Transcript Glucagon Injections

Glucagon
Administration
for Unlicensed
Assistive Personnel
by
Donna Canfield, RN, BSN, NCSN
Objective

To provide Clark County School Nurses a
tool to train unlicensed assistive personnel
in Glucagon administration in emergency
situations (severe hypoglycemia).
Goal

The key protocol outcome: unlicensed
assistive personnel will be trained to
recognize signs and symptoms of severe
hypoglycemia and administer an injection of
Glucagon in an emergency situation.
Nevada School Nurse Regulation
and Advisory Opinion
Delegation

1.The Registered Nurse determines when it is appropriate to delegate
or assign any portion of the provision of care. This
delegation/assignment must occur in accordance with the standards of
practice outlined in the Nurse Practice Act and the guidelines of this
Advisory Opinion.

2.The Registered Nurse School Nurse is solely responsible for the
determination of when it is appropriate to delegate or assign nursing
care to a qualified person. A "qualified person" is:
a. A person whose license/certification authorizes his/her
practice; or
b. A willing person whom the RN School Nurse has determined has
acquired and/or maintained knowledge, skill and ability to perform the
care in a safe and effective manner required by the child.
School Nurse Regulation and
Advisory Opinion (cont.)


3. This definition precludes the automatic utilization of
the office manager, secretary or teacher as a qualified
person. Only the School Nurse may delegate or assign
nursing care. The School Administrator cannot legally
delegate or assign nursing care. A Licensed Practical
Nurse providing nursing care in a school may not delegate
or assign nursing care procedures to school personnel.
4. A family member/friend, designated or identified by
the student's parent or legal guardian, is exempt from the
regulations of the Nurse Practice Act and, without
delegation, training or supervision by the school nurse,
may perform required care for the student unless employed
by the school district.
Medication Administration under the
School Nurse Regulations


To administer medications, the School Nurse must have
written permission from parent/guardian, and medication
must have been prescribed by licensed prescribing
practitioner, labeled and dispensed by licensed dispensing
practitioner/pharmacist. Administration must be
accompanied by a reliable tracking system.
The Nevada State Board of Nursing recognizes the
administration/assistance with medication is an issue of
primary concern in school districts. School Nurses/School
Districts are referred to the State Board of Pharmacy to
work out a suitable mechanism for the accomplishment of
this task. Any medication procedure developed must meet
the standard requirement for the safe
administration/assistance of medications.
Medication/Procedure Administration Under
the School Nurse Regulations (cont.)

…The School Nurse may delegate the
Administration of Glucagon injection kit in
emergent situation to a “qualified person”.
The Basics of The Good Samaritan
Law

“Any person who, in good faith, renders
emergency medical care or assistance to an
injured person at the scene of an accident or
other emergency without the expectation of
receiving or intending to receive
compensation from such injured person for
such service, shall not be liable in civil
damages for any act or omission, not
constituting gross negligence, in the course
of such care or assistance.”
Learning Objectives

Participants will learn:
Diabetes basic care
 Symptoms and treatment of hypoglycemia (low
blood glucose)
 Procedure for the emergency administration of
Glucagon

Diabetes Basics



Diabetes is a disease where the body does not
produce insulin or does not use insulin properly.
Insulin is a hormone normally made by the body.
It helps glucose (sugar) enter cells where it can be
used for energy.
Without insulin, glucose remains in the blood
stream and cannot be used for energy by cells.
Diabetic Basics
Children with diabetes must monitor their
blood glucose levels.
 Safe blood glucose levels are achieved through
a careful balance of food intake, exercise and
insulin.
 Insulin and exercise –may cause
low blood glucose
 Food –may cause high blood glucose
 Stress, illness or injury-may cause low or high
blood glucose

Diabetes Basics


Sometimes, blood glucose levels are too high
resulting in a condition called hyperglycemia.
If this happens, insulin must be administered to
lower blood glucose levels. Insulin administration
for children with Type 1 Diabetes is essential for
survival. Call RN and/or parent if they are unable
to give their own insulin!

Sometimes, blood glucose levels drop below the
safe range resulting in a condition called
hypoglycemia.
Causes of Hypoglycemia






Too much insulin
Too little food or delayed meal or snack
Extra physical activity
Illness
Medications
May occur for no apparent reason
Signs/Symptoms of Hypoglycemia
Symptoms of hypoglycemia can range from mild to severe,
and include any or all of the following:
•Mild Symptoms
Hunger
Sweating
Feeling shaky
Feeling nervous
•Moderate Symptoms
Headache
Behavior changes
Blurred, impaired or double vision
Crabbiness or confusion
Drowsiness
Weakness
Difficulty talking
Signs/Symptoms of Hypoglycemia
(cont.)

