Campus Health Clinic Walk Through: General Compliance

• Site conducted

  Select

• Campus

• Campus RN

• Conducted on

  Date

• Prepared by

General

• Clinic is neat, clean and orderly; storage areas are organized and uncluttered.

  Yes

  No

  N/A

• Gloves are readily accessible and latex-free

  Yes

  No

  N/A

• Disposable items are unexpired, undamaged, not discolored and latex-free (bandages, tape, etc.)

  Yes

  No

  N/A

• Sharps container is appropriately secured/stored and safely accessible when needed

  Yes

  No

  N/A

• Sub information sheet current

  Yes

  No

  N/A

• Supplies and information for special procedures, medications, diabetes care are easy to access/find, labeled

  Yes

  No

  N/A

Emergency Preparedness

• Blue Medical Bag visible/nearby med cart or other evacuation supplies.

  Yes

  No

  N/A

• Contents of bag are not expired

  Yes

  No

  N/A

• Equipment is properly assembled (BP cuffs, stethoscope, etc.)

  Yes

  No

  N/A

• C.A.T is in bag

  Yes

  No

  N/A

• Kerlix rolls (2 minimum)

  Yes

  No

  N/A

• Glucose gel

  Yes

  No

  N/A

• Clinic stock EpiKit is readily available/easy to find.

  Yes

  No

  N/A

• EpiKit syringe expiration date

• EpiKit epinephrine expiration date

• Diabetes evacuation kit (clear bag with glucose sources & backup meter) is stocked and stored in Med Cart or Blue Bag

  Yes

  No

  N/A

• Glucagon is stored in a readily accessible location, and can be easily taken with evacuation (recommend all glucagon in Med Cart for elementary & middle school)

  Yes

  No

  N/A

• Emergency seizure meds are stored in readily accessible location & easily taken for evacuation (recommend storage in Med Cart for elementary & middle school)

  Yes

  No

  N/A

• Medications are labeled with pink dots if high priority for evacuation, if time allows.

  Yes

  No

  N/A

• Campus RN has evacuated with medical supplies at least once/semester with campus evacuation drill [med cart (elementary & middle schools); med kit/box/diabetes kit (high schools); Blue Medical Bag; Med Binder; Winbook]

  Yes

  No

  N/A

• Winbook and charger are ready/available for evacuation

  Yes

  No

  N/A

• Student emergency information current and PDF stored on Winbook

  Yes

  No

  N/A

• Employee emergency information current/complete and PDF stored on Winbook

  Yes

  No

  N/A

• RN is wearing badge buddy with emergency procedures and evacuation instructions.

  Yes

  No

  N/A

• AED maintenance checks are current

  Yes

  No

  N/A

• Medical Emergency Response Team (MERT) identified/updated for current school year

  Yes

  No

  N/A

• Adequate number of MERT members have current CPR certification

  Yes

  No

  N/A

• MERT drill/training completed 1st semester drill scheduled or completed

  Yes

  No

  N/A

• Plan in place for entry into locked bathroom doors in clinic or other campus locations (hex/Allen key, coin, or other device); MERT/campus staff know procedure

  Yes

  No

  N/A

• Cafeteria manager has been provided food allergy list and completed special diet request forms

  Yes

  No

  N/A

• Teachers/staff have been provided food allergy information and assisted with classroom/campus food allergy safety procedures

  Yes

  No

  N/A

• Alert box and critical alerts have been entered/updated (Skyward)

  Yes

  No

  N/A

Screening and Health Education/Promotion

• Audiometer monthly biological checks are completed/up-to-date

  Yes

  No

  N/A

• Vision mass screening

  Completed

  Scheduled, not yet completed

  Not scheduled

  N/A

• Hearing mass screening

  Completed

  Scheduled, not yet completed

  Not scheduled

  N/A

• AN mass screening

  Completed

  Scheduled, not yet completed

  Not scheduled

  N/A

• Assessments done and documented in Skyward

  Yes

  No

  N/A

• Spinal mass screening (required in fall semester)

  Completed

  Scheduled, not yet completed

  Not scheduled

  N/A

• Hand washing signs posted on campus

  Yes

  No

  N/A

• Hand washing education; respiratory etiquette; cold & flu prevention

  Yes

  No

  N/A

• 5th grade boys & girls Growth & Development (Fall semester)

  Completed

  Scheduled, not yet completed

  Not scheduled

  N/A

Immunizations

• Affidavits (conscientious exemptions) are current and accurately documented in Skyward

  Yes

  No

  N/A

• Affidavits are scanned/attached in Skyward Portfolio

  Yes

  No

  N/A

• Original paper Affidavits are stored student's pink health file

  Yes

  No

  N/A

• Campus has a student with medical vaccine exemption

  Yes

  No

  N/A

• Medical exemption is accurately documented in Skyward (review statement: date signed by physician, good for one year or lifelong)

  Yes

  No

  N/A

• Medical exemption letters are scanned/attached in Skyward Portfolio

  Yes

  No

  N/A

• Original paper medical exemption letter is stored in student's pink file

  Yes

  No

  N/A

Medications

• Medication keys and medication cabinets secured at time of walk through (visual inspection)

  Yes

  No

  N/A

• Principal medication assignment form is current and signed by Principal

  Yes

  No

  N/A

• Standing order medications are stocked

  Yes

  No

  N/A

• Current year's standing orders are posted in front of Med Binder

  Yes

  No

  N/A

• Standing order meds are not expired

  Yes

  No

  N/A

• Current student declination list is posted & visible near medications/treatment area

  Yes

  No

  N/A

• No unauthorized student-use unassigned medications are present

  Yes

  No

  N/A

• Expiration Log is up to date

  Yes

  No

  N/A

• Medication Worksheet is printed and being used

  Yes

  No

  N/A

• Student prescribed epinephrine is stored in a readily accessible location

  Yes

  No

  N/A

• Controlled medications are properly secured

  Yes

  No

  N/A

• All controlled medications (inventory sub-types) are tracked in Skyward ("Track Inventory" checked)

  Yes

  No

  N/A

• Weekly inventory documentation is current and no variances are noted

  Yes

  No

  N/A

• Inventory completed by campus RN and Health Services Administrator

  No variances

  Variance noted

  No controlled meds

• Describe variance and reconciliation; complete written variance report form

• Diabetes supplies are readily available and clear plan in place for evacuation with supplies

  Yes

  No

  N/A

• UDCA assignment form current with all assigned UDCAs and signed by the Principal

  Yes

  No

  N/A

• All assigned UDCAs have completed initial training and posttest

  Yes

  No

  N/A

• UDCA skills training current and documented on diabetes care checklist

  Yes

  No

  N/A

• Transportation notifications have been completed for all students with diabetes that ride bus.

  Yes

  No

  N/A

• Transportation notifications have been sent for all students with special procedures or medically complex conditions that may require emergency intervention.

  Yes

  No

  N/A

• Supplies for special procedures are ready for evacuation (recommend storing one package of IC or TF supplies in Med Cart)

  Yes

  No

  N/A

• Delegated procedures

  Yes

  N/A

• Competency training documented with minimum of 3 successful return demonstrations

  Yes

  No

  N/A

• RN is conducting supervisory visits and documenting student status in Skyward at least every 2 weeks

  Yes

  No

  N/A

• Professional Goal is entered in Strive for current school year

  Yes

  No

  N/A

• Additional comments/feedback

• Audit completed with Campus RN:

• Audit completed by: