Nurse Files: includes Individualized Health Plans
Contains Instructions, Individualized Health Plans, Standards of Care, Provider Order forms, Documentation records/logs and resources
STANDARDS AND GUIDELINES:
- Standards-of-Care-Diabetes-School-Management-Colorado 2015 Final: These standards of care for students with Type 1 Diabetes are to be used in conjunction with the Colorado Provider Orders & Individualized Health Plans. The student’s health care provider may indicate exceptions to these standards on the student’s individual orders. These Standards were developed in 2013 by the Colorado Kids with Diabetes Care and Prevention Collaborative of local health care providers, nurses and stakeholders.
- Guidelines for Insulin Management: Specific guidelines on insulin management in Colorado
- Guiding Principles Chronic Health Conditions: Guidance from the Colorado Department of Education and the American Diabetes Association
- Bus Emergency Medication on Bus 2013: Provided by the Colorado Department of Education – guidelines for medication administration on school buses.
- #500 School Nurse Intake Form: Documentation tool for interviewing parent/guardian of student with diabetes
- 501 School Nurse Checklist August 2014: Provides a detail list for the processing of a new student with Type 1 Diabetes or for the returning student for the start of the school year
- 201-Provider Orders Injections 2014: Orders to be completed by healthcare provider for student receiving insulin by injection and/or oral medications
- 202-Provider-Orders-Pump-2014: Orders to be completed by healthcare provider for student receiving insulin by pump
INDIVIDUALIZED HEALTH PLANS: The Individualized Health Plan (IHP): Diabetes in School Setting and Addendums should be used in conjunction with the 200-Standards-of-Care-Diabetes-School-Management-Colorado 2014 Revised and the individual student’s orders from their Health Care Provider.
I. HEALTH CARE PLANS FOR THE STUDENT THAT NEEDS ASSISTANCE WITH SELF CARE:
- Instructions for the IHP & Addendums: Provides specific directions for using the Individualized Health Plan and appropriate addendums for the student with diabetes. These are meant for the delegarted unlicensed personnel (health assistants, teachers, coaches) providing services
- Instructions -Inserting-Photo-into-IHP
- 100 IHP Diabetes May 2014: This IHP documents the “where, what, when” of organizing the care for students with diabetes. Includes provider/parent names, telephone numbers, self-care skills, etc. Instructions -Inserting-Photo-into-IHP
- 100-A-Emergency-Action-Plan-Glucose-Monitoring-Treatment-2014 This IHP documents treatment of hypoglycemia and hyperglycemia. All students with diabetes should have this IHP. Give to ULP that will respond to hypo/hyperglycemia.
- 100-B-Insulin-Medication-Addendum-Revised-2015: To be used for students receiving insulin by injection and/or oral medication
- 100-C-Insulin-Pump-Addendum 2014: To be used for students on insulin pump
- #100-D Continuous Glucose Monitor Addendum: To be used for students with Continuous Glucose Monitor
- #100-E Supplies- Diabetes Management Addendum: (Optional), To be used to document supply needs.
- 300 Diabetes Classroom Daily Care 2014: Specifically, for classroom teachers, use with Hypo-Hyper Flowsheet
- #303 Hypo-Hyper Flowsheet Plan
II. HEALTH CARE PLANS FOR THE INDEPENDENT STUDENT :
- 100-A-Emergency-Action-Plan-Glucose-Monitoring-Treatment-2014: This IHP documents treatment of hypoglycemia and hyperglycemia including Glucagon. All students with diabetes should have an emergency action plan. Give to ULP & Staff that will respond to hypo/hyperglycemia.
- 400-Diabetes-Independent-Management-6: Designed for teachers of students that are independent – should be used with the Hypo-Hyper Flowsheet (below).
- #401 Agreement for Students Ind Mgmt: Agreement to be signed by student, parent and school nurse
- #303 Hypo-Hyper Flowsheet Plan
III. OPTIONAL HEALTH CARE PLANS & FORMS:
- Instructions Form #300
- 300 Diabetes Classroom Daily Care 2014: Individualized plan for the classroom
- #301 Hypoglycemia Flowsheet: Visual tool for responding to hypoglycemia
- #302 Hyperglycemia Flowsheet: Visual tool for responding to hyperglycemia
- #303 Hypo-Hyper Flowsheet Plan: Visual tool that includes response to both hypoglycemia & hyperglycemia
- Instructions Form #400 401
- #400 Diabetes Independent Management: To be used for students that are independent
- #401 Agreement for Students Ind Mgmt: Agreement to be signed by student, parent, and school nurse
- #502 Insulin Carb Calculation worksheet: Documentation tool for daily Insulin Carb dosing
- #505 School Reporting Form-BDC: Optional form to report Blood Glucose that are out of range
- #720 Low-High BS HandsA great visual tool that lists the symptoms, causes and how to problem solve both high and low blood sugars on one piece of paper. Great reference for classroom teachers, substitute teachers, aids and other school staff like bus drivers!
SCHOOL LOG RECORDS
- Diabetes school log record for UAP: to be used by the unlicensed assistive personal(UAP) and school nurse in documenting care including insulin, snacks, etc.
- Diabetes school log record for RN use: to be used by the school nurse providing care to document care.
PROVIDER ORDER FORMS: The provider orders should be used in conjunction with the #200 Standards of Care Diabetes School Management-Colorado. The standards provide details of regarding standard of care for students with diabetes in the school setting. NOTE: The student’s health care provider may indicate exceptions to these standards on the student’s individual orders. These Standards were developed in 2013 by the Colorado Kids with Diabetes Care and Prevention Collaborative of local health care providers, nurses and stakeholders.
- #201 Provider Orders Injections: Orders to be completed by healthcare provider for student receiving insulin by injection and/or oral medications
- #202 Provider Orders PUMP: Orders to be completed by healthcare provider for student on an insulin pump.
- #203 One Time Order for BG Correction: To be used by the school nurse to Fax to provider for one-time orders or can be used to document verbal orders taken by the school nurse from provider.
Note: Provider orders from the Barbara Davis Center may be computer generated and look different from the above orders but will contain the same information. For more information on clarifying orders, see Clarification of Pump Orders from BDC. The school nurse can contact their region’s Diabetes Resource Nurses or contact the Barbara Davis Center for further clarification.
#520 School Nurse FAQs regarding Diabetes Management: Answers questions related to stabilizing snack, correction factors, out of state orders, lack of supplies, field trips, etc.
NDEP Helping the Student with Diabetes Succeed: The purpose of this guide is to educate school personnel about effective diabetes management and to share a set of practices that enable schools to ensure a safe learning environment for students with diabetes, particularly those who use insulin to control the disease (all students with type 1 and some with type 2 diabetes).
#728 Developmental Stages and Diabetes: Students need to be encouraged and supported to gradually assume diabetes self-care as they mature and demonstrate confidence. Newly diagnosed students may temporarily be unable to perform tasks per their developmental age until they adjust to their diagnosis and new life. This general list can help guide discussions as a child matures and advances in responsibility.
#729 Psycho-Social Aspects of Diabetes: The diagnosis of diabetes can cause any number of feelings in each family member as well as in the family as a group. This guide can be helpful as a child with diabetes grows into their disease and may help identify possible solutions.
#726 FieldTripConsiderations: A tip sheet for making arrangements with the classroom teacher and school so that your child is safe and well cared for on field trips.