Ala. Admin. Code r. 610-X-7-.10

Current through Register Vol. 42, No. 8, May 31, 2024

Section 610-X-7-.10 - Delegation Of Insulin And Glucagon Administration In The School Setting

(1) DEFINITIONS

(a) Glucagon: a hormone that raises the level of glucose in the blood and is administered by injection to individuals to treat severe hypoglycemia that is indicated by the inability to eat food or drink, unconsciousness, unresponsiveness and/or seizures or convulsions.

(b) Insulin: a hormone made and released by the pancreas that allows glucose to enter the cells where it is used for energy. Students with type 1 diabetes and some students with type 2 diabetes need to administer insulin at regular times and take insulin to cover carbohydrate intake to correct hyperglycemia.

(c) Medication Administration and Safety: See Chapter 610-X-6-.07.

(d) School setting: preschool through 12^th grade in a public or private school or school activity sponsored by such a school, in which the student is a direct participant.

(e) Trained, Unlicensed Medication Assistant: a school employee who volunteers to receive delegation of administration of insulin and glucagon in the school setting and receives the approved training.

(2) GENERAL PRINCIPLES

(a) The injection of insulin or glucagon is a nursing task that may be delegated in accordance with the requirements of Act 2014-437 and the student's individualized health plan (IHP). The selection of the type of insulin and dosage levels shall not be delegated.

(b) An Individualized Health Plan (IHP) shall be developed for any student diagnosed with diabetes who is in the school setting as provided for in Alabama Act No 2014-437.

(c) Delegation of tasks for students with diabetes shall be confined to procedures that do not require nursing assessment, judgment, evaluation, or complex skills.

(d) Factors the school nurse shall consider and may include in the IHP are:

1. Age of onset and current age of student with diabetes

2. Recent hospitalization

3. Most recent hemoglobin A1C (HgAlC)

4. Recent change in type of insulin, delivery method, and dosage

5. If and when glucagon was required

6. Comorbidities or other chronic illnesses

7. Participation in sports or other school-sponsored activities

8. Orders from a legally authorized prescriber

9. Carbohydrate counting

10. Blood glucose monitoring

11. Activation or suspension of an insulin pump

12. Usage of insulin pens

13. Self-administration evaluation

14. Student's comprehension and adherence to treatment

15. Parental comprehension and adherence to treatment

16. Emergency protocol related to glucagon administration

17. Student's overall health needs

18. Insulin to carbohydrate ratios and correction factors

19. Symptoms and treatment of hypoglycemia and hyperglycemia

20. Ketone testing

(e) Teaching school personnel about diabetes does not constitute delegation.

(f) Insulin and glucagon administration delegation is limited to:

1. The student's Individual Health Plan

2. Trained, Unlicensed Medication Assistants who have received training and competency validation for each student assigned to them.

3. Specific students

4. Specific identified time frame

(g) The delegation shall include documentation of administration of glucagon and insulin and appropriate reporting to the school nurse.

(h) If the local education agency determines that school nurses shall provide the care to students with diabetes, delegation may not be required.

(3) PROCEDURE

(a) The school nurse shall validate the competency of the trained, unlicensed medication assistant to whom delegation of administration of insulin and glucagon is given.

(b) Insulin injection by the Trained, Unlicensed Medication Assistant receiving the delegation shall only occur when consistent with the IHP.

(c) Dosages of insulin may be injected by the Trained, Unlicensed Medication Assistant as designated in the IHP.

(d) Non-routine and/or large correction dosages of insulin may be given by the Trained, Unlicensed Medication Assistant only after consulting with the school nurse, parent or guardian, as designated in the IHP and after verifying and confirming the type and dosage of insulin being injected.

(e) When the student is not capable of self-administration, routine daily meal boluses (routine correction dosages) of insulin, based on carbohydrate counts and blood glucose levels, may be administered by the Trained, Unlicensed Medication Assistant as designated in the IHP.

(f) Training of the Trained, Unlicensed Medication Assistants shall occur prior to any delegation of administration of glucagon and insulin.

(g) The school nurse shall follow the training guidelines developed by the State Department of Education in consultation with the Alabama Board of Nursing.

(h) The local education agency, in consultation with the school principal, shall identify any volunteer in each school to the school nurse for possible training.

(i) An annual report of the number of Trained, Unlicensed Medication Assistants in each school and the delegation of administration of insulin and glucagon to specific Trained, Unlicensed Medication Assistants shall be provided to the Board of Nursing by the Lead Nurse of each school system.

Ala. Admin. Code r. 610-X-7-.10

Adopted by Alabama Administrative Monthly Volume XXXIII, Issue No. 06, March 31, 2015, eff. 4/17/2015.

Adopted by Alabama Administrative Monthly Volume XXXIV, Issue No. 10, July 29, 2016, eff. 9/8/2016.

Author: Alabama Board of Nursing

Statutory Authority:Code of Ala. 1975, § 34-21-2(c)(21).