ARKANSAS DIVISION OF ELEMENTARY AND SECONDARY EDUCATION AND STATE BOARD OF NURSING RULES GOVERNING THE ADMINISTRATION OF INSULIN, GLUCAGON, AND MEDICATION FOR ADRENAL INSUFFICIENCY OR ADRENAL CRISIS TO ARKANSAS PUBLIC SCHOOL STUDENTS
Effective May 3, 2022
CHAPTER 1:
REGULATORY AUTHORITY, PURPOSE, AND DEFINITIONS
1.00
REGULATORY AUTHORITY
These rules are enacted pursuant to the Arkansas State Board of
Education's authority and the Arkansas State Board of Nursing's authority under
Ark. Code Ann. §§
6-11-105
6-18-711
6-18-718
17-87-103
and
17-87-203.
2.00
PURPOSE
The purpose of these rules is to set forth protocols and procedures for
the administration of insulin, glucagon, and medication for adrenal
insufficiency or adrenal crises by a student or trained volunteer school
personnel.
3.00
DEFINITIONS3.01 "Adrenal crisis"
means a sudden, severe worsening of symptoms associated with adrenal
insufficiency, which can lead to circulatory collapse, heart and organ failure
brain damage, and death.
3.02
"Adrenal insufficiency" means: 3.02.1 A
chronic medical condition in which the adrenal glands do not produce enough of
the necessary hormones to respond to stressors such as illness and injury;
and
3.02.2 The hormones involved
help maintain and regulate key functions of the body such as blood pressure,
metabolism, the immune system, and how the body responds to stress.
3.03 "Diabetes" means a group of
metabolic disorders characterized by hyperglycemia resulting from defects in
insulin secretion, insulin action, or both.
3.04 "Emergency dose medication" (for
purposes of adrenal crisis) means intramuscular hydrocortisone sodium
succinate.
3.05 "Emergency
Situation" means a circumstance in which students with low blood glucose cannot
be treated with a glucose-containing substance by mouth because the student has
an altered mental state, is having a seizure, or has high blood glucose
requiring emergency administration of insulin to prevent
complications.
3.06 "Glucagon"
means a hormone prescribed by a licensed healthcare practitioner that
stimulates the release of glucose in the blood. Glucagon is dispensed as a
"Glucagon Emergency Kit" or a "Glucagon Emergency Kit for Low Blood
Sugar."
3.07 "Insulin" means a
hormone that regulates the metabolism of glucose and other nutrients. It
generally is given by injection or through a subcutaneous insulin delivery
system. It is prescribed by a licensed healthcare practitioner.
3.08 "Licensed Healthcare Practitioner"
includes, but is not limited to, Medical Doctors, Doctors of Osteopathy,
Advanced Practice Registered Nurses with prescriptive authority, Registered
Nurse Practitioners, and Physician Assistants who work under physician-approved
protocols.
3.09 "Licensed School
Nurse Employed by a School District" means those nurses employed by an Arkansas
public school district or open-enrollment public charter school who hold the
following licenses or certificate:3.09.1
Registered Nurse (RN);
3.09.2
Advanced Practice Registered Nurse (APRN); or
3.09.3 Diabetes Nurse Educator.
3.09.4 This definition does not include
License Practical Nurses (LPNs). LPNs may assist in the provision of training
under these rules. However, training under these rules must be performed by
Registered Nurses, Advance Practice Registered Nurses, or Diabetes Nurse
Educators.
3.10
"Non-scheduled dose of insulin" means an additional or corrective dose of
insulin to treat hyperglycemia or to cover a rise in blood glucose
levels.
3.11 "Other Healthcare
Professional" includes the following:3.11.1
Registered Nurse (RN);
3.11.2
Advanced Practice Registered Nurse (APRN);
3.11.3 Diabetes Nurse Educator;
3.11.4 Medical Doctor (MD);
3.11.5 Registered Nurse
Practitioner;
3.11.6 Doctor of
Osteopathy;
3.11.7 Physician
Assistant;
3.11.8 Pharmacist;
and
3.11.9 Certified Diabetes
Educator.
3.12
"Scheduled dose of insulin" means a dose of insulin administered at regular
times during the school day.
3.13
"Stress dose medication" (for purposes of adrenal insufficiency) means oral
hydrocortisone.
3.14 "Trained
Volunteer School Personnel" means licensed or classified personnel employed by
an Arkansas public school district or open-enrollment public charter school who
volunteer and successfully complete training for the administration:
3.14.1 Of insulin, glucagon, or both to
students diagnosed with diabetes; and
3.14.2 Of an emergency dose medication to a
public school student who is diagnosed with an adrenal insufficiency using the
appropriate delivery equipment when a public school nurse is
unavailable.
CHAPTER 2:
ADMINISTRATION OF INSULIN AND GLUCAGON
4.00
GENERAL REQUIREMENTS
4.01 Upon written request of a parent or
guardian of a student with diabetes and written authorization by the treating
physician of the student, a student, in the classroom, in a designated area at
the school, on school grounds, or at a school-related activity may
4.01.1 Perform blood glucose
checks;
4.01.2 Administer insulin
through the insulin delivery system the student uses;
4.01.3 Treat hypoglycemia and hyperglycemia;
and
4.01.4 Possess on his or her
person the necessary supplies and equipment to perform diabetes monitoring and
treatment functions.
4.02 A student shall have access to a private
area to perform diabetes monitoring and treatment functions upon request of the
parent or guardian of a student, as outlined in the student's health
plan.
4.03 A public school employee
may volunteer to be trained to administer and may administer glucagon to a
student with Type 1 diabetes in an emergency situation as permitted under Ark.
Code Ann §
17-87-103(11).
4.04 A school district shall strive to
achieve the following staffing ratios for...