Severe Hypoglycemia
Unresponsive (i.e. unable or unwilling to take
oral feeding)
Loss of consciousness
Convulsions (seizure activity)
It is important to note that the symptoms of
hypoglycemia may vary from person to person; a given
individual may not experience all of these symptoms in the
order they are listed.
Seriousness of Hypoglycemia
 Hypoglycemia
poses the most immediate
risk to a student with diabetes because
onset is sudden, it is not always
preventable, and may progress to
unconsciousness
 If
person is unresponsive (breathing
or pulse are absent) call 9-1-1 and
initiate cardiopulmonary
resuscitation (CPR.)
What to do next….
1. If breathing and pulse are present, assume the
person with diabetes is having severe
hypoglycemia. DO NOT give any food or liquid
to a person who cannot swallow or is
unconscious/unresponsive.
 2. Delegate someone to call 9-1-1 or other
emergency response system. (If the person is
unwilling or unable to take oral feeding,
unresponsive or unconscious.)
If possible, also have someone call the affected
person’s parent/RN/Health Care Provider.

What to do next (cont.)



3. OBTAIN GLUCAGON EMERGENCY KIT
and check person’s name against
kit. Verify any special physician instructions
including correct dosage. NOTE: BRING supplies
to the person, do not move the person. Time is
critical for administering treatment to ensure
recovery.
4. PREPARE AND ADMINISTER Glucagon for
injection.
5. If student has Insulin Pump, clamp the tubing
so they are not receiving insulin.
What is Glucagon?
Glucagon is a hormone produced in the
pancreas. It increases blood sugar levels.
 Glucagon is used to treat insulin coma or
insulin reaction resulting from severe
hypoglycemia (low blood sugar).
For more information about Glucagon, see
http://www.cigna.com/healthinfo/d00593a
1.html

Glucagon Emergency Kit
Emergency Kit Contains:
1 mg. of freeze-dried Glucagon (vial)
1 ml. water for reconstitution (syringe)
Preparation
of Glucagon Injection
1. Flip cap off
glass vial
containing dry
powder
2. Remove cap
from syringe
Mixing the Glucagon Solution
3. Inject entire fluid in
syringe into the bottle
containing powder
Mixing Glucagon Solution
(cont.)
4. Shake gently or roll to mix until
all powder is dissolved and
solution is
clear.
Drawing Out the Solution
5. Inspect. Solution should be clear and
colorless.
6. Draw prescribed
amount of Glucagon
back into the syringe.
Dosing and Injecting
7. Put on gloves.
8. Clean site with alcohol swab if possible.
9. Inject at 90° into the tissue under cleansed
area
 buttocks
 thigh
 arm
Injecting Glucagon (cont.)


Withdraw needle, then apply light pressure
at injection site. Discard needle into a
sharps container or, if unavailable, back into
its case.
Do not recap needle.
After Injecting Glucagon


It may take 10-15 minutes for the student to
regain consciousness.
Vomiting may occur -keep the student
positioned on side to prevent choking.
Next Steps
• Once the student is awake and able to drink, give
sips of fruit juice or regular soda and advance diet
as tolerated.
• Remain with the student until emergency medical
services assumes control. The student should not
resume normal activities.
• Notify appropriate parties of incident details and
attend debriefing meeting with school nurse.
School nurse will document incident in
appropriate health records.
Don’t Be Surprised If…
The student does not remember being
unconscious or is incoherent or
lethargic.
 The student feels nauseated, vomits, or
has a headache.

Video review
<I plan to insert the video from Costal
(Glucagon injection portion only) at this
time to re-emphasize and re-teach the
actual preparation and injection of
Glucagon and then have a practice session
with the UAP’s using the ‘demos’ from the
Lily company>

Quick Review


Mild to moderate hypoglycemia can be
treated with a quick acting source of
carbohydrate (15 grams).
Signs of severe hypoglycemia include:
Unconsciousness
Seizures
Inability to swallow
Quick Review (cont.)

Severe hypoglycemia is a medical
emergency requiring immediate
administration of Glucagon.

Treat, then follow the district policy for
medical emergency care.
References







Cigna. (2005). Glucagon [Brochure]. Retrieved from
http://cigna.com/healthinfo/d00593a1.html
Drugsite Trust. (2006). Glucagon [Fact sheet]. Retrieved from
http://www.drugs.com/pro/glucagon.html
Eli Lilly and Company. (2004). Glucagon for Injection Vials and Emergency Kit
[Brochure]. Retrieved from
http://www.theodora.com/drugs/glucagon_for_
injection_vials_and_emergency_kit_lilly.html
Eli Lilly and Company. (2008). Understanding Glucagon [Fact sheet]. Retrieved
from http://www.humalog.com/patient/hypoglycemia_treatment.jsp
Gursky, B. S., & Ryser, B. J. (2007, April). A Training Program for Unlicensed
Assistive Personnel. Journal of School Nursing, 23, 92-97.
McKesson Corporation. (2006). Diabetes: Glucagon Injections [Fact sheet].
Retrieved from http://med.umich.edu/1libr/pa/pa_glucagon_hhg.htm
Nevada School Nurse Regulation and Advisory Opinion, Nevada
Administrative Code § 632.226 (2000).