Oxfordshire Childrens Diabetes - The Primary Schools Intervention Programme

Abstract

Poorly controlled diabetes adversely affects a child's education, with concentration difficulties, alterations in mood, behaviour and fatigue associated with high or low blood glucose levels. Between years 2004-6 we started all toddlers and children on intensive insulin regimens (multiple dose injection or pump) making it imperative that they received support during the school day. This required close monitoring of blood glucose levels and counting carbohydrate intake to adjust rapid-acting insulin dose or pump bolus at every meal. We report our experience of formulating a sustainable structure of support in primary schools based on trained volunteers who partake in the daily ‘Individualised Care Plan (ICP)’.After overcoming multiple barriers, an acceptable system was negotiated with our Primary Care Trust (PCT) and Local Education Authority (LEA). In 2009, the PCT confirmed 3 years funding for a Paediatric Diabetes specialist nurse (PDSN) for schools. In 2010, the first full school year with agreed protocols was in place. By July 2012, our nurses had trained a total of 342 volunteers who provide care for 132 children.The Oxfordshire Schools Intervention Programme ensures that legal obligations are met. A risk assessment allows the LEA to provide indemnity to their school staff to give injections and do blood tests, after training and competency sign-off by a PDSN. Parents, volunteers and PDSN jointly agree a comprehensive ‘ICP’ and utilise a hand-held communication record book. Diabetes control improved (age 4-11 years cohort from 2004 onwards: Mean (SD) HbA1c in 2001-4 = 8.38 (1.09)%; in 2005-8 = 7.74 (0.81)%; in 2009-12 = 7.58 (0.69)%; ANOVA p<0.001). This requires 500-1000 hours of DSN time to train/retrain/problem-solve annually (approximately 5-10days per month). The cost-benefits are discussed.We advocate that our programme supports each child’s ICP, use of intensive insulin regimes in school-day and reassures parents that schools can deliver this safely.

ISPAD Clinical Practice Consensus Guidelines 2018: Management and support of children and adolescents with type 1 diabetes in school

“…In many countries where school nurses are available they often have the requisite legal authorization to administer insulin as part of their qualifications; otherwise, educational authorities must rely upon school personnel to execute the necessary complex care plan, which is usually outside of the individual personnel member's scope of practice. In the absence of a school nurse, it may be possible in some jurisdictions for an adult volunteer (including teacher) to act as an agent on behalf of the parent . But several requirements need to be fulfilled for this to be possible—particularly the obligation for ongoing training (a health care team/school responsibility), for informed parental consent and competency reassessment (a parent responsibility).…”

Diabetes care in the early primary school setting: narratives of Australian mothers

“…[20][21][22][23] A parent or "Agent" of the parent, for example non-nursing school staff, may also be legally authorised when nurses are not available. [24][25][26][27] Parents can grant Agency (after informed consent) to a school staff member who has; (a) freely volunteered, (b) completed appropriate training and (c) been deemed competent by the parent. This applies to both supervision and administration of insulin therapy.…”