School teachers, school nurses, teaching assistants, lunchtime supervisors and first aiders.
Changes in availability of insulins and evidence showing that insulin is much more effective at keeping the blood glucose normal when it is given along with every meal i.e. breakfast, lunch and evening meal, which means that many children and young people may need to have insulin injection in school at lunch times. Many schools would therefore need to support children with the administration of insulin and take responsibility for procedures, which would be new to many schools.
Schools that have no experience of supporting pupils with complex medical needs have concerns about who will carry out the procedure and the consequences if one makes a mistake. Schools might also not be aware of the arrangements in place to support schools with funding, insurance and training, therefore these could be barriers to support the administration of insulin in schools.
How this service improves
Schools in the Nottinghamshire County and Nottingham City were made aware of the changes in insulin regimens from twice daily to four times daily and that many children and young people may need to have insulin administered at school.
Working together the Local Authority (LA) and the paediatric diabetes specialist nurses (PDSN) provided training for school staff to remove barriers and support them in implementing administration of insulins in schools in order to comply with the guidelines issued by the LA.
If the school has followed the Local Authority’s guidance for administering medicines; staff have received appropriate training and have followed documented procedures, then they will be fully covered by the Local Authority’s public liability insurance.
Supporting the Administration of Insulin in Schools
A group of professionals from health and education met to look at how schools could be supported and possibly publish guidance for schools in Nottinghamshire and Nottingham City. The paediatric diabetes specialist nurses and school nursing managers for the different areas of the county were invited.
The group produced a poster to send out to schools, over the Intranet, to make them aware of the changes. School nurses were given a copy of the poster and promoted the initiative to schools.
Guidance on supporting the administration of insulin in schools was then produced by consulting each member of the group and their colleagues. The guidance was sent to all schools and it includes information about the duties schools have under the Special Education Needs and Disability Act 2001 and the Disability Equality Duties 2005; treatment of type 1 diabetes; hypos; food; physical activity; administering insulin; support for training and funding (The Guidance on the Adminstration of Insulin can be downloaded from the right hand column on this webpage).
The guidance was approved by the Medical Needs Panel and Nottinghamshire Children and Young People’s Service Director for Inclusion and Engagement.
Diabetes Awareness Training Session
To support school staff with the implementation of the LA guidance on Supporting the Administration of Insulin in Schools, the LA, local paediatric diabetes staff and Diabetes UK East Midlands held training and awareness sessions for primary and secondary school staff.
These sessions were aimed at teachers, school nurses, teaching assistants, lunchtime supervisors, first aiders and any other staff who feel they require information and advice in order to support children and young people with diabetes.
- Practical knowledge of diabetes
- Monitoring of blood glucose levels
- Administration of medications (including equipment)
- Treating emergency situations (including hypos)
- Access to healthy and appropriate food
- Participating in physical activity programmes
- Participating in extra curricula and social activities
- Support that can be provided to schools
- Disability Equality Duty update/discrimination law
The training is aimed at all schools and flyers were sent out to all schools in Nottinghamshire and Nottingham City, as it is predicted that in the near future every school in Nottinghamshire will have at least one pupil with diabetes who will need support from school staff by giving or supporting injections and blood tests at lunchtimes. A certificate of attendance was provided for staff to include in their professional development portfolio.
Where a child or young person requires support with the administration of insulin there will be a named person in school who will be trained and responsible for that child’s support. It is also advised that schools should have more than one person trained to cover illness, school visits, residential. The paediatric diabetes specialist nurse and the Assistant Special Educational Needs Officer work in partnership to support schools with issues regarding training.
Examples of practice at schools:
1) In one school there are 3 children with diabetes, 2 on insulin pumps. The school has a number of staff trained and there is a key person for each child designated through the day but it may be a different person in the afternoon from the morning.
Glucose checks vary according to the individual child, e.g. some children are checked 3 times a day but checks may need to be repeated after an hour, if a child is not feeling well this could be more often. The level of support is indicated in the health care plan and the PDSN supports the school in writing the health care plan. To apply for health funding schools must submit a health care plan, and the LA’s policy is that schools should follow the Managing Medicines in Schools and Early Years Settings document. Most schools use the health care plan provided in this document and the health care plan can be saved and schools can use it electronically.
Disclaimers were given that the training was awareness training and that the paediatric diabetes specialist nurse would provide training for school staff to support individual children and young people.
To ensure that children and young people with diabetes are supported in the administration of insulin by school staff.
To offer awareness raising sessions and training on specific points and examples of practical ways in which schools can support children and young people with diabetes.
The diabetes awareness training sessions were very well received with 96% of participants grading the training as good to excellent.
The guidance has been extremely helpful in ensuring that children and young people with diabetes are supported in schools. Schools ensure that staff are identified and trained to administer insulin and test blood glucose levels as necessary.
The success of the project was the partnership between the LA and paediatric diabetes staff. This partnership ensures support for children and young people with diabetes. The local authority is able to call on paediatric diabetes staff’s knowledge and expertise and the paediatric diabetes specialist nurses have a named person in the LA who they can refer school staff for advice and support in meeting the needs of children and young people with diabetes in school.
The success of the training and awareness sessions led to the LA and local paediatric diabetes staff providing further training and awareness sessions for school staff during 2009. This will be delivered by the LA, local paediatric diabetes staff and supported by Nottinghamshire LA workforce remodelling training.
The LA and local paediatric diabetes staff are exploring providing training and awareness sessions for Youth Service staff and school nurses.
Liz Mangle, Assistant Special Educational Needs Officer, Access and Diversity
Children and Young People's Services
SEN Strategic Services
Nottinghamshire County Council
tel. 0115 9773856
Karen Cuttell, Children’s Diabetes Nurse
Nottingham University Hospitals NHS Trust
City Hospital Campus
Tel: 0115 969 1169