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School Nurse Issue...Advice Please

Discussion in 'Parents of Children with Type 1' started by Anyelday, Sep 23, 2013.

  1. Anyelday

    Anyelday Approved members

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    We had a problem at my daughter's school today. They have a different nurse on Mondays- and she has only been there once or twice so far this year. She called me at 2:22 to tell me Eliza's blood sugar was 390 and she told me she didn't give her insulin at lunch because she only had 36 carbs and not 40. Eliza's ratio is 1:40. Eliza actually had 40 but I didn't write the popcorn down, but still...she should have given her 1 unit or at least half a unit. She had 40 carbs with no coverage. She also did not check for ketones at 390.

    I asked her to call Eliza to the office to correct her and thought I communicated to keep her there in the office to wait for me to pick her up. I did not want her to be corrected and then ut on the bus or put on the bus with a blood sugar that high. When I got to the school the nurse had corrected her and put her on the bus. Luckily, I was able to get her off and drive her home. The bus ended up being late and the kids were on there for an hour and I am pretty sure the bus drivers have not received any training at this point.

    It was a stressful day to say the least. I am just not sure how this should be addressed. The nurse apologized and told me she is learning...but it makes me worried that she clearly knows so little about Diabetes. I am not out to get anyone...but want my child and the 3 other T1 kids at that school) to be safe.

    We have a 504 plan that states she shouldn't get on the bus that high and that she should be checked for ketones over 250. The regular nurse usually does not correct kids and then put them on the bus.

    Any advice would be greatly appreciated
     
  2. KatieSue

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    Would it be possible to make a sort of cheat sheet with just clear bullet points for the Monday nurse? Maybe that would give her clearer direction? It sounds like at least she realized she'd been mistaken and is willing to correct.

    Something like-

    1. If over 300 and corrected do not put on bus please call Mom.
    2. If lunch is less than 40 carbs give a half a unit.
     
  3. ksartain

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    This nurse needs serious training on your child. If it were me, I would e-mail the regular nurse and the principal, let them know what happened, that the 504 plan was not followed and that you want this nurse to be trained to your child pronto. It doesn't matter if shie's only at the school once a day. She needs to know that diabetes management plan better than she obviously does.

    A cheat sheet would help, yes, but she should know that plan anyway.
     
  4. missmakaliasmomma

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    I would be livid. You need to go to whoever you have to to make sure that they train her. No coverage for her carbs? you seriously don't need to be a genius to know to cover them. I'm mad even knowing you and your daughter went through this.
     
  5. virgo39

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    I am glad you were able to get your daughter and that she was okay.

    We have had a couple of issues with substitute nurses, fortunately nothing that had serious consequences. Each time, I raised it with the regular nurse. I inform her what happened and ask her what we need to do to avoid the problem in the future. Each time, she has apologized, indicated that she will speak with the sub, and we review and reconsider the care plan and other instructions that we have in place. We have made changes to procedures and instructions and the subs have been told when they make an error.

    People, especially those who are not dealing with this every day, are likely to make mistakes. I would review the care plan to make sure the bolusing instructions are clear regarding dosing and make sure the sub understands them.
     
  6. Lizzy731

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    Meet with the principal and regular school nurse or first write them an email explaining how the nurse was not in compliance with the 504...if you don't get a satisfactory response or plan of action to properly train her (or worse yet, it happens again) then call the hotline that will report them.
     
  7. mmgirls

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    You need to review the doctors orders and how the school nurse has interpreted them on paper for other nurses to follow.

    Many kids on MDI do not use 1/2 units and only full units. So while we as parents would either do a 1/2 unit or have the kiddo have a few more carbs so that they got a bolus a nurse may not.

    Also many Dr orders have to check ketone after 2 high readings.

    Either way, you need all nurses to do the same thing with your daughter or at least call you for guidance
     
  8. mmgirls

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    I don't see this as being a "504" issue but more so as a health care plan and the RN license on the line.

    While I know that many people/schools have medical management written on 504's , when push come to shove, it is the nurse that is on the line.

    At least that is how I view it.
     
  9. bisous

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    I don't know, I think you can work with this woman. While it seems clear to ME that she should have at least received some insulin, it is also clear (and comforting) that at least she understands that giving too much insulin is a real danger and she was attempting to be precise. I wouldn't go to the principal after this issue if it were me. It seems like it was a mistake rather than a deliberate attempt to thwart the 504 and I think she still sounds teachable! If it were me, I'd leave my phone number and have the Monday nurse call in before dosing/treating until she gets the hand of it. I have hope for this nurse!
     
  10. swellman

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    Yea, I'm torn here. I'm not sure why they would not administer ANY insulin because the carb count was off. However, correcting a high isn't anything to freak out about.

    I would work with them but I do think you will find that, with experience, these things seem way worse than they actually are. I don't think any child will go into DKA on a bus ride home. That's not to say I would want my child in the 300's or 400's for an hour but that stuff happens and we just have to deal and adjust. IMO.
     
  11. mmgirls

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    I think it might be more a fear of a low afterwards on a bus without trained persons, not DKA.

    Knowing my school and reading doctors orders for MDI, there are many times that kiddos are not given insulin when they have not made their carb ratio. And end up coming back for a correction.
     
  12. swellman

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    Bus drivers aren't trained???
     
  13. mmgirls

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    Just going by what she said.
     
  14. Mimi

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    This seems a very reasonable course of action given the circumstances.
     
  15. Anyelday

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    I was more worried about her going low after the correction. She ate at 10:30 with no correction and they called me at 2:30. When she gets corrected with no food she can drop pretty fast and our buses are known for being late and/or breaking down. They were on the bus for over an hour yesterday.
     
  16. Anyelday

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    No. Apparently they are working on it :( . There are two kids with type 1 on our bus and our driver has not been trained. I gave our driver the pamphlet from the toolkit from JDRF and he gave it back to me.
     
  17. Lizzy731

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    Our 504 has issues like this in there. It's more official and protects the child and parents if the school isn't following what is required. My husband is a school psychologist and deals with these things all the time.
     
  18. hawkeyegirl

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    Our bus drivers are not trained. And really, I have very little confidence that a bus driver could/would administer glucagon if in that situation anyway. Our bus driver knows Jack has D. Our 6 year old knows that if he starts acting funny that she is to get the juice out of his (or her) backpack and ask him to drink it. Frankly, if the worst happened, I'd probably just want the bus driver to go straight back to the school or straight to our house. Neither would be more than a couple of minutes away.
     
  19. Anyelday

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    The bus did actually break down yesterday which seems to happen at least once a week. Apparently Charleston uses the oldest buses in the country.

    The principal and the regular nurse actually called me today and we were all in agreement that the Monday nurse needs more training so that she can properly care for Eliza and the other D kids. I told them that there is a nurse liaison who worked with our D team that would be happy to help her and fill in any knowledge gaps but I am not sure they will take me up on the offer. At the very least, the regular nurse will go over things with her. I will also have her call me and verify BG and dosing for at least a few weeks until she feels more comfortable.

    Although I was upset I really just want to prevent this from happening again and do my best to build positive relationships with the school staff. She is only in Kindergarten and has many years of school ahead of her.
     
  20. GreatSambino

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    Agreed. The principal and the regular nurse should understand what happened, and how serious the consequences would be. Then the other nurse needs some serious training. When we have a sub in, the rule is that they call me at lunch and if anything out of the ordinary is going on. Our normal nurse is amazing, and she reiterates to any subs to do so. It has worked out well so far.
     

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