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Can a school nurse check a child’s blood glucose if the child has not been diagnosed with diabetes?

Friday August 22, 2014
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Question:

Dear Nancy,

As a school nurse, can I check a child’s blood glucose if the child has not been diagnosed with diabetes? In other words, if a child presents with hypoglycemia, can I check their blood sugar without a
physician’s order?

Ruth



Dear Nancy replies:

Dear Ruth,

As a school nurse, if a child you are responsible for as the school nurse appears to be in a hypoglycemic state — and you can observe signs and symptoms — this is a potentially emergent situation. In an emergency, consent or an order from a physician to check the blood sugar level is usually not necessary.

If it is determined that the child's blood sugar level is low, immediately calling 911 and pursuant to your protocol in the school, administering orange juice or a sugared cola (if the child is conscious), would be within your role and scope of practice as a school nurse. Also protecting the child from any further danger (e.g., seizure if the blood sugar level drops lower) is important.

You would need to stay with the child until the paramedics arrive. Once the student is in their care, you must contact the parents and document your interventions and all other information essential to the situation. Keep in mind your interventions would be essential to any student who you, in your clinical judgment, determine to be hypoglycemic.

If the student has an individualized healthcare plan because the student is a known diabetic, the concern for an order is non-existent since the parents are usually asked to sign consent for treatment forms. If the latter is correct, your facility might even have a specific form allowing you to test for blood glucose and call paramedics, if the need arises. Even though an emergency does not require these pre-signed forms, it is also a good risk management approach to have them signed and in the student's health file, especially with a student with a known condition.

You might review an excellent text on school nursing that might help with situations such as this and others. Schwab and Gelfman's Legal Issues In School Health Services: A Resource for School Administrators, School Attorneys, School Nurses (Authors Choice 2005) is a good resource text. Other good sources are the National Association of School Nurses at (www.nasn.org) and your local chapter of this association.

Cordially,
Nancy




Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.