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yes or no. Do you allow your childs school to call thier Dr?

Discussion in 'Parents of Children with Type 1' started by valerie-k, Jan 19, 2012.

?

Do you allow the school nurse to talk to your childs Dr office?

  1. yes

    2 vote(s)
    3.6%
  2. no

    54 vote(s)
    96.4%
  1. MamaBear

    MamaBear Approved members

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    It is pretty vague, and I totally agree with you. We had a great relationship with our district nurse and health aide last year, so great she wants to hire me, BUT what if next year in 7th grade, she's not there anymore. What if we end up with some ninny who wants to call our endo every time he stays home or has an off BG?

    I am still reading around the site trying to see if there is anything more specific.
     
  2. BittysMom

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    Yeah, I love Caroline's school nurse and am VERY thankful for, and to her. But we'll only have her 2 more years at most. I've met some serious busy-bodies in my time who don't know their place and I want no part of being at their mercy.;)
     
  3. Style mom

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    I would start taping his sites down. We've been pumping 4 years, and we've never lost one in the night. How often does this happen?
     
  4. Flutterby

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    Honestly, I'd tell her its non of her business about his care. If she needs something saying he was home because of diabetes, then, welll, she needs to take it from you. Or you'll get documentation from the dr's office herself. They don't have time to varify for her that he was home. Thats not what they are there for. In this case I would NOT, in any way, let that nurse have permission to call the dr's office. She's stepping WAY over the line. I'd simply tell her that the dr. is well aware of what is going on. I'd then call the dr's office and see if someone can send you a paper simply saying that any diabetes related problem that you (the parent) feels he needs to be at home for in part or all of a day, needs to be excused, and leave it at that. if she doesn't like it, well, tuff crappola for her.
     
  5. JaxDad

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    As I understand it the nurse can talk to the physician to determine appropriate medical treatment/interventions, i.e. she can receive training for the specific condition(s) and how to treat the specific patient. I do believe that it's illegal for her to discuss the specific medical history of the patient, i.e. she can't call the doctor to discuss her thoughts/opinion about the patient as seems to be the case here.

    The nurse has every right and, in fact has a duty, to address her concerns with, or offer education to, the patients caregiver, as uncomfortable or condescending that may seem to someone receiving their input.

    In most all states, doctors, nurses, teachers, EMTs, etc. are "mandatory reporters" meaning that if they have a reason to suspect negligence or abuse they are required by law to file reports on the matter, i.e. they CAN'T just talk to the parent/caregiver about their concern. I'm not inferring that the nurse here has that opinion, just stating my understanding of the law. I am not a nurse or teacher so if anyone has more specific knowledge, I would be happy to be corrected.
     
    Last edited: Jan 19, 2012
  6. Flutterby

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    You are right about teachers/nurse etc being manditory reporters. while the nurse has the right to know about medical conditions andhow to treat, I don't believe she can just call up the dr's office and have a chat about medical history or dosages.. she can call and tell them she's concerned about so and so. She doesn't have a right to all the medical records.

    Sounds to me like the nurse being discussed in this thread is being sneaky. I wouldn't give her an inch, she'll take a mile.
     
  7. MommaKat

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    Actually, because she's either a school nurse, or a health aide, working in a school, she's bound by both HIPPA and FERPA. While she may, under HIPPA, be considered to have a need to know she still has to have a signed authorization from a parent for release of information and the two providers to discuss his care under HIPPA & FERPA. (The quoted material above is concerning the right of the treating physician, nurse, or case manager to contact school officials or providers of health care, and only covers sharing of medication / treatment required in the school setting. That said, most treating physician's offices still require a signed authorization to do so.) Without a signed auth, the school nurse / health aid is breaking the law, and it could really set the school up for huge problems. I'm guessing that's why the director then called asking that the OP sign a form.

    Personally, we fought this battle as well since dd's middle school wants the health aide to be able to contact the endo clinic directly. Our RN case manager was more than happy to let the school that they would not allow that, and reasserted that her medical orders authorize me to make changes within specific parameters. The OP might want to contact her own case manager to hear their read on all of this. They may not allow it either, and may also have some ideas on the ketone issue, or at the very least, can support her with the school.
     
    Last edited: Jan 20, 2012
  8. MamaBear

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    Ah ok that makes sense. Thank you. What I was reading before seemed a little scary to me.
     
  9. liasmommy2000

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    They've never asked. I guess that's one good thing about a school district with NO nurses/health care staff. The doctor signs the DMMP once a year (that I fill out) and after that the school does what I say, no questions at all.

    ETA I did have one issue where a year or so into our journey the principal asked if Lia REALLY should be eating the birthday/party treats. Not sure why it was a concern all of a sudden but she asked me to get something from the doctor stating it was ok. Bugged the crap out of me but I did have the endo write a short note stating it was fine and that was it. I did it but trust me I was thinking all sorts of snarky things I wanted to say to the principal!
     
    Last edited: Jan 20, 2012
  10. jules12

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    I signed the release the first year he was dx and then after that starting marking out information on it before I signed. This year I didn't even bother signing it.

    We (the nurse and I) had an awkward moment because the nurse took it personal that I didn't want her to contact the doctor. Once I explained it wasn't personal but that I as the primary caregiver, needed to be involved in any changes to his doctor orders so that we are all on the same page, she started to understand. The nurse finally said "as long as you get me what I need to that the orders match what is actually going on I am fine with it."
     
  11. Christopher

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    Based on the new information that you have given, I would not sign it.

    However, I think she is doing it because she is concerned, which is a good thing. But it is not her place to try and work with his endo to resolve this issue. That is your job.

    Is his bg only really high when his sets come off? If that is the case, then figuring out a better way to keep the sets in place should solve the problem.

    As for this statement:

    I am not sure that giving carbs is the best method for dealing with ketones. You should speak with his endo about this.

    Danielle rarely gets ketones, so I am by no means an expert, but I thought that if someone has really high bg and has ketones, the best thing to do is give insulin to bring down the bg and the ketones will resolve.

    Another thing to think about is a way to not keep him home so much when he has ketones. Maybe work with the school to see if you could instruct them on how to deal with them, that way he would not be missing so much school.

    Good luck.
     
  12. MommaKat

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    I'm by no means very experienced in this, but dd's been sick and producing ketones. The on call endo (the one who was awesome in the hospital) reminded me that with moderate to high ketones, it's more important to bring ketones down than the bg. He asked us to cover at least 1/2u to 1u worth of carbs along with the correction, and to not bring bg down too quickly. He did say to avoid liquid sugars when doing this. For the first time, I felt really comfortable with both the correction, and the instructions for bringing ketones down, and it worked amazingly well. (I even corrected overnight, which I've been petrified of.)
     
  13. Flutterby

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    Treating ketones when sick and treating ketones because of a pulled site are two different things. We treat them completely different.:cwds:
     
  14. Amy C.

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    Yes, simply resuming the insulin with a correction for the high blood sugar works for my son. As long as you know why the ketones developed, resolving the problem -- giving insulin -- is all that needs to be done.
     

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