Clinic Visit Report

• Clinic Visit Report

• Nurse:

• Area assignment:

  Berkner

  Lake Highlands

  Pearce

  Richardson

• School:

  Select Berkner HS Liberty JH Apollo JH Audelia Creek Big Springs Christa McAuliffe LC Dartmouth Forestridge Jess Harben Mark Twain MST Magnet O'Henry Terrace Richland Springridge Yale Special Procedures

  • Berkner HS
  • Liberty JH
  • Apollo JH
  • Audelia Creek
  • Big Springs
  • Christa McAuliffe LC
  • Dartmouth
  • Forestridge
  • Jess Harben
  • Mark Twain
  • MST Magnet
  • O'Henry
  • Terrace
  • Richland
  • Springridge
  • Yale
  • Special Procedures

• School:

  Select Lake Highlands HS Lake Highlands Freshman Center Forest Meadow JH Lake Highlands JH Aikin Forest Lane Academy Hamilton Park Pacesetter Magnet Lake Highlands Elem Merriman Park Moss Haven Northlake Skyview Stults Road Thurgood Marshall Wallace White Rock Special Procedures Resource Nurse

  • Lake Highlands HS
  • Lake Highlands Freshman Center
  • Forest Meadow JH
  • Lake Highlands JH
  • Aikin
  • Forest Lane Academy
  • Hamilton Park Pacesetter Magnet
  • Lake Highlands Elem
  • Merriman Park
  • Moss Haven
  • Northlake
  • Skyview
  • Stults Road
  • Thurgood Marshall
  • Wallace
  • White Rock
  • Special Procedures
  • Resource Nurse

• School:

  Select Pearce HS North JH Parkhill JH Bowie Brentfield Intermediate Brentfield Primary Canyon Creek Greenwood Hills Mohawk Northrich Prairie Creek Prestonwood Special Procedures

  • Pearce HS
  • North JH
  • Parkhill JH
  • Bowie
  • Brentfield Intermediate
  • Brentfield Primary
  • Canyon Creek
  • Greenwood Hills
  • Mohawk
  • Northrich
  • Prairie Creek
  • Prestonwood
  • Special Procedures

• School:

  Select Richardson HS West JH Westwood JH Arapaho Classical Magnet Carolyn Bukhair Dobie Primary Dover Northwood Hills Heights RISD Academy Spring Creek Spring Valley Special Procedures Resource Nurse

  • Richardson HS
  • West JH
  • Westwood JH
  • Arapaho Classical Magnet
  • Carolyn Bukhair
  • Dobie Primary
  • Dover
  • Northwood Hills
  • Heights
  • RISD Academy
  • Spring Creek
  • Spring Valley
  • Special Procedures
  • Resource Nurse

• Date/Time:

  Date

• Visit Completed By:

  Select Gloria Canham, Director HS Becky Geise, Lead Nurse Mandi Holton, Team Leader Kathy Powell, Team Leader Beverly Rasor, Team Leader Sharon Simpson, Team Leader

  • Gloria Canham, Director HS
  • Becky Geise, Lead Nurse
  • Mandi Holton, Team Leader
  • Kathy Powell, Team Leader
  • Beverly Rasor, Team Leader
  • Sharon Simpson, Team Leader

• This visit was:

  Routine

  Requested by principal

  Requested by RN supervisor

  Requested by RN

Clinic Environment

• Clinic is a nonhazardous environment (free of spills, clear traffic pattern, body fluids cleaned immediately).

  Yes

  No

• Emergency Bags are easily accessible and properly stocked.

  Yes

  No

• Is the 2nd Emergency bag stored in a location away from the clinic (in case of the event that the clinic was inaccessible)?

  Yes

  No

• Campus crisis plan and white emergency flip chart are available and the role of the nurse is understood.

  Yes

  No

• Student health concerns are easily identifiable and accessible.

  Yes

  No

• Are health cards and student health information forms able to be locked up (locking file cabinet or clinic door)?

  Yes

  No

• Does the nurse have an updated notebook/written plan for substitutes to follow?

  Yes

  No

• Are parent emergency phone numbers easily accessible?

  Yes

  No

• Is the nurse properly identified as a registered nurse?

  Yes

  No

• Is the nurse using the most up-to-date forms (special procedure forms, staff training forms, accident reports, etc)?

  Yes

  No

AED(s)

• Are school AED(s) accessible to all school personnel during all hours (not stored in locked room or cabinet)?

  Yes

  No

• Are AED location signs posted in the school?

  Yes

  No

• Is each AED notebook up-to-date regarding the daily/monthly maintenance checks?

  Yes

  No

• Are the AED pads current (non-expired)?

  Yes

  No

• Are the correct pad expiration dates listed in the AED notebook?

  Yes

  No

• Is there a list of current personnel with valid certification expiration dates on the AED sheet?

  Yes

  No

Medications

• Are medications* stored out of reach of children in a locked cabinet? (*except for epinephrine injectors)

  Yes

  No

• Are emergency diabetic supplies and anaphylaxis medications easily accessible in a secure but unlocked location?

  Yes

  No

• Are they labeled in such as way as to be located quickly by staff?

  Yes

  No

• Are inhalers stored in a manner that would be easily removed and carried during a fire/other emergency?

  Yes

  No

• Do all medications have a completed and signed Parent/Physician Authorization to Administer Medications form?

  Yes

  No

• Are all prescription medications in their original container and properly labeled with a pharmacy label that matches the Parent/Physician Authorization to Administer Medications form?

