- advertisement -

Doctors Orders?

Discussion in 'School and Daycare' started by PamB, Jan 22, 2009.

  1. PamB

    PamB Approved members

    Joined:
    Nov 21, 2008
    Messages:
    19
    Hi all,

    We (10yro daughter) just started using the omnipod and are having problems with the school nurses. They are demanding that everytime something changes, pen to pump, IC ration etc, they have a new doctors order. As we have just started to use the pump, we are having to make a lot of adjustments. How can they realisticly expect to have the dr providing orders for every adj.? It seems insane to me! I am getting calls for this everyday now, I gave up and just told them to contact the dr office, but they are not able to get what they want there either and still calling me every day!

    We are in TX and I am wondering if anyone else has had similar problems and how they resolved it.

    The DE told me to tell the nurses not to make adjustments....they won't listen to me. My daughter is independent enough to do everything herself; she counts her carbs for her lunches and snacks the night before and puts it on paper in her lunch box. The nurses will sometimes tell her that the carbs she has calculated (based on the packaging) are wrong and they should instead use a generic carb counter index result.

    I guess what I want to know....is it really necessary for her to have to go to the nurses office to give her bolus? Can't she just take care of it all on her own in the lunch room (it is all recorded) and not miss class time because they are dickering around......to have the nurses/nurses aides available for emergencies only?! Would they in that case still be hounding me for dr orders?
     
  2. Amy C.

    Amy C. Approved members

    Joined:
    Oct 22, 2005
    Messages:
    5,560
    Even though I am in Texas as well as Austin, my son attends a private school where he does all his own care. He is never bothered by a nurse telling him what to do.

    Do you have a medical plan on file? I had my son's endo sign one (I filled it out) stating how the sugars are to be managed (i.e. -- the school was to do nothing, my son was to do it all). There are samples on the CWD site. In it you can state how you want the diabetes managed during the school day.

    Another thing, as long as your daughter can self manage, she doesn't have to go to the nurse's office to test or bolus. She can do this anywhere on campus. I would advise you to go to http://www.statutes.legis.state.tx.us/SOTWDocs/HS/htm/HS.168.htm to check out your daughter's rights. This is the Texas law and being in Austin, the nurses are surely aware. This law has been on the books for a couple of years.
     
  3. sonwtype1

    sonwtype1 Approved members

    Joined:
    Jan 19, 2009
    Messages:
    48
    Dr. Orders

    Pam,

    I'm not sure about Texas, but I live in California and my son who is 12 just recently got on the omnipod. He has a medical plan that says what his ratio is and what he is allowed to do at school. It is a form the endo office filled out for me. When he switched to the pump we did have a problem because now that sheet had to say he was pumping and for whatever reason they put down with assistance which made the school nurse flip out because my son doesn't come into the office. I was lucky enough to have an endo appt. and I made them change his medical plan to erase "with assistance" and got a copy to take to school. Also, you should check into the school having a plan for your daughter. My son can eat, drink, check his BG, go to the bathroom or use his cell phone whenever he needs to and they have to let him. The nurse at our school typed this all up and made a copy for every teacher he has so they all know his rights and what they need to look for if you is feeling high or low. Good luck.
    Sue
     
  4. PamB

    PamB Approved members

    Joined:
    Nov 21, 2008
    Messages:
    19
    Yesterday after school, I was entering all of the bg's and insulin doses and noticed that the nurse (actual RN) was changing the bolus to something different than recommended, using a 10/1 IC rather than the 15/1 IC and IGNORING the reverse correction! She caused my daughter to go even more hypo than she already was!!

    Thank you Amy for the link. I think there is a lot of info in this which is being disregarded at my daughters school. I went to the school board web site and printed out the same form which I was provided at the beginning of the school year. I am opting out of having her require the nurses assistance except in an emergency. Suprisingly, as I am re-entering all of our information into this form, I notice a line in bold stating:

    "*Parent will need to communicate all changes in doctor's orders to the school nurse"

    It seems the nurse is not aware of the rules for anything....which concerns me even more to the level of 'training' she provided to the unlicensed assistants, which cannot be held liable.

    This now begs the question, do I rock the boat and risk having more negative behaviour befall my daughter or do I just cut the ties? I am leaning towards just cutting the ties, but by doing so, I will feel guilty about the other children and parents who may not be aware of thier negligence.

    Advice??
     
