Visit Checklist

Clinic Environment

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

Emergency Bags are easily accessible and properly stocked.

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

Personal Protective Equipment (PPE) (2 per nurse assigned to campus) is clearly labeled and stored in a secure location.

Campus crisis plan and standard response protocol chart are available and the role of the nurse is understood.

Are the original "gold forms" and a printed version of the current health conditions list easily accessible?

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

Does the nurse have an updated notebook/written plan for substitutes to follow (using updated template)?

Are parent emergency phone numbers easily accessible?

Is the nurse properly identified as a registered nurse?

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

AED(s)

Are school AED(s) accessible to all school personnel during all hours (mounted in recessed cabinet in public area)?

Are AED location signs posted in the school?

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

Are the AED pads current (non-expired)?

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

Is there a list of current personnel with valid certification expiration dates on the AED sheet? (minimum 3 per campus)

Has an Emergency Response Team (6 person minimum) been established for the year?

Has the team participated in an AED drill WITHOUT students present this year?

Has the team participated in an AED drill WITH students present this year?

Medications

Are medications* stored out of reach of children in a locked cabinet? (*except for severe allergy medication)

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

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

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

Are current year "Principal Designees for Medication Administration" and "Medication Signature" forms completed and accessible in the medication book?

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

Is the evaluator able to locate current year completed staff medication training forms for staff administering medications?

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

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?

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

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

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

Run the Medications checklist report for the campus in Focus. Compare this list with the one being used in the medication book.

Have all medications been entered into Focus?

Are the appropriate Days to be Administered checked (the days the med should be available for use)?

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

Documentation

Are clinic visits up-to-date in Focus? (entered and in Completed Events section of log)

Has a clinic visit documentation audit been completed for the nurse this semester?

Run a current Nurse Health Conditions report in Focus (or review a recently printed version of this report).

Has the nurse entered a comment for each health condition (not just the disease code)?

Have health condition comments been cleaned up since the data transfer from Star Student (previous dates are removed from the comments, etc)?

Run the Medical Alerts report for the campus (Reports menu, but not under District Reports) in Focus.

Are all medical alerts appropriate?
~ there is no hearing/vision related alert info coded as a MEDICAL alert
~ alerts are appropriate (think life-threatening/urgent...ex: an alert for ADHD is not appropriate)

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

Are Individualized Healthcare Plans in place for pertinent students?

Have the IHPs, EAPs, and any applicable physician orders been uploaded into Focus for the school year?

Have the IHPs for special education students been uploaded into eSTAR Archive Manager?

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

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

Describe the quality of the health history and assessment sections.

Notes:

Did the nurse identify appropriate nursing diagnosis(es) based on assessment data, and using standardized nursing language?

Did the nurse develop goals for the student/family related to the selected nursing diagnosis(es)?

Did the nurse utilize NOCs appropriate to the selected nursing diagnosis(es)?

Are the NOC indicators appropriate for the student?

Has the nurse completed the initial evaluation of the NOC indicators and calculated the initial overall NOC score?

Are the listed Nursing Interventions (NIC) appropriate for the student?

Are the Nursing Services minutes reflective of the amount of SCHEDULED nursing care the student needs when RISD is providing the care?

Is there a student with a private duty nurse on the campus?

Does the school nurse:

Have current RISD orders uploaded (not just agency orders)?

Have an IHP for the student (complete with RISD nurse assessment etc)?

Know the child and his/her care well enough to step in and provide care on short notice?

Immunizations

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

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

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

Miscellaneous

Have all initial screenings for Hearing/Vision/AN been completed?

Have all rechecks been completed?

Is progress on referrals being documented?

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

Scoliosis Screening

Growth & Development / HIV classes

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

Has the Team had at least one meeting this year?

Has a date been set for the meeting?

Additional Comments

Equipment & Reference Materials

Clinic Equipment

Does the clinic have a functioning...

Oral thermometer

Temporal or infrared thermometer

Stethoscope (in addition to ones in emergency bags) (district issued)

Nebulizer

Pulse Oximeter

Large Adult BP cuff (in addition to ones in emergency bags)

Adult BP cuff (in addition to ones in emergency bags)

Pedi BP cuff (in addition to ones in emergency bag)

Automatic BP monitor (optional)

Wall-mounted stadiometer

Scale

Wheelchair

Reference Materials

Blood-borne Pathogens Manual

Davis Drug Guide

Year

Dermatology

Growth & Development materials

Medical Dictionary

Health Care Plans for School Nurses

Minor Emergencies

Nursing Diagnoses 2015-2017 (NANDA) book

Nursing Outcomes Classification (NOC) book

Redbook

Year

School Nursing (Selekman)

Supporting Students w/Special Health Care Needs (purple spiral or 3rd ed.)

Sports First Aid

2016 School Nurse Resource Manual

Signatures

School Nurse
Auditor
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.