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3 Major Nursing Errors

Discussion in 'Parents of Children with Type 1' started by Mo1, Feb 11, 2015.

  1. Mo1

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    What to do?
    1. First day of school the nurse did not give DD a bolus for lunch and she was too high at the end of the day to get on the bus
    2. A month later or so DD accidentally pulled out her pump site at school. I guided the nurse through changing the cleo over the phone. At the end of the day she was over 400 and going up, nurse randomly changed tubing on the pump and didn't prime insulin. She'd not had basal insulin for most of the day. Had to call Endo hotline to help with extra dosages
    3. Today sub nurse did not follow doctor's orders and did not dose DD before lunch. She waited an hour after eating to take BG which was 312. She gave her a correction and the bolus for the food at the same time so she gave her essentially a double dose/insulin o.d. for the same event. Then she had the nerve to say DD gave herself too much insulin. At the end of the 69' shakey and Dex going downhill. She gave her 5 tabs to get her up to 102 and she still had 2.5 IOB (equiv of approx. 50 carbs). I had her give her juice and then headed to pick her up. Too low to ride the bus.
    I've followed up with the lead nurse (over sees paperwork), principal etc. Earlier in the year after the first 2 incidences, I had Tandem rep give a training to the nurse. Worried a lot when she's at school.
     
  2. Sarah Maddie's Mom

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    Do you have a 504 plan?
     
  3. Mo1

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    Yes, there is a 504 plan in place. The lead nurse has claimed that the DMMP violated the nursing care act, because doctor gave me authority to change insulin dosing without getting a new order each time. Been consulting with legal on that issue, and that the school is claiming they don't have to cover some extracurricular activities because it is another entity providing it. Just not sure what to go next about the nursing errors. Feeling a little exhausted.
     
  4. Sarah Maddie's Mom

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    You have to break it down into parts. The first is your relationship with the nurse. Much as it may be difficult, you two have to get along for your child to be safe. I'd suggest meeting with her and kindly and gently and respectfully communicating that you have some concerns and seek her assistance with resolving them. Bring a bunch of infusion sets and offer yourself as the test subject. Walk her through the process again. We never asked the nurse to do a site but that was more about my kid's comfort level than my lack of confidence in the nurses, but if you want her to change a site then you must make sure she knows how and feels comfortable and confident.

    Start there and then brainstorm with her about how best to train and communicate with Subs. You really have no choice, short of threatening legal action, but to do your level best to make sure that you have provided the best training and the most open communication.

    If you can get her on your side then the "nursing care act" won't be so much of a weapon for her to use to cover her discomfort, anxiety and lack of confidence.

    As for the after school activities the law is clear and you can find all this on the ADA's site, kids with "disabilities" cannot be excluded from after school activities and must be provided accommodations. That was added to the Act a year or 18 months ago.

    Good luck!
     
    Last edited: Feb 12, 2015
  5. virgo39

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    I completely agree about breaking it down and putting the relationship with the nurse first. If it were me, I would not have the nurse do site changes and set up a backup plan using injections while working on getting the at school bolusing done correctly. Your DD is young, but does she understand the procedure? It's a lot to ask a child to advocate for herself, but if she knows "it's lunchtime, I need to see the nurse before eating," and the lunch supervisor knows to send her to the nurse, that could help.

    Once the bolusing was working, I'd think about the nuances of the pump.

    Good luck,
     
  6. Portabella

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    I remember somebody on this forum writing about this before - nurse not bolusing and not priming the set, and the child being too high for a bus. My DS is only 3, but I'm really not looking forward to school :(
    Can you tell me about these highs and lows requirements for the bus? Why won't the bus take "too high"?
     
  7. Sarah Maddie's Mom

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    Not the OP but we always set our own thresholds for dismissal. I don't recall ever having a "too high" for the bus. If she was crazy high and not feeling well as a result I'd just pick her up but if I recall correctly she had to be >100 to ride the bus and she always had juice and tabs with her and too, the driver had a back-up emergency kit.