  5. Amy C.

    Amy C. Approved members

    Joined:
    Oct 22, 2005
    Messages:
    5,560
    You could point out the nurses are not following their own guidelines. It seems a letter to this nurse's supervisor is in order. I don't think it would be considered rocking the boat -- the nurses are not in the right here.

    These nurses are simply way off base. There must be other Type 1s at your school or in your district who would benefit from you doing this.

    I would also cut the ties. If your daughter can self manage, she ought to be allowed to do this.
     
  6. John

    John Approved members

    Joined:
    Jan 28, 2009
    Messages:
    5
    Hi Pam,
    Sorry you're having so much difficulty with your school administrators and nursing staff. I thought the law in Texas, where I reside also, allows your daughter to manage herself (especially if it is documented in the 504).
    We use a system call mycareconnect (www.mycareconnect.com). It is an internet site where your child and/or her caregivers can share information using instant messaging. When my daughter tests throughout the day, she enters information on the website. Instantly the school nurse is notified as well as her other teachers, my wife (who gets a text message) and myself (I choose to get notified via e-mail). You, as the parent, set up the site. It can also house all of her basal rates and ratio's. If you make a change you can notify the nurse with a quick note and let her know your daughters numbers have been updated on the system - that way there is no misunderstanding (and only you control that data). If the nurse has a concern, she uses the same system to send a note - that way we don't play phone tag or have to look for notes in our daughters backpack (which used to happen all the time). My daughters school nurse and teachers love it. She tests in her classes and she puts the information in the system (at a logical break in the class). It has given her a lot of freedom. My daughter is also allowed to enter information into mycareconnect through her phone, it is very easy, according to my daughter, it automatically puts the information in mycareconnect. She never has to leave the classroom. It has come in handy when odd things come up like a battery dying on a meter, or she is out of insulin - we can react much faster.
    If you need additional advice, my wife and I are JDRF Volunteer Outreach Mentors. We can arrange a call if you need. We'd love to help.
     
  7. KitKat

    KitKat Approved members

    Joined:
    Dec 5, 2007
    Messages:
    898
    I am a trained ADA school advocate. I would call the 1-800-DIABETES number and speak with them. There is already a law on the books in TX in regards to diabetes and school. The nurse NOT doing as the doctor says is a HUGE issue and I would rock the boat. Please let your principal know what is going on and I would have my child, if capable do all the bolusing. If they do NOT have to go to the nurse, I wouldn't.

    You also can contact the Board of Nursing to complain she is not following doctor orders.

    PM me and I will give you my telephone number and we can speak.

    Kathy
     
  8. Nancy in VA

    Nancy in VA Approved members

    Joined:
    Jul 16, 2007
    Messages:
    7,308
    I think the issue is that the "doctors orders" are written and the I:C ratios are changing, so the pump isn't "following doctor's orders as written". We aren't in the school system but I know others that have had issues where the school needs to follow exactly what's written, even if the child/parent knows its changed
     
  9. Flutterby

    Flutterby Approved members

    Joined:
    Nov 11, 2006
    Messages:
    14,623

    is the SCHOOL nurse trying to change her ratios? I say, if your daughter can handle it and she WANTS to do it then she should be allowed to do it.. if Her dr says she's capable of doing it.. have him write those orders and the school can't say anything about it.. if she doesn't want to do it then have the orders written up that You, the parent can change ratio's at anytime and that your daughter is to use the carb counts ON the packages of the products she's eating, only use the generic counter if there is no carb count on the packaging .. the school shouldn't be doing anything but following the dr's orders.. if they are telling you things need to be changed, just simply tell them that you and her dr are working on it, that its not all that simple, and hopefully soon you'll have those ratios closer to where they should be..
     
  10. Flutterby

    Flutterby Approved members

    Joined:
    Nov 11, 2006
    Messages:
    14,623
    By her changing the ratios, lower even.. so she's giving MORE insulin, that is so dangerous. I would document this, write a letter to her supervisor and report her.. if a nurse ever did this to Kaylee's pump without my knowledge she would no longer be in charge of Kaylee.. The aid that does Kaylee's stuff clears everything with me first.. and if I ask her to over ride a bolus (Usually giving less insulin) she marks it in her book 'per mom' she notes and dates everything..
     
  11. lodiej

    lodiej Approved members

    Joined:
    Feb 21, 2008
    Messages:
    66
    I don't have answers to most of your questions, but I do have one. On our school form from the md it states that dosing will be done by parent. Our daughter who is 5 uses the omnipod and isn't independent has doses change all the time, I never update the school. Hope this may help a little. I would be more than happy to show you a copy of our form if it helps!
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice