Child Health BC participated in the development of the following BC Nursing Support Services policy, which does not support delegation of insulin or glucagon administration. These policies place children at risk and do not meet their medical needs, and according to the ADA, a "medically safe school environment" can only be achieved if the individual student's needs are being met. US and UK policies support children with diabetes, often by training non-medical school staff to administer insulin.

In our discussions with Child Health BC, they thought this did not result in "any children having to seriously compromise their diabetes care to be able to attend school safely", in other words, it's OK to compromise their diabetes care somewhat? We believe that BC schools and BC Nursing Support Services have a duty to accommodate children with diabetes under Canadian Human Rights laws. 

Child Health BC claims to be "dedicated to excellence in the care of infants, children and youth in British Columbia", yet a staff pediatrician claims we do not "even have the resources to teach lay people how to give insulin or glucagon." Is Child Health BC about excellence in care or about justifying the rationing of health care by BC Ministries? A conflict of interest, since Child Health BC is funded by the ministries it advises? How can Child Health BC claim to be dedicated to excellence, when they support policies that are second rate compared to the UK and US?

The Director of Child Health BC, Dr. Bob Peterson can be reached at (604) 875-2074 or at info@childhealthbc.ca
The Director of BC Nursing Support Services, Linda Verhagen can be reached at (250) 387-5858 or at mcf.childrenyouthspecialneeds@gov.bc.ca


August 2009
    

Nursing Tasks Not Typically Delegated by NSS

 

At this time, NSS  does not typically delegate the following nursing tasks related to insulin administration, due to the variables involved in carrying out these tasks safely, the need for caregiver judgement, and the potential risks if an incorrect insulin dose is administered (refer to additional background information found  in Diabetes Management and Blood Glucose Monitoring Education Module):

·        Determining an insulin dose using a mathematical formula or flow sheet.  This is the responsibility of the parent or designate, in collaboration with the child/youth. 

·        Administering an insulin dose.  This is the responsibility of the child/youth and/or the parent or designate.

·        Any insulin pump operation, including helping the child/youth to troubleshoot pump operation.  If a child/youth encounters difficulty with pump operation, it is the responsibility of the parent or designate to be available by phone, or to respond to the school in person, to assist the child/youth.

·        Any insulin pump site care.

·        Supervision of self-administration of an insulin bolus dose via syringe.

 

NOTE:  When an insulin pump is funded by PharmaCare, parents must sign a PATIENT/FAMILY AGREEMENT FOR AN INSULIN PUMP, which includes the following statement: “If the patient is a younger child, you [parents] acknowledge that school and day care personnel will not operate the pump.  You will have a plan for pump operation when the Patient is out of your care and you will be available at all times in case there is a problem.”

 

Subcutaneous or intramuscular administration of glucagon to treat severe hypoglycemia is delegated only in situations when this is determined to be in an individual child/youth’s best interests.   Severe hypoglycaemia is rare in school settings.  Glucagon administration is a complex task that school caregivers would have to carry out in an emergency situation, likely without having had the opportunity to perform the task previously.  There is potential risk of harm to the child/youth if the task is performed incorrectly.  Delegation of glucagon administration in the school setting may be in a child’s best interests when Emergency Medical Services (EMS) are unavailable or unable to respond within a reasonable time, when a child is at increased risk of severe hypoglycaemia, or in other unusual or exceptional circumstances.  The NSS Coordinator will work with each child/youth, family, school and health care team to determine whether glucagon administration is in an individual child/youth’s best interests.