Management of Students with Diabetes
According to the Centers for Disease Control and Prevention (CDC), diabetes is defined as a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.
ACT 86 is a voluntary option (not mandated) for schools. If schools choose to opt into ACT 86 they must be sure to read the ACT and the Resource Guide in their entirety. Schools must ensure compliance with
all the requirements in the law and resource guide and have the appropriate policies, permissions, agreements and orders in place. Each student with diabetes is to have an individual plan in place specific to their diabetes healthcare needs.
Act 86 of 2016 amended the Public School Code (Article XIV; 24 P.S. §§ 14-1401 – 14-1424) with a number of provisions related to diabetes education and care in Pennsylvania schools. More specifically, Act 86 permits school nurses, in consultation with their chief school administrator or a designee, to identify at least one school employee ("Identified Employee") in each school building attended by a student with diabetes to be designated in a student's service agreement or Individualized Education Program (IEP) to administer diabetes medications, use diabetes monitoring equipment, and provide other diabetes care. If the school building attended by a student with diabetes does not have a school nurse assigned to carry the caseload full-time, the chief school administrator may consult with the school nurse to identify a school employee.
The Identified Employee should not be the school nurse, and does not need to be a licensed health care practitioner. The Identified Employee may decline the responsibility and related directives. An Identified Employee is required to complete annual education in specifically-identified areas through educational modules developed by the Pennsylvania Department of Health (DOH) in consultation with the Pennsylvania Department of Education (PDE), annual education offered by a licensed health care practitioner with expertise in the care and treatment of diabetes that includes information substantially similar to that in the educational modules, or both. These educational modules and other information are included in the
Diabetes in School Children: A Recommendation & Resource Guide for School Personnel, first released by DOH and PDE on November 22, 2016. The resource guide provides detailed steps that administrators, school nurses, school personnel, parents/guardians, and students should consider to help ensure effective diabetes management. An Identified Employee shall be provided a copy of this resource.
Training and Resources
Once an Identified Employee has completed the education requirements, the employee may perform diabetes care and treatment for students. For an Identified Employee who is not a licensed health care practitioner to administer diabetes medications via injection or infusion, the following must occur:
The Identified Employee must complete the annual education modules outlined in subsection (a) or annual education offered by a licensed health care practitioner with expertise in the treatment and care of diabetes which includes substantially the same information outlined in subsection (a).
The school entity must receive written authorization from both the student's health care practitioner and parent or guardian that the Identified Employee, who is not a licensed health care practitioner, may administer specified medications.
The "Guidelines on Bloodborne Pathogens for the Public Sector" applies to all employers and employees in the public sector who are not covered by federal standards of the Occupational Safety and Health Administration (OSHA). It addresses all actual or potential occupational exposures to blood or other infectious materials in a public sector healthcare facility, home healthcare organization or other facility providing health care-related services. Schools fall under "other facility providing health care-related services."
Employer - An employer with public employees whose duties could reasonably result in occupational exposure to blood and other material potentially containing a bloodborne pathogen.
Occupational exposure - Reasonably anticipated eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood, bodily fluids or other potentially infectious materials that result from the performance of an employee's job duties.
Parenteral – A piercing of mucous membranes or the skin barrier through such events as needlesticks, human bites, cuts, and abrasions.
Public employee - An employee of the Commonwealth or a political subdivision employed in a health care facility, home health care organization, or other facility providing healthcare-related services who is engaged in activities that involve contact with a patient, blood or other body fluids from a patient and is responsible for patient care with potential exposure to a sharps injury. This term does not include a licensed individual who provides only intraoral care.
Students may also be permitted to possess and use their own diabetes medication and monitoring equipment, with written authorization from the student's health care practitioner and parent or guardian and written acknowledgment from the school nurse that the student has demonstrated the capability to self-administer medication. This provision may be revoked or restricted due to noncompliance, and the school entity shall then ensure the medication and monitoring equipment is readily accessible to the school nurse or other identified and trained school employee in the student's building.
Nonpublic schools may also comply with these provisions allowing school employees to be designated to provide certain diabetes care tasks and students to possess and self-administer their diabetes medications and monitoring equipment. This provision does not alleviate school districts from providing school nurse services when requested by the nonpublic school. It is recommended that a memorandum of understanding be developed between the two school entities.
The information above is not inclusive of all the requirements in the School Code. The newly-added and amended school health services provisions of the School Code should be carefully reviewed by school entities, in consultation with solicitors and other professionals, to ensure compliance.