CLINIC MANAGEMENT

  • Clinic orderly and free of clutter.

  • Follow up with corrective action will be completed by:

  • Supplies are easily accessible.

  • Follow up with corrective action will be completed by:

  • Equipment (audiometer, otoscope, scales, pulse ox, sphygmometer, Titmus) in working order.

  • Follow up with corrective action will be completed by:

CLINIC VISIT DOCUMENTATION

  • Accurate and complete documentation of assessments in electronic health record according to TAC 217.11

  • Follow up with corrective action will be completed by:

  • Accurate and complete docimentation of interventions in electronic health record according to TAC 217.11

  • Follow up with corrective action will be completed by:

  • Accurate and complete documentation of response to interventions in electronic health record according to TAC 217.11

  • Follow up with corrective action will be completed by:

MEDICATION PROCEDURES

  • All medication orders are signed by the parent. Prescription medication orders or medication given longer the 15 days signed by the parent and physician.

  • Follow up with corrective action will be completed by:

  • All medication orders entered in the electronic health record.

  • Follow up with corrective action will be completed by:

  • All medication properly labeled and secured in a locked cabinet.

  • Follow up with corrected action will be completed by:

  • Original medication requests are kept in a properly labeled binder and are readily accessible.

  • Follow up with corrected action will be completed by:

UNLICENSED ASSISTIVE PERSONNEL

  • Medication skills checklists are complete for all staff members who have been assigned by the Principal to administer medications (UAP, coaches, field trips, extra-curricular).

  • Follow up with corrected action will be completed by:

DIABETES CARE

  • DMMP current and signed by the parent and physician.

  • Follow up with corrective action will be completed by:

  • EMS - Extra copies of DMMP in labeled envelope for EMS personnel.

  • Follow up with corrective action will be completed by:

  • UDCA authorization present on DMMP or UDCA authorization form.

  • Follow up with corrective action will be completed by:

  • UDCA checklists completed and readily accessible.

  • Follow up with corrective action will be completed by:

  • Transportation plan complete if bus rider. Copy given to bus driver and transportation supervisor.

  • Follow up with corrective action will be completed by:

  • Emergency Action Plan (EAP) for each student completed as needed (teachers, coaches, specials).

  • Follow up with corrective action will be completed by:

  • Emergency kits available for diabetic students, or students self carry in the event of a lock down or evacuation.

  • Follow up with corrective action will be completed by:

SEVERE ALLERGY AND ANAPHYLAXIS

  • Level 1 Anaphylaxis training completed and documented with epinephrine auto-injector and/or medication skills training checklist.

  • Follow up with corrective action will be completed by:

  • Level 2 (staff specific) Anaphylaxis training completed and documented with epinephrine auto-injector and review of Action Plan.

  • Follow up with corrective action will be completed by:

  • EAPs for each student completed as needed (teachers, coaches, specials).

  • Follow up with corrective action will be completed by:

  • Epinephrine auto-injectors are kept in an unlocked labeled cabinet.

  • Follow up with corrective action will be completed by:

  • Epinephrine auto-injectors are clearly labeled to be rapidly identifiable for emergency use.

  • Follow up with corrective action will be completed by:

  • Transportation plan complete if bus rider. Copy given to bus driver and transportation supervisor.

  • Follow up with corrective action will be completed by:

SEIZURE CARE

  • Seizure Action Plan completed and signed by the parent and physician.

  • Follow up with corrective action will be completed by:

  • Parent questionnaires, and/or information about seizure condition is present and current.

  • Follow up with corrective action will be completed by:

  • Seizure Action Plan in place with need-to-know staff.

  • Follow up with corrective action will be completed by:

  • Transportation plan complete if bus rider. Copy given to bus driver and transportation supervisor.

  • Follow up with corrective action will be completed by:

SPECIAL PROCEDURES

  • Orders for special procedure(s) are current, signed by parent and physician.

  • Follow up with corrected action will be completed by:

  • Special procedure skills checklists are complete for any staff member who assists with special procedures and are readily accessible.

  • Follow up with corrected action will be completed by:

IMMUNIZATION COMPLIANCE

  • Immunizations current/updated and documented in the electronic health record.

  • Follow up with corrected action will be completed by:

  • Conscientious and Medical Exemptions current, signed by parent or physician according to nursing protocol, notorized, documented in the electronic health record, and the original filed in student file.

