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Dealing with mistakes?

Discussion in 'Parents of Children with Type 1' started by samson, Sep 28, 2016.

  1. samson

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    How do people deal with mistakes by caregivers? Our son was at preschool yesterday and went so low during nap that Dexcom simply read "LOW." We got him back up eventually but it became apparent that no one had been monitoring his receiver because they did not fully understand who was in charge and the people on the floor weren't clear on the procedures in the first place. It's been a chaotic time there, with the head teacher quitting last week and a bunch of subs taking her place while they hire a replacement. The other two well-trained teachers were on lunch break. This is the first time he's been seriously low at daycare since he got on a pump, but it's the scariest scenario, as he was sleeping with a ton of IOB.

    I want ensure my son's safety but also realize that mistakes happen (we sure have made them) and that the teachers have a lot on their plates right now. How do I get across the importance in a diplomatic way and make sure this doesn't happen again? No need for shame or guilt but want to increase the vigilance and knowledge level. We've already done three education sessions and we have a simple, clear, poster with the guidelines stated.

    Thanks for any suggestions.
     
  2. forHisglory

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    It sounds kind of unstable with the change in staff lately. I think I would inquire about a personal aide that stays with him at all times citing the last incident. Or looks for another situation/school. Safety of your son has to come first and if they cannot get the hang of it, it's time to look elsewhere. That is just my personal opinion. It sounds like you have done everything you can to educate them!
     
  3. Snowflake

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    I know you said you've done three trainings, but maybe you could offer another training once the new teacher comes on board? We once re-trained a preschool teacher at her own request after staffing changes led her to assume more responsibility for our daughter's care. I know that trainings are time-consuming, but you'll need to do it for the new teacher anyway, right? And that training might be a good time to emphasize the dangers of serious lows.

    Maybe also ask for a conversation with the director to ensure that the school keeps your son's care in mind when scheduling breaks?

    Finally, where does he wear the receiver and is the volume turned up as high as it will go? Our daughter's preschool was so joyously loud that we had to jack it to top volume for the teachers to hear the alarm.
     
  4. Brhodes

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    That's pretty much he entire reason for nightscout and share. You don't even need a data plan if the school has wifi. We've given up on depending on anyone but us to monitor. I'm assuming there's someone at the school you could call if you need to.
     
  5. samson

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    Snowflake, I think the volume was off or reduced somehow on the receiver, good point! Maybe we need to set up some kind of ultra-loud alarm once it drops below 70.

    Brhodes, we do have Share and NightScout -- which is how we spotted the problem and went to treat him. And we have another teacher's number but she's not a primary preschool teacher, so not the best person to ask when issues come up. I think we need to press for a teacher to carry a cell phone, even if we need to provide it. At least that way if something is missed we can contact them to check.

    forHisglory if this continues perhaps we can look for another care situation. He is only 2 at a private preschool so getting him a full-time aide would require finagling money from the city coffers, a bureaucratic nightmare that already has my head spinning.
     
  6. Nancy in VA

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    I think I'd ask for another meeting with the director. Ask for a documented plan to show which TRAINED adult will be physically near your child at all times.

    My daughter is older and monitors her Dexcom herself. We have share and it is set to alarm US as soon as she gets the low alarm. she is to text me with a simple message - "Treated the low". I have told her, her teachers, and the nurse, that if I don't get that text, they will be getting a call from me to make sure she isn't passed out in a bathroom or something. Maybe you could have a similar protocol - the school texts you to acknowledge they are addressing a low alarm on the Dexcom.
     
  7. samson

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    Nancy, They are supposed to text when he's been treated. That's how I spotted the low this time, as there was no text message and he dropped slightly below his fast-acting carb threshold, to 78. He just dropped incredibly fast on the five-minute drive to daycare. And this time there was a teacher sitting two feet from him who had no idea she was responsible for CGM monitoring.

    Realizing now that there's also no protocol for who to call to immediately ensure treatment. The protocol can't be that one of his parents drops everything at work to drop a glucose chew in his mouth.

    Really seems like we need to have a clearer plan so everyone knows who's monitoring him at all times, and better lines of communication. It's unrealistic to imagine he'll never fall through the first-line of defense but we need a better second-line and third-line plan.
     
  8. samson

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    ...And they just fired a teacher (the one who was sitting there and didn't know to treat him.) Really frustrating.
     
  9. forHisglory

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    Even if there were no diabetes in the picture.......this alone (all the turnover) would send me searching! It would make me nervous when there is that much disruption. From the top-down things are not right. Caregivers coming and going has to be confusing for the children as well. I'm hoping for a quick resolution and a better situation to preset itself to you all!
     
