Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Personnel
CLINIC MANAGEMENT
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Clinic orderly and free of clutter.
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Follow up with corrective action will be completed by:
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Supplies are easily accessible.
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Follow up with corrective action will be completed by:
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Equipment (audiometer, otoscope, scales, pulse ox, sphygmometer, Titmus) in working order.
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Follow up with corrective action will be completed by:
CLINIC VISIT DOCUMENTATION
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Accurate and complete documentation of assessments in electronic health record according to TAC 217.11
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Follow up with corrective action will be completed by:
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Accurate and complete docimentation of interventions in electronic health record according to TAC 217.11
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Follow up with corrective action will be completed by:
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Accurate and complete documentation of response to interventions in electronic health record according to TAC 217.11
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Follow up with corrective action will be completed by:
MEDICATION PROCEDURES
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All medication orders are signed by the parent. Prescription medication orders or medication given longer the 15 days signed by the parent and physician.
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Follow up with corrective action will be completed by:
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All medication orders entered in the electronic health record.
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Follow up with corrective action will be completed by:
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All medication properly labeled and secured in a locked cabinet.
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Follow up with corrected action will be completed by:
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Original medication requests are kept in a properly labeled binder and are readily accessible.
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Follow up with corrected action will be completed by:
UNLICENSED ASSISTIVE PERSONNEL
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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).
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Follow up with corrected action will be completed by:
DIABETES CARE
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DMMP current and signed by the parent and physician.
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Follow up with corrective action will be completed by:
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EMS - Extra copies of DMMP in labeled envelope for EMS personnel.
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Follow up with corrective action will be completed by:
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UDCA authorization present on DMMP or UDCA authorization form.
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Follow up with corrective action will be completed by:
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UDCA checklists completed and readily accessible.
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Follow up with corrective action will be completed by:
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Transportation plan complete if bus rider. Copy given to bus driver and transportation supervisor.
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Follow up with corrective action will be completed by:
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Emergency Action Plan (EAP) for each student completed as needed (teachers, coaches, specials).
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Follow up with corrective action will be completed by:
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Emergency kits available for diabetic students, or students self carry in the event of a lock down or evacuation.
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Follow up with corrective action will be completed by:
SEVERE ALLERGY AND ANAPHYLAXIS
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Level 1 Anaphylaxis training completed and documented with epinephrine auto-injector and/or medication skills training checklist.
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Follow up with corrective action will be completed by:
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Level 2 (staff specific) Anaphylaxis training completed and documented with epinephrine auto-injector and review of Action Plan.
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Follow up with corrective action will be completed by:
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EAPs for each student completed as needed (teachers, coaches, specials).
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Follow up with corrective action will be completed by:
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Epinephrine auto-injectors are kept in an unlocked labeled cabinet.
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Follow up with corrective action will be completed by:
- 1 day
- 10 school days
- 30 days
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Epinephrine auto-injectors are clearly labeled to be rapidly identifiable for emergency use.
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Follow up with corrective action will be completed by:
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Transportation plan complete if bus rider. Copy given to bus driver and transportation supervisor.
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Follow up with corrective action will be completed by:
SEIZURE CARE
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Seizure Action Plan completed and signed by the parent and physician.
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Follow up with corrective action will be completed by:
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Parent questionnaires, and/or information about seizure condition is present and current.
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Follow up with corrective action will be completed by:
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Seizure Action Plan in place with need-to-know staff.
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Follow up with corrective action will be completed by:
- 1 day
- 10 school days
- 30 days
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Transportation plan complete if bus rider. Copy given to bus driver and transportation supervisor.
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Follow up with corrective action will be completed by:
SPECIAL PROCEDURES
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Orders for special procedure(s) are current, signed by parent and physician.
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Follow up with corrected action will be completed by:
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Special procedure skills checklists are complete for any staff member who assists with special procedures and are readily accessible.
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Follow up with corrected action will be completed by:
IMMUNIZATION COMPLIANCE
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Immunizations current/updated and documented in the electronic health record.
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Follow up with corrected action will be completed by:
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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.
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Follow up with corrected action will be completed by:
SCREENINGS
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Hearing and Vision screenings completed within 120 days of enrollment and documented in the electronic health record.
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Follow up with corrected action will be completed by:
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Scoliosis screenings completed by spring break for grades 6 and 9.
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Follow up with corrected action will be completed by:
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Acanthosis screenings completed.
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Follow up with corrected action will be completed by:
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Screening referrals documented in the electronic health record and follow-up completed or on schedule.
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Follow up with corrected action will be completed by:
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Self-audit of Hearing, Vision, and Spinal State Report has been completed and corrections to data entry have been made.
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Follow up with corrected action will be completed by:
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AN screening updated and documented in RFES website.
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Follow up with corrective action will be completed by:
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Monthly Biological Callibration of audiometer documented and easily accessible.
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Follow up with corrective action will be completed by:
HEALTH CONDITIONS AND INDIVIDUAL HEALTH PLANS (IHPs)
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Skyward alert information has been updated/added, critical alert box checked if appropriate.
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Follow up with corrective action will be completed by:
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Health conditions and alerts updated in electronic health record and designated 0, 1, or 2 in accordance with nursing protocol.
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Follow up with corrective action will be completed by:
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Notification of need-to-know staff has been done and documented (teachers, 504 coordinator, coaches, extra- curricular sponsors, child nutrition manager).
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Follow up with corrective action will be completed by:
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IHPs have been created or updated for identified students.
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Follow up with corrected action will be completed by:
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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.).
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Follow up with corrected action will be completed by:
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Syndromic Surveillance report completed and documented on Fort Bend DSHS website.
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Follow up with corrected action will be completed by:
EMERGENCY PREPAREDNESS
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Emergency care consent forms are printed and available to be quickly accessed during an emergency.
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Follow up with corrected action will be completed by:
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ICE updated on iPad and available to be quickly accessed during an emergency.
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Follow up with corrected action will be completed by:
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AED/Crisis Team has been identified.
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Follow up with corrected action will be completed by:
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AED/Crisis Team DRILLS/TRAINING:<br>First semester drill completed and documented. Date:
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Follow up with corrective action will be completed by:
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AED/Crisis Team DRILLS/TRAINING:<br>Second semester drill completed/scheduled. Date:
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Follow up with corrective action will be completed by:
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Emergency bag is stocked, contents are unexpired, and readily accessible.
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Follow up with corrected action will be completed by:
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Emergency bag contents checklist complete and easily accessible.
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Follow up with corrected action will be completed by:
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Evacuation plan in place for students, medications, special procedures, and diabetes supplies/equipment.
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Follow up with corrected action will be completed by:
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Evacuation of clinic emergency supplies has been practiced with at least one fire/evacuation drill.
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Follow up with corrected action will be completed by:
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AED daily, monthly, and annual checks are performed and documented.
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Follow up with corrective action will be completed by:
SUBSTITUTE BINDER
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SECTION 1: Daily Schedule/ Essential Information
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Follow up with corrective action will be completed by:
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SECTION 2: Medical Alert Information
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Follow up with corrective action will be completed by:
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SECTION 3: Emergency procedures
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Follow up with corrective action will be completed by:
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SECTION 4: Clinic procedures
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Follow up with corrective action will be completed by:
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SECTION 5: Communicable Disease Guidelines
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Follow up with corrective action will be completed by:
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SECTION 6: Telephone Lists/Communication
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Follow up with corrective action will be completed by:
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SECTION 7: Miscellaