Current through Register Vol. 49, No. 6, March 15, 2024
PURPOSE: The purpose for this rule is to enable
schools to ensure a safe learning environment for students with diabetes. These
materials are based on the belief that children with diabetes can participate
in all academic and non-academic school-related activities. In order for
children with diabetes to be successful in school, a comprehensive health plan
must be collaboratively developed by families, students, school personnel, and
licensed health care providers. The individualized health plan (IHP) implements
the Diabetes Medical Management Plan (DMMP) provided by the healthcare
provider, physician orders, and provisions appropriate to each student's needs
during the school day and for other school-related activities. The IHP must be
based upon and consistent with the DMMP.
(1) For purposes of this rule, the following
terms shall mean:
(A) Department of
Elementary and Secondary Education (department);
(B) Diabetes Medical Management Plan (DMMP)-a
document developed by the student's personal health care team that sets out the
health services needed by the student at school and is signed by the student's
personal health care team and parent/guardian; For a student determined
eligible under Section 504 of the Rehabilitation Act of the Individuals with
Disabilities Education Act (IDEA), the DMMP may be incorporated or referenced,
as appropriate, into the health services provisions of the student's 504 Plan
or Individualized Education Program (IEP);
(C) Diabetes-a chronic disease in which blood
glucose (sugar) levels are above normal;
(D) Personal Health Care Team-a team that
includes the student's health care provider, parent/guardian, and as
appropriate, school nurse and/or the student. For a student determined eligible
under section 504 of the Rehabilitation Act or the Individuals with
Disabilities Education Act (IDEA) the team of individuals required to develop
the section 504 Plan or the individualized education program (IEP) may
constitute the personal health care team inclusive of the student's health care
provider or input from that provider.
(E) School-shall include any public school
located within the state of Missouri;
(F) School employee-shall include any person
employed by a Local Education Agency (LEA), any person employed by a local
health department who is assigned to an LEA, or any subcontractor designated
for this function; and
(G) Trained
diabetes personnel-a school employee who volunteers to be trained in accordance
with this rule. Such employee need not be a health care professional.
(2) The school board of
each school district and the governing body of each charter school may provide
all students with diabetes in the school or district appropriate and need- ed
diabetes care as specified in their Diabetes Medical Management Plan.
(A) The parent or guardian of each student
with diabetes who seeks diabetes care while at school should submit to the
school a Diabetes Medical Management Plan (DMMP), which upon receipt shall be
reviewed by the school.
(B) The
DMMP is developed by the stu- dent's personal health care team and sets out the
health services needed by the student at school and is signed by the student's
personal health care team and parent/guardian. The plan covers how, when, and
under what cir- cumstances the student should receive blood glucose monitoring
and injections of insulin as well as steps to take in case of an
emergency.
(C) Schools must
receive written permis- sion from the student's parent/guardian to allow
monitoring of the student's blood glu- cose and to administer insulin by
injection or the delivery system used by the student. This written permission
should be included in the DMMP.
(3) Section
167.803,
RSMo, requires schools choosing to adopt these guidelines to train at least
three (3) school employees at each school attended by a student with diabetes.
A school employee shall not be subject to any penalty or disciplinary action
for refusing to serve as trained diabetes personnel.
(A) Training shall be coordinated by a school
nurse, if the school district or charter school has a school nurse, and
provided by a school nurse or another health care professional with expertise
in diabetes. Such training shall take place prior to the commencement of each
school year, or as needed when a student with diabetes is newly enrolled at a
school or a student is newly diagnosed with diabetes, but in no event more than
thirty (30) days following such enrollment or diagnosis. Local boards of
education or charter school governing boards shall ensure that the school nurse
or other health care professional provides follow-up training and supervision
as necessary. Coordination, delegation, and supervision of care shall be
performed by a school nurse or other qualified health care
professional.
(B) Training shall
include, but not be limited to-
1.
Understanding the appropriate actions to take when blood glucose levels are
outside of the target ranges indicated by a student's DMMP;
2. Understanding physician instructions
concerning diabetes medication drug dosage, frequency, and the manner of
administration;
3. Performance of
finger-stick blood glucose checking, ketone checking, and recording the
results;
4. The administration of
glucagon and insulin and the recording of results;
5. Understanding how to perform basic insulin
pump functions;
6. Recognizing
complications that require emergency assistance; and
7. Understanding recommended schedules and
food intake for meals and snacks, the effect of physical activity upon blood
glucose levels, and actions to be implemented in the case of schedule
disruption.