  10. mmgirls

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    I have never had a child in Daycare or school where sleeping would be involved. If you have Nightscout I would think that if you provided a iPhone you can set it up as constant stationary visual of Dexcom. I learned that the find my phone app makes the phone ring until it is attended to. So maybe if it is an iPhone you can use that as a sort of "hey who is taking care of my kid alarm?". also if the have the website up they can log in Careportal treatments or even questions to you or notations on why they decided to do xyz. We don't have "pushover" set up on our nightscout but it might help.
     
  11. samson

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    mmgirls, he wears iPhone and during nap they take it out of his pouch and put it on the desk near him for monitoring. But everyone makes a good point, alarms when he goes low are an important element that somehow got lost in the shuffle! I'll look into the find my phone app. Before this he was rarely low at daycare because we set his carb-treatment thresholds high enough to prevent it and the one well-trained teacher was great about monitoring it, so they probably never got to the alarm thresholds anyways.

    forHisGlory, it is frustrating. But unfortunately we live in a city where there are year-long waitlists for any decent childcare situation, and I doubt we could find a better place that would both have openings and be willing to monitor our son's blood sugar all day. I know that by law discrimination is barred but having someone who feels uncomfortable and unwilling take care of our son doesn't sound like a great option either. But we will look around and we have him on the waiting list for public preschool.

    Our older son went to the same school and it was much more stable then, with a core staff with 10+ years in the same place and a head teacher who'd been around for 4 years. The same core staff is there, but this last year they've gone through three head teachers. They keep hiring these young college graduates who have great education but are not motivated to stick around.
     
  12. Snowflake

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    I hear you on this. And even if you do switch, it's really hard to judge whether another provider would be any better until you actually start at a different school.

    Having transitioned from a shoe-string budget non-profit preschool to a large public school system with an ADA bureaucracy, there are days where I miss having un-fetterd text message contact with anyone at the preschool I needed to get in touch with. Our dd's public school is doing a pretty good job and they make a deal about formal legal compliance, but I do think there's something to be said for the personal touch and concern you get in a small preschool. Just my two cents, every situation is different!
     
  13. samson

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    Yes, Snowflake, my son's preschool is willing to change plans, update them informally, the downside is simply that there are clearly still places where he can slip through the cracks. Then again, my son has gone into Dex LOW territory on my watch and my partner's watch and we are both absolutely dedicated to his care. He has a busted pancreas, his blood sugar will sometimes be insane, that's the nature of the beast. It's impossible to prevent all mistakes and I am willing to accept that caregivers can do the best they can and still bad things can happen. The trick is to create systems that are idiot-proof and have layers of safety built in so that the worst case scenario isn't that bad. Seems to be trial-and-error and we are still working out the kinks.

    I am looking forward to the legal protection of public school but I'm guessing there are many more layers of bureaucracy when asking for care that differs from that required for other D-students in the district, and that getting changes approved will likely be a process.
     
  14. forHisglory

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    Wow, that is tough! Bummer......
     
  15. quiltinmom

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    This situation seems a little tricky right now, so this may or may not help. I might take a slightly different approach, if changing daycare isn't something your interested in.

    I might go to them and say, "there was that low incident that happened the other day. I don't want this to happen again, and I know it's in your best interest to avoid this happening again also. Let's look at why this happened, and what do you think can be done to prevent it in the future?" They were probably shaken up a little by this also, which will probably help them be more vigilant already. It's one thing to waltz in there and tell them what to do, which is ok since you are paying them for their services, but I think plans will work better if they are involved in figuring out what will work with what they already have going on, if it's a plan you can be ok with also.

    Yes, it is frustrating and scary, but how many times have we had lows in out own children and made mistakes? I don't think I would switch after just one incident. If it has happened more than once, or if they seemed overwhelmed by diabetes or didn't seem to take it seriously overall, then I'd look at finding other care.

    Good luck!
     
  16. samson

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    quiltinmom, agreed! Working with them to figure out what is making it time-consuming, stressful or difficult to keep track of my son will help long-term. But right now I've accepted that one of us will have to be there more than usual, at least until they train a new teacher. Yesterday we tried a new protocol: We made sure each teacher was scheduled to monitor CGM for one half-hour portion, so the entirety of son's nap was covered. Still, I texted the roving teacher before he met his fast-carb threshold to ensure he got a gummy. The texting protocol took less than a minute and was much less intrusive for everybody.
    That confirmed to me that someone with him needs a cell phone or smart-watch that instantly alerts when carbs are needed. It's against their policy (they don't want teachers texting with friends or getting distracted), but it will make their lives and ours so much easier, and I think will be safer long-term.
     

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