  • Follow up with corrected action will be completed by:

SCREENINGS

  • Hearing and Vision screenings completed within 120 days of enrollment and documented in the electronic health record.

  • Follow up with corrected action will be completed by:

  • Scoliosis screenings completed by spring break for grades 6 and 9.

  • Follow up with corrected action will be completed by:

  • Acanthosis screenings completed.

  • Follow up with corrected action will be completed by:

  • Screening referrals documented in the electronic health record and follow-up completed or on schedule.

  • Follow up with corrected action will be completed by:

  • Self-audit of Hearing, Vision, and Spinal State Report has been completed and corrections to data entry have been made.

  • Follow up with corrected action will be completed by:

  • AN screening updated and documented in RFES website.

  • Follow up with corrective action will be completed by:

  • Monthly Biological Callibration of audiometer documented and easily accessible.

  • Follow up with corrective action will be completed by:

HEALTH CONDITIONS AND INDIVIDUAL HEALTH PLANS (IHPs)

  • Skyward alert information has been updated/added, critical alert box checked if appropriate.

  • Follow up with corrective action will be completed by:

  • Health conditions and alerts updated in electronic health record and designated 0, 1, or 2 in accordance with nursing protocol.

  • Follow up with corrective action will be completed by:

  • Notification of need-to-know staff has been done and documented (teachers, 504 coordinator, coaches, extra- curricular sponsors, child nutrition manager).

  • Follow up with corrective action will be completed by:

  • IHPs have been created or updated for identified students.

  • Follow up with corrected action will be completed by:

  • IHPs include evidence of interventions completed and goals being met or in progress (notes in office visit, medication administration notes, on IHP, skills checklists, etc.).

  • Follow up with corrected action will be completed by:

  • Syndromic Surveillance report completed and documented on Fort Bend DSHS website.

  • Follow up with corrected action will be completed by:

EMERGENCY PREPAREDNESS

  • Emergency care consent forms are printed and available to be quickly accessed during an emergency.

  • Follow up with corrected action will be completed by:

  • ICE updated on iPad and available to be quickly accessed during an emergency.

  • Follow up with corrected action will be completed by:

  • AED/Crisis Team has been identified.

  • Follow up with corrected action will be completed by:

  • AED/Crisis Team DRILLS/TRAINING:
    First semester drill completed and documented. Date:

  • Follow up with corrective action will be completed by:

  • AED/Crisis Team DRILLS/TRAINING:
    Second semester drill completed/scheduled. Date:

  • Follow up with corrective action will be completed by:

  • Emergency bag is stocked, contents are unexpired, and readily accessible.

  • Follow up with corrected action will be completed by:

  • Emergency bag contents checklist complete and easily accessible.

  • Follow up with corrected action will be completed by:

  • Evacuation plan in place for students, medications, special procedures, and diabetes supplies/equipment.

  • Follow up with corrected action will be completed by:

  • Evacuation of clinic emergency supplies has been practiced with at least one fire/evacuation drill.

  • Follow up with corrected action will be completed by:

  • AED daily, monthly, and annual checks are performed and documented.

  • Follow up with corrective action will be completed by:

SUBSTITUTE BINDER

  • SECTION 1: Daily Schedule/ Essential Information

  • Follow up with corrective action will be completed by:

  • SECTION 2: Medical Alert Information

  • Follow up with corrective action will be completed by:

  • SECTION 3: Emergency procedures

  • Follow up with corrective action will be completed by:

  • SECTION 4: Clinic procedures

  • Follow up with corrective action will be completed by:

  • SECTION 5: Communicable Disease Guidelines

  • Follow up with corrective action will be completed by:

  • SECTION 6: Telephone Lists/Communication

  • Follow up with corrective action will be completed by:

  • SECTION 7: Miscellaneous

  • Follow up with corrective action will be completed by:

  • SECTION 8: Clinic Forms

  • Follow up with corrective action will be completed by:

COMPREHENSIVE SCHOOL HEALTH PROGRAM

  • Professional development hours completed with content relevant to school nursing.

  • Classroom education done supporting health TEKS.

  • Special event/committee involvement?

  • Review of professional goals.

  • Additional Comments

Signatures

  • Coordinator of Health Services

  • School Nurse

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