Plano Independent School District s4

PLANO INDEPENDENT SCHOOL DISTRICT
School Health
Glucagon Injection
Employee Name / Campus
Instructor / Training Date / Review Date
In order to perform a Glucagon Injection for students, employees must complete training and demonstrate the ability to perform the following tasks:
Trained / Reviewed
1) / Check doctor’s orders, IHP, PISD guidelines and parental consent.
2) / Identify student and check prescription label for correct medication and dose.
3) / Remove the flip-off seal from the bottle of glucagon.
4) / Wipe rubber stopper on bottle with alcohol swab (if available).
5) / Remove the needle protector from the syringe.
6) / Inject contents of the syringe into the glucagon bottle.
7) / DO NOT REMOVE THE PLASTIC CLIP FROM THE SYRINGE.
8) / Remove syringe from the bottle.
9) / Swirl bottle gently until glucagon dissolves completely. GLUCAGON SHOULD NOT BE USED UNLESS THE SOLUTION IS CLEAR AND OF A WATER LIKE CONSISTENCY.
10) / Using the same syringe, hold bottle upside down and, making sure the needle tip remains in solution, gently withdraw solution (1 mg mark on syringe) from the bottle. The plastic clip will prevent the rubber stopper from being pulled out of syringe. If the plastic plunger rod separates from the rubber stopper, simply reinsert the rod by turning it clockwise.
11) / Children weighing less than 44 lb., give ½ the adult dose (0.5 mg). Discard unused portion.
12) / Cleanse injection site on buttock, arm or thigh with alcohol swab.
13) / Insert the needle into the loose tissue and inject. Apply light pressure at the injection site and withdraw the needle.
15) / Turn the patient on his/her side, in case of vomiting to prevent choking.
16) / Record on student’s medication sheet.

I have received instructions on the steps to be followed in the procedure of a Glucagon Injection at school following Plano Independent School District guidelines and understand my responsibilities.

Employee Signature / Date
Instructor Signature / Date