    It's worth bearing in mind that "school nurse" threads are, by their nature, almost always written to seek help with a problem. Very few members put up a thread stating "Things are great! Our school nurse is the BEST!" so don't assume that this thread represents the norm. Most Type 1 kids in US public schools get good, even great, support from their schools.
     
  8. Christopher

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    Just echoing what Sarah said. Danielle has been doing this since she was 8 and has been through 1 elementary school, 2 "middle" schools and is currently in High School. For the vast majority of the time she has had great experiences with the school nurses and the school administration themselves. They have been very accommodating and have taken good care of her. Yes, I did have to do some advocating in the beginning, but I kept it civil, firm and educational in tone and things went fine.
     
  9. jenm999

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    I think this is a good point. We have a great school nurse and I feel she's a critical part of our team, always looking out for my son.

    That said, I think until a nurse has had a T1 in their regular care, they understand the big picture better than the mundane details, which can vary from kid to kid. For instance, in our 504 meeting, our nurse (who is new this year) was very adamant to the other staff that my son should NOT take himself to the nurse when low. But she was not familiar with our therapy regimen because her last and only prior student with T1 was on NPH and had a carb "allowance" at lunch but no bolus.

    I found that making a "cheat sheet" of what I expected, apart from the endo's orders, apart from teh 504, in plain English, was really helpful for her and me (and when we have a sub it's invaluable). I also set up a pump training for her with our Tandem rep. My son inputs his own numbers and waits impatiently to hit DELIVER once he gets the thumbs up from an adult so he can run off to be with his friends. Having the chance to play with the dummy pump, practice clearing the tubing of bubbles with saline, verify the correct basal profile was set, etc. made her much more confident.

    HOWEVER, the instances you describe are truly outrageous. I don't know how an RN could not understand that insulin must be given with a meal and that a simultaneous correction and late bolus without food would be an overdose. I would be livid. I think the advice you've been given here is good.
     
  10. momof1CWDinohio

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    I agree about the poor decisions the nurses have made at school. They are outrageous and very very frustrating. I think the advice you've been given about how to handle this is excellent.

    However, I will say that even almost 5 years in, my husband (who admittedly is not an RN and doesn't do most of the day to day, but he does enough to know better, and he is our Nightscout tech guru and very up on all the research) can make some very bad decisions about diabetes care. He recently overdosed my son while he was skiing -- somehow, I forgot to bolus his breakfast; instead of either correcting the high OR belatedly dosing the carbs, my husband did both.

    Ugh! Can't believe he would make that mistake 5 years after dx. This doesn't AT ALL excuse the RN's decision making -- they should know better. But I think sometimes the people who aren't doing the bulk of the day to day management don't always make the decisions that come like second nature to the rest of us.
     
  11. Mo1

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    Thanks for the replies. My DD is on the bus for an hour or an hour and 15 min. each way. If she is too high or too low that is my decision at the end of the day to make. It wouldn't be a big deal if it was a short ride. There is no supervision on the bus for her so it is a day to day decision.

    I have a good relationship with the agency nurse who does her day to day care but have found frustration with the nurse from the school district who comes to the school once a week to oversee the medical portion of the school. The agency the district contracts out for doesn't seem to send nurses with diabetes training to cover. It is the agency nurse who made the first few mistakes, but we worked through them.The school forwarded my concerns to the agency about this last incident. One of the previous sub nurses in December lied to me about when my DD was dosed for lunch, and falsified her documentation as part of the nursing log. I printed out the tandem report yesterday too and sent it with the email of concerns. Not feeling a lot of trust right now. Am happy that her regular agency nurse was back today. She knows my DD diabetes pretty well now....
    I agree about not wanting to have them change a site at school but my distance from the school at the time warranted it. Hind sight of giving an injection and then going to pick her up would have been a better idea. Well, I'm learning a lot about advocacy, and problem solving diabetes related issues.
     

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