Omak School District Administrative Procedure Page 1 of 6

Transcription

1 Administrative Procedure Page 1 of 6 STUDENTS Parent Designated Adult for Diabetic Student ACCOMMODATING STUDENTS WITH DIABETES If parents choose they may designate an adult through proper legal procedures to assist a specific student in managing his/hers diabetes. This Parent Designated Adult (PDA) volunteer, which may include school staff, must file a letter showing their intent to act in that capacity. Parents, rather than the school, are responsible for training the PDA (Parent Designated Adult). 1. If the PDA is a school employee, he/she must be approved by the individual building principal to determine if he/she can care for this student and continue his/her present duties. 2. The PDA will need to have Washington State Patrol Finger Printing done at the parent s expense. 3. All PDA s must file a current voluntarily written letter of intent to act as a PDA. IF a PDA is a school employee, the district must keep on file a current, voluntarily written letter of intent from the employee to act as a PDA. This letter must be filed without coercion from the employer. Additionally, the letter must state the employee s willingness to be a volunteer PDA. School district employees may not be subject to any reprisal or disciplinary action for refusing to file a letter. 4. School districts will keep on file documentation of the required additional training that all PDA s must receive for the additional care the PDA may provide as authorized by the parent, such as insulin or glucagon injections and blood glucose monitoring. In addition, documentation of school district training for PDA s who are school district employees or comparable training by PDA s who are not district employees must be kept on file. 5. A diabetes educator who is nationally certified or a health professional must provide the training. However, only the School District Nurse may be designated to consult and coordinate with the student s parents and health care provider, and to supervise appropriate school district personnel. The School District Nurse is not responsible for the supervision of the PDA for those procedures that are authorized by the parent for the PDA to provide. 6. School District Nurse may not delegate procedures such as blood glucose testing and insulin injections to unlicensed staff. 7. Immunity from liability is provided if the individual is acting in good faith and in compliance with school policies and the student s IHP/504 Plan. : 05/24/05

2 Administrative Procedure Page 2 of 6 OMAK SCHOOL DISTRICT Parent Designated Adult Checklist Attachment A Signed Letter of Intent by Parent Signed Letter of Intent by PDA (Parent Designated Adult) School Employees To be trained by school nurse and Health Professional and recommended they attend school inservice Non-School Employees To be trained by Diabetic Educator or Health Professional and recommended they attend school inservice Diabetes Training Documentation Washington State Patrol finger printing Schedule appointment with Omak School Nurse

3 Administrative Procedure Page 3 of 6 Attachment B Voluntary Parent Designated Adult Notice of Intent Washington State requires public school districts to address the medical needs of students with diabetes. The school district uses this document to certify that a person intends to serve or continue to serve as a volunteer parent designated adult pursuant to chapter 350, Laws of 2002, which added sections to RCW 28A.210. For the purpose of this form, parent designated adult means: a volunteer, who may be a school district employee, who received additional training from a health care professional or Certified Diabetic Educator selected by parents, and who provides care, if needed, for the child consistent with the individual health plan. The additional training is for care that would otherwise be performed by a health professional licensed under RCW A parent designated adult, acting in good faith and in substantial compliance with the student s individual health plan and the instructions of the student s licensed health care professional, that provides assistance, or services shall not be liable in any criminal action or for civil damages, as a result of the services provided to a student with diabetes. INFORMATION: Name: Birthdate: Address: Phone: Message phone:_cell: STATEMENT OF INTENT: I,, certify that I voluntarily will serve or continue to serve as a Parent designated adult for (Students name)_and will provide diabetes related health care to the best of my ability, consistent with the student s individual health plan. I further certify that: I have had the Diabetic Education Training provided by the district. I have completed training comparable to the district provided training necessary to act as a parent designated adult. I have completed additional training for the additional care that I am authorized by the parent to provide prior to any acts that I perform as a parent designated adult. Parent designated adult signature If the PDA is a school employee: As a school district employee, I understand that I am not required to serve as a PDA, but choose to do so voluntarily. I have not been coerced by my employer to sign and file this notice of intent and I understand that my refusal to do so cannot be a basis for disciplinary action. Signature

4 Administrative Procedure Page 4 of 6 DESIGNATION OF A PARENT DESIGNATED ADULT Attachment C Washington State requires public school districts to address the medical needs of student with diabetes. Pursuant to chapter 350, Laws of 2002, which added sections to RCW 28A.210, the school district uses this document to allow the parent to designate a Parent Designated Adult (PDA) who can provide care, if needed, for a student with diabetes. For purposes of this form, Parent Designated Adult means: a volunteer, who may be a school district employee, who received additional training from a health care professional or certified diabetes educator selected by the parents. The PDA provides care, if needed, for the child consistent with the individual health plan. The additional training is for care that would otherwise be performed by a health care professional licensed under RCW By law, a school district, school district employee, agent, or a Parent Designated Adult, acting in good faith and in substantial compliance with the student s individual health plan and the instructions of the student s licensed health care professional, shall not be liable in any criminal action or for civil damages for the services provided to the child with diabetes. INFORMATION: Name of Child: Birthdate Address: Phone # School Year: School: M F Name of PDA: Birthdate Address: Phone # Message Phone: Cell: Relationship to child_ GRANT OF PERMISSION: As a parent or guardian of, a child with diabetes, I hereby acknowledge that I have read and understand this form and agree to the following: I hereby authorize _, to be a Parent Designated Adult (PDA) for the above named student and empower him/her to provide diabetes related health care to my child. I further agree that if the PDA is not a district employee and does not participate in the district diabetes education training, I will arrange for the PDA to receive comparable training. I further agree to arrange for the PDA to receive in depth training for the additional care I authorize the PDA to provide. Prior to the PDA providing care to my child, I will provide you with a signed documentation from an MD, DO, ARNP or CDE that the training was provided. Signature of Parent/Guardian PLEASE SIGN AND RETURN THIS FORM TO YOUR SCHOOL OFFICE. If no form is on file, it will be assumed that permission for a PDA has not been granted and there will be no Parent Designated Adult designated for your child.

5 Administrative Procedure Page 5 of 6 Attachment D Diabetes Training Documentation Parent Designated Volunteer I, _, a Health Care Professional or Certified Diabetic Instructor, have trained,the Parent Designated Adult (PDA),of (student)on (date) in the Symptoms, Treatment and Monitoring of Diabetes. Signature

6 Administrative Procedure Page 6 of 6 Attachment E Diabetes Training Documentation For Care That Would Otherwise Be Performed By A Health Professional Licensed Under RCW I,, a Health Care Professional or Certified Diabetic Educator, as selected by the parents, have trained, the Parent Designated Adult (PDA) in the following procedures: Blood Glucose monitoring Insulin Injections Glucagon Injections Signature _