A current copy of “Guidelines for Care of Students with Diabetes” (Washington Office of Superintendent of Public Instruction) shall be maintained in each health room and shall be used to develop the Individualized Healthcare Plan (IHP)/504 and serve as a guide for procedures for students with diabetes.

I. Individualized Plan/504

All students known to have diabetes must have an Individualized Healthcare Plan /504 in place at school. The plan must be distributed to appropriate staff on a ‘need to know’ basis, and must include the following information:

a. Provisions for the storage of medical equipment and medication provided by the parent:

b. Provisions for the student to perform tests and treatments during school hours anywhere on the school grounds including in the classroom and at school- sponsored events, to have easy access to necessary supplies and equipment:

c. A description of the student’s school day schedule for the timing of meals, snacks, blood sugar testing, insulin injections, and related activities:

d. An individualized emergency care plan that plans for both a health emergency for the student and a school emergency such as an earthquake:

e. Legal documents allowing a parent-designated adult to provide care, if the parent has designated such a person:

f. Any parent requests and instructions, as well as orders from licensed health professionals, such as self-carry of necessary supplies and equipment.

g. The parent/guardian will ensure that back-up supplies/medications are available to the student after school hours and traveling to/from or during school-sponsored events.

If the student needs medication/treatments while at school, an OSPI Health Care Provider Authorization Form or equivalent must be completed.

The Individualized Health Plan/504 must be updated at least annually or more frequently if necessary.

Parents are key partners in providing for the safety and health of their children during the school day. Parents are responsible for:

· Providing written requests and instructions to the school including orders from a health care provider prescribing within the scope of their prescriptive authority for treatment monitoring at school.

· Providing a current signed consent to exchange information with the child’s health care provider.

· Participating in the development of the IHP/504.

· If designated, provide written authorization for a Parent Designated Adult (PDA) to provide additional care. This may include blood glucose testing and injections.

II. Food and Drink

Students with diabetes must be allowed to eat or drink whenever and wherever necessary, including on the bus or in other areas where food and drink are generally prohibited. Students with diabetes must have unrestricted access to water and bathroom use. Food or water shall never be withheld as a disciplinary action or because of nonpayment fees.

III. Parent-Designated Adult (PDA)

A PDA is a volunteer, who may be a school district employee, and must be selected by a parent, to receive additional training from a health care professional or expert in diabetic care also selected by the parent, to provide care for the student consistent with the student’s individualized plan.

To be eligible to be a PDA, a school employee who is not a licensed nurse must file a voluntary written letter of intent with the school nurse. The letter must be dated and shall be valid for not longer than one year. No employee who refuses to file such a letter shall be subject to reprisal or disciplinary action. No employee may be coerced into filing such a letter. A non-employee may become a PDA by filing a letter of intent with the school nurse and by completing a non-school employee training as outlined below.

PDA’s must receive training as indicated below. The nursing supervisor or nurse designee is not responsible for the supervision of the PDA for those procedures that are authorized by the parents.

IV. Training-School Employees

In-service training: In schools attended by diabetic students, all school employees must undergo an in-

service training on general symptoms, treatments, and the additional observations that may be needed in different situations that may arise during the school day and during school-sponsored events.

Specific Training: School employees who have responsibility for diabetic students must complete training in proper procedures for care of students with diabetes. Either the nursing supervisor or his or her nurse designee will offer such training. Such training must include information in the individual student’s plan requirements, as well as information on treatment and monitoring of students with diabetes.

The nursing supervisor or nurse designee shall train school employees.

V. Training - PDA’s

PDA’s who are school employees must undergo both the in-service and the specific training, as outlined above. PDA’s who are not school employees must show evidence of comparable training. Additionally, all PDA’s must receive training from a health care professional or expert in diabetic care selected by the parents. This additional training is required to allow the PDA to provide the additional care the parents have authorized the PDA to provide.

VI. Delegation

Delegation describes who may assume responsibility for actions identified in the individualized plan as determined by the school nurse.

VII. Diabetic Care at School

Checking blood glucose levels at school, if ordered, will be specified in the IHP/504 Plan.

a. The student, parent, family member, PDA, or licensed staff R.N. or licensed practical nurse (L.P.N.) may perform this procedure as defined in the individualized plan. A health care provider’s (HCP) order is needed if blood glucose checks are being done by a licensed school health professional. Assessment of the student’s ability to independently perform this procedure will be determined by the parent, school nurse, and HCP. Supervision of the student may be needed due to the student’s developmental ability, level of independence, proximity to initial diagnosis, and/or age. Such supervision can only be provided by a parent, PDA, or licensed personnel.

b. Verification of the number on the meter by non-licensed school personnel for a student independent in the management of his/her self-monitoring can be performed after training, supervision, and delegation by the school nurse.

c. Checking blood glucose for symptoms of low (hypoglycemia) or high (hyperglycemia) blood sugar will be done by the student (if able), the parent, or PDA. The school nurse or nurse designee, if available and with an HCP order, can also perform the procedure.

d. Verification of the number on the Continuous Glucose Monitor (CGM) by non-licensed school personnel can be performed after training, supervision and delegation by the school nurse.

e. Verification of the amount dialed on an insulin pen and/or entered insulin pump by a non-licensed school personnel for a student independent in self-injecting can be performed after training, supervision and delegation by school nurse.

f. Drawing up insulin, verification of insulin dose and insulin injection may be done by the student (if independent in skill), the parent or PDA. The school nurse or nurse designee, if with HCP can also perform this procedure.

g. Administration on intranasal glucagon can be performed by unlicensed school personnel after training, supervision and delegation by the school nurse.

h. Administration of ketone urine test can be performed by unlicensed school personnel after training, supervision and delegation by the school nurse.

f. Any district or school staff can:

-Follow treatment plan for mild, moderate, severe low and/or high blood glucose (except injections)

-Call 911 if student is unconscious or unable to swallow

-Provide snacks according to student’s IHP

The district, its employees, agents or parent-designated adults who act in good faith an in substantial compliance with a student’s individualized healthcare plan /504 and the instruction of the student’s health care provider shall not be criminally or civilly liable for services under RCW 28A.210.330-.350.

Legal References: RCA 28A.210.330-.350 WAC 246-840-700 Guidelines for Care of Students with Diabetes, 2024, Washington Office of Superintendent of Public Instruction

Highline School District 401 Approved by the Superintendent: November 17, 2009
Revised by the Superintendent 07.24