(C) Schools
shall document training provided under section
167.803,
RSMo. Specifically, schools shall record the name, title, and credentials of
the health care professional providing the training, and the names and titles
of the school personnel receiving training as trained diabetes
personnel.
(D) Schools will assure
that trained personnel have mastered training competencies. Suggested resources
for developing a diabetes skills checklist can be found on the department's
website.
(E) The department
recommends that all trained diabetes personnel and other school personnel be
familiar with recommended resources available on the department's
website.
(F) If at any time fewer
than three (3) school employees are available to be trained at a school, the
principal or other school administrator shall distribute to all staff members a
written notice seeking volunteers to serve as diabetes care personnel. The
notice shall inform staff of the following:
1. The school shall provide diabetes care to
one (1) or more students with diabetes and is seeking personnel willing to be
trained to provide that care;
2.
The tasks to be performed;
3.
Participation is voluntary and the school district or school shall take no
action against any staff member who does not vol- unteer to be
designated;
4. Training shall be
provided to employ- ees who volunteer to provide care;
5. Trained personnel are protected from
liability under section 167.831, RSMo; and
6. The identity and contact information of the individual who
should be contacted to volunteer
(4) Each school shall review and implement
the DMMP provided by the parent/guardian of a student with diabetes who seeks
diabetes care while at school. Generally, the school nurse is the most
appropriate person in the school setting to provide care management for a
student with diabetes. Other trained diabetes personnel shall be available as
necessary.
(A) The school nurse or at least
one (1) trained diabetes personnel may be on site at each school and available
during regular school hours and during all school sponsored activities,
including school-sponsored before school and after school care programs, field
trips, extended off-site excursions, extracur- ricular activities, and on buses
when the bus driver has not completed the necessary train- ing, to provide care
to each student with a DMMP being implemented by the school.
(B) Each LEA may provide training in the
recognition of hypoglycemia and hyper- glycemia and actions to take in response
to emergency situations to all school personnel who have primary responsibility
for supervis- ing a child with diabetes during some portion of the school day
and to bus drivers responsi- ble for the transportation of a student with
diabetes.
(C) In accordance with
the request of a parent/guardian of a student with diabetes and the student's
DMMP, the school nurse or, in the absence of the school nurse, trained diabetes
personnel, may perform functions including, but not limited to, responding to
blood glucose levels that are outside of the student's target range;
administering glucagon, administering insulin, or assisting a student in
administering insulin through the insulin delivery system the student uses;
pro- viding oral diabetes medications, checking and recording blood glucose
levels and ketone levels, or assisting a student with such checking and
recording; and following instructions regarding meals, snacks, and physical
activity.
(D) Upon written request
of a student's parent/guardian and if authorized by the stu- dent's DMMP, a
student with diabetes shall be permitted to perform blood glucose checks,
administer insulin through the insulin delivery system the student uses, treat
hypo- glycemia and hyperglycemia, and otherwise attend to the monitoring and
treatment of his/her diabetes in the classroom, in any area of the school or
school grounds, and at any school-related activity, and he/she shall be
permitted to possess on his/her person at all times all necessary supplies and
equipment to perform such monitoring and treatment func- tions. If the
parent/guardian or student so requests, the student shall have access to
aprivate area for performing diabetes care tasks. Schools should encou rage par
ents to provide backup supplies for each child to the school nurse in the event
the student does not have them in possession when needed.
(5) Sample forms of Diabetes Medical
Management Plans (DMMPs) are available on the department website.
(A) A DMMP shall be signed by a health care
professional.
(B) A DMMP should-
1. Outline the dosage, delivery system, and
schedule for blood glucose monitoring, insulin/medication administration,
glucagon administration, ketone monitoring, meals and snacks, physical
activity, and include the stu- dent's usual symptoms of hypoglycemia and
hyperglycemia, and their recognition and treatment;
2. Include emergency contact informa-
tion;
3. Address the student's
level of self- care and management.
(C) A proposed DMMP should be com- pleted and submitted to the
school at least annually.
(D)
Emergency contact information and any medical history contained in the DMMP may
be updated at any time without signature or assistance of a health care
professional.
(6) No
physician, nurse, school employee, charter school, or school district shall be
liable for civil damages or subject to discipli- nary action under professional
licensing reg- ulations or school disciplinary policies as a result of the
activities authorized by sections
167.800 to
167.824,
RSMo, when such acts are committed as an ordinarily reasonably prudent person
would have acted under the same or similar circumstances.
