA becoming aware that Child’s nameis entering a Severe state of Hypoglycaemia –(BSL < 2 even after following steps in Mild and Moderate state of Hypoglycaemia)
This procedure will be carried out in accordance with hospital guidelines i.e. hospital staffs agree that the following procedures are in accordance with hospital guidelines:
- In the event of a BSL of < 2, the Child will be put in the recovery position. Her breathing will be checked.
- The parents/guardians will prepare and administrate Glucagen injection. In the event that the Child’s parents have not arrived in the school a member of school staff may prepare and administrate the Glucogen injection. This depends on which member of staff is trained and confident in preparing and administrating the Glucagen injection in the school.
- The Child will be continuously watched for the symptoms of continued Hypoglycemia, as advised by the Child’s parents/guardians.
- Re-check BSL after 15 mins.
- If the BSL is normal, inform the parents/guardians of the result and the Child will be sent home.
- If the BSL is abnormal, call emergency services.
Procedure to be carried out in the event of the SNA becoming aware that Child’s name is entering a Mild State of Hyperglycemia – (BSL >10)
- This procedure will be carried out in accordance with hospital guidelines i.e. hospital staffs agree that the following procedures are in accordance with hospital guidelines
- In the event of a BSL of > 10, the SNA / Class Teacher will immediately call the parents/guardians and give the Child water. The Child has unrestricted access to water and the toilet.
- Recheck BSL after 30 mins
- If the BSL is normal (5-10), inform the parents/guardians and carry on as usual
- If the BSL is abnormal (remaining the same or rising), water should be given to the Child. Call the parents/guardians to come into the school to deal with the situation. If Mother’s name cannot be contacted, use the phone policy.
Procedure to be carried out in the event of the SNA becoming aware that the Child entering a Severe State of Hyperglycaemia – (BSL >14)
This procedure will be carried out in accordance with hospital guidelines i.e. hospital staffs agree that the following procedures are in accordance with hospital guidelines
- In the event of a BSL of > 14, the SNA will immediately call the parents/guardians to come to the school as the Child may need extra insulin. Give the Child unrestricted access to water and toilet.
- Recheck BSL after 30 mins. Give water to the Child.
- If the BSL is normal (5-10), the parents/guardians and carry on as usual
- If the BSL is abnormal (remaining the same or rising), water should be given and the Child sent home.
- If the BSL remains abnormally high over a period of time it is the parents/guardians responsibility to check ketone levels and inform the school of this.
- If the Child’s BSL is continuously high when she is tested at break time over 2 weeks, that her medication will be reviewed.
Procedure to be carried out when making phone calls in the event of an emergency in relation to Child’s name condition
- Two calls will be made to the Child’s parents/guardians (Landline/Mobile) on both her home number and her mobile phone. If she cannot be contacted, the school will make:
- Two calls to Dr. GP’s Name (Phone Number) at his surgery. If he cannot be contacted or is unavailable, the school will make
- Two attempts to contact one of the three Pediatric Diabetes Nurses,
Name, Name or Name (Telephone No. or Mobile) in Hospital name. In the event of the Pediatric Diabetes Nurse not being available, the school will contact the Pediatric Registrar on call.
If the Pediatric Registrar on call cannot be contacted, the SNA/Class Teacher/Principal will wait for a maximum time of 30 mins before rechecking Child’s name BSL. If the BSL still indicates a problem, the SNA/Principal will call an ambulance to take Child’s name to hospital and will:
- Call Hospital in advance
- Send Record Card with Child’s name
Authentication
The following have read the above Policy and are in agreement with all of its provisions.
| Name | Signature | Date |
| GUARDIAN ONE Name | ||
| Guardian Two | ||
| Family GP Dr. Name | ||
| Diabetes Consultant, Hospital Dr. Name | ||
| Pediatric Diabetes Nurses, Hospital Name Name Name | ||
| Chairman BOM | ||
| Príomhoide | ||
| SNA | ||
| Resource Teacher | ||
Review
This policy will be reviewed on an annual basis, at the beginning of each school year. All of the parties concerned will be asked to contribute to such reviews. Any suggested changes will be inserted and circulated for approval by all parties. In the case of any change in the Child condition which necessitates it, the policy will be immediately reviewed.
It is scheduled for review again in September 2017
Appendix A – List of Phone Numbers
| Name | Telephone Number |
| Mother’s name Mother of Child’s name | Landline / Mobile |
| Father’s name Father of Child’s name | Mobile |
| Dr. Name Family Doctor | Telephone Number |
| Name, Name, Name Children’s Diabetes Nurses | Telephone Number / Mobile |
| Ask for the Pediatric Registrar on call (Hospital switch board) | Telephone Number |
| Ask for the ??? Ward, Hospital name (Hospital switch board) | Telephone Number |
| Name Clinic Nutrition Dietician | |
| Diabetes Clinic Appointments | Telephone Number |
| Eye Clinic Appointments | Telephone Number |
Appendix C – Indemnity
THIS INDEMNITY made on _________________ BETWEEN
Father’s name (lawful father of Child’s name of
Address
and
Mother’s name (lawful mother of Child’s name of
Address
(Hereinafter called the ‘parents’) of the One Part
AND for and on behalf of the Board of Management of School situated at School Address (hereinafter called ‘the Board) of the Other Part.
WHEREAS
The parents are respectively the lawful father and mother/lawful guardians of _______________________, a pupil of the above school. The pupil suffers on an ongoing basis from the condition known as Diabetes. The pupil requires that a medical procedure, as described in the attached policy, be carried out a number of times daily and that medicine be administered to the pupil on a daily basis.
The parents/guardians have agreed that the said medical procedures be carried out by a Special Needs Assistant or by the Class Teacher or by the School Principal and that said medication be administered by a Special Needs Assistant or by the Class Teacher or by other persons as may be designated from time-to-time by the Board.
NOW IT IS HEREBY AGREED by and between the parties hereto as follows:
In consideration of the Board entering into the within Agreement, the parents, as the lawful father and mother respectively of the said pupil HEREBY AGREE to indemnify and keep indemnified the Board, its servants and agents including without prejudice to the generality of the said pupil’s class teacher, the Principal or Special Needs Assistant or by other persons as may be designated from time-to-time by the Board from and against all claims, both present and future, arising from the carrying out or not carrying out of the said medical or from the administration or failure to administer the said medication.
IN WITNESS whereof the parties hereto have hereunto set their hands and affixed their seals the day and year first herein WRITTEN.
SIGNED AND SEALED by the guardian(s) in the presence of:
_____________________________________________________________
Guardian Principal’s name
SIGNED AND SEALED by the parents in the presence of:
____________________________________________________________
Guardian Class Teacher name