  Yes

  No

• Are all OTC meds in their original container and properly labeled with the student's first and last name?

  Yes

  No

• Are medications being signed off as given with the time and initials of administrator on the RISD Med form?

  Yes

  No

• Have all personnel administering medications signed off on the Medication Signature sheet?

  Yes

  No

• Is an up-to-date medication check-off sheet being utilized?

  Yes

  No

• Pull up this week's medication checklist in Star Student. Compare this checklist with the one being used in the med book. Have all medications been entered into Star Student (student Medication tab)?

  Yes

  No

• Are PRN meds listed correctly? (Should be in their own table and not mixed in with the scheduled meds.)

  Yes

  No

• Are there any meds listed from previous school years that should be closed out in the record?

  Yes

  No

• If there have been missed medications or medication errors, has the nurse completed and submitted incident reports to the Director of Health Services?

  Yes

  No

  N/A

Documentation

• Have clinic visits been entered into Star Student?

  Yes

  No

• Does documentation include history of complaint, assessment, intervention, and evaluation?

  Yes

  No

• Consistently entered in a timely manner (within 3 days)?

  Yes

  No

• Is the nurse maintaining hard copies of the clinic passes and/or sign-in sheets if utilized?

  Yes

  No

• Are they kept in an organized fashion that is easily understood/accessible to office staff, while maintaining confidentiality?

  Yes

  No

• Have student health conditions been entered into Star Student (Disease tab)?

  Yes

  No

• Has the nurse entered details about the health conditions (not just the disease codes)?

  Yes

  No

• Is an EFFECTIVE documentation method in place when the nurse is out of the building?

  Yes

  No

• Are Individualized Healthcare Plans in place for pertinent students?

  Yes

  No

• Was the auditor able to review an IHP during the visit?

  Yes

  No

• Will a time be arranged to provide the nurse feedback regarding an IHP prior to his/her evaluation?

  Yes

  No

• Describe the quality of the health history and assessment sections.

  Missing (no info)

  Some info, but needs more

  Thorough, pertinent information

• Notes:

• Did the nurse identify appropriate needs and risks for the specific student/family?

  Yes

  No

• Did the nurse develop individualized, measurable goals for the student/family?

  Yes

  No

• Are the interventions for each goal individualized?

  Yes

  No

• Are the expected outcomes measurable and specific to the interventions listed? (not just a restatement of the overall goal)

  Yes

  No

• Has the nurse made any progress notes since the care plan was developed (electronically or hand-written)?

  Yes

  Not Yet

Immunizations

• Does the nurse have an effective system in place with the office staff for enrolling students (with regard to shot records and health concerns)?

  Yes

  No

• Does the nurse have a process in place to routinely monitor immunization compliance?

  Yes

  No

• Are there students enrolled at the campus that have a CO or medical exemption (1M or LM)?

  Yes

  No

• Are the original exemption documents filed in the students' CUM folders?

  Yes

  No

Miscellaneous

• Hearing/Vision/AN screening

  Done

  Date Set

  Not Set

  NA

• Have rechecks been completed?

  Yes

  Not Yet

• Is progress on referrals being documented?

  Yes

  No

• Has student data been entered/updated in the ANTES system?

  Yes

  Not Yet

  NA

• Scoliosis Screening

  Done

  Date Set

  Not Set

  NA

• Growth & Development / HIV classes

  Done

  Date Set

  Not Set

  NA

• Has a Campus Food Allergy Management Team been set up for this year?

  Yes

  No

• Has the Team had at least one meeting this year?

  Yes

  No

• Has a date been set for the meeting?

  Yes

  No

Additional Comments

Clinic Equipment

• Does the clinic have a functioning...

• Temporal thermometer?

  Yes

  No

• Oral thermometer?

  Yes

  No

• Stethoscope (in addition to ones in emergency bags)?

  Yes

  No

• Nebulizer?

  Yes

  No

• Pulse Oximeter?

  Yes

  No

• Large Adult Blood Pressure cuff (in addition to ones in emergency bags)?

  Yes

  No

• Adult Blood Pressure cuff (in addition to ones in emergency bags)?

  Yes

  No

• Pediatric Blood Pressure cuff (in addition to ones in emergency bags)?

  Yes

  No

• Automatic Blood Pressure monitor (optional)?

  Yes

  No

• Wall mounted Stadiometer?

  Yes

  No

• Scale

  Yes

  No

  In Gym

• Wheelchair

  Yes

  No

Reference Materials

• Blood-borne Pathogens Manual

• Community Council Resources

• Year

  Select 2009 2010 2011 2012 2013 2014

  • 2009
  • 2010
  • 2011
  • 2012
  • 2013
  • 2014

• Davis Drug Guide

• Dermatology

• Drug ID Bible

• Growth & Development materials

• Essentials of Musculoskeletal Injuries

• Medical Dictionary

• Merck Manual

• Health Care Plans for School Nurses

• Health Services Manuals

• Minor Emergencies

• PDR

• Year

  Select 2009 2010 2011 2012 2013 2014

  • 2009
  • 2010
  • 2011
  • 2012
  • 2013
  • 2014

• Redbook

• Year

  Select 2009 2010 2011 2012 2013 2014

  • 2009
  • 2010
  • 2011
  • 2012
  • 2013
  • 2014

• Special Procedures (purple spiral)

• Sports First Aid

• Whaley and Whong

• Yellow School Health Emergencies Book

• School Nurse

  Sign

• Auditor

  Sign