Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
Clinic Evaluation Visit
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Conducted on
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Prepared by
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Location
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Personnel
Audit
Professionalism
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Is the clinic professional in appearance? Does it look like a professional adult is employed in this setting? Is the clinic clean, orderly and well organized?
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Is there paper on the cots? Are cots being wiped down and paper being replenished between patients/students?
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Is nurse/aide wearing RN/LVN/Clinic Assistant name tag with designation? Is RN/LVN/Clinic Assistant dressed professionally?
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Are clinic passes being used? If not, is the staff member able to articulate that there is a safe and orderly way to identify students seeking care in the clinic?
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Does the nurse have an organized substitute binder? Does the substitute binder include the following items: Substitute nurse report/feedback form, A report on medically fragile students with care plans, forms (head injury checklist, medical referral forms, CFBISD Guidelines for Sending Ill Students Home, Bell Schedule, Lunch Schedule, School Map.
Compliance with medication policy and procedures
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What is your telehealth process? How do you maintain privacy during visits?
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Are there corresponding medication orders for each medication being administered?
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Do medication orders include medication name, dosage, route, time, frequency, reason for administration? Is frequency being adhered to? Daily medications being given on a daily basis, etc?
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Are the medications secured in the medication cart? Are controlled substances under double lock in the lockbox at bottom of cart? Are staff using safe medication administration practices, i.e. utilizing the stop sign/boundary present so that nurse/aide may administer medication safely and protect student privacy? Has campus staff been trained not to interrupt medication administration? Is documentation completed at time of administration?
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Are pictures present on medication, book and medication cart so that a students may be correctly identified prior to medication administration?
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Has the campus staff been trained in safe medication administration practices this year? UDCA training, epi-pen training, narcan training etc.? Has the training been documented in Frontline under Educational Sessions?
Documentation
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Are medications and procedures set up in Frontline?
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Is the nurse/aide documenting on a daily basis? Is documentation thorough?
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Please document the number of care plans completed. Are physical assessments completed on each student receiving care on a daily/regular basis? Is case management/coordination of care being documented?
Emergency Preparedness
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Show me your biohazardous waste container, does it have a red bag in place? Is it labelled do not empty? Where is your sharps container? Are you using a Isolyzer Sharps disposal unit? Show me your Red binder entitled, "Emergency and First Aid Guidelines."
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Is supply inventory adequate to meet the needs of students/staff seen in the clinic? Are first aide supplies where staff can locate when needed in absence of nurse (illness and no substitute, after hours, etc.) ?
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Is disaster bag readily available? Does disaster bag have current emergency lists and have expiration dates of supplies been checked and expired items replaced? When were the batteries changed in the Stop the Bleed cabinet?
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Does the campus have a list of at least 10 staff members on campus to serve as the AED Team? Has the campus held or scheduled their AED TEAM drill? Has the AED Team been loaded into Raptor?
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Does the principal assigned clinic backup have current Heartsaver CPR certification?
Screenings/Immunizations
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Does the nurse have a system (in collaboration with campus administration/front office) for tracking newly enrolled students? How does the nurse track immunization compliance?
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Does the nurse have a system to track students who need state mandated screenings?
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Does the nurse have a system to follow up on vision, hearing, spinal and AN referrals?
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Have monthly biological calibrations been completed on the audiometer as required by TDSHS?
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Is the nurse using one of the required vision screening charts as per TDSHS guidelines (HOTV or Sloan)? Show me your scoliometer. Do you have supplies needed to complete screenings?