For many years, federal and state laws have required public schools to provide health services to students participating in school-sponsored settings and activities. The Kentucky Board of Nursing (KBN) had advised that only licensed nurses could administer insulin and glucagon to students who need help with their diabetes needs at school and at school-sponsored activities. This KBN advisory stated that student diabetes care is a nursing function that cannot be delegated to nonlicensed personnel. As funds became tighter, this inability to utilize nonlicensed personnel created limitations on student activities. School districts could not fund a sufficient number of licensed nurses to provide care for the growing population of diabetic students at a large number of locations.
This changed on March 5, when Gov. Steve Beshear signed House Bill 98, amending KRS 156.502. As the bill contained an emergency clause, most provisions in the bill are now in effect. However, KSBA was able to obtain a provision deferring the new training requirements for nonlicensed diabetes and seizure disorder caregivers working in the schools until July 15. These nonlicensed caregivers are called “nonlicensed health technicians” in the new legislation. Also deferred until July 15 is the requirement for specified teams to decide if a student with diabetes or a seizure disorder will be relocated due to health-care needs.
HB 98 provides much-needed flexibility for schools in management of diabetes and seizure disorder care for students. New flexibility provisions in effect as of March 5 are:
1) Administration of diabetes medication and seizure disorder medication in schools is no longer considered a nursing practice in Kentucky, and thus not controlled by the KBN.
2) Districts no longer have to use Kentucky Department of Education-approved training to train nonlicensed personnel in administration of diabetes medication, but can use “any adequate and appropriate training program or guidelines.”
There are some caveats to this second point, however:
· Nonlicensed health technicians must be trained in diabetes and seizure disorder medication administration by a physician, advanced practice registered nurse or registered nurse.
· The physician or nurse must approve, in writing, of delegating the diabetes or seizure disorder medication administration to each nonlicensed health technician who will be assigned to perform such tasks.
· Nonlicensed health technicians assigned to perform diabetes management must be trained in administering insulin and glucagon, as well as recognition of the signs and symptoms of hypoglycemia and hyperglycemia and the appropriate steps to be taken to respond to these symptoms.
3) The new statutory language clarifies that not only school employees, but also independent contractors, qualify to perform health services for students in the school setting and at school activities.
Nonlicensed Health Technician
The new law authorizes nonlicensed health technicians to administer and/or assist with self-administration of:
· Glucagon subcutaneously to students with diabetes who are experiencing hypoglycemia or other conditions noted in the health care practitioner's written statement.
· Insulin subcutaneously, through the insulin delivery method used by the student and at the times and under the conditions noted in the health care practitioner's written statement.
· A seizure disorder rescue medication approved by the United States Food and Drug Administration and any successor agency.
Other provisions
The law states that students must be allowed to attend to their diabetes in the “school setting and at school-related activities.”
A student also must be allowed to “possess on his or her person at all times” necessary supplies and equipment to perform these diabetes monitoring and treatment functions. If requested by a parent or student, the student must have access to a private area to perform diabetes care tasks.
If you have questions about the new legislation, contact Teresa. T. Combs, KSBA’s director of Legal and Administrative Training Services at 1-800-372-2962. She worked closely with Shannon Stiglitz, KSBA’s director of Governmental Relations, to get the legislation tailored to best meet school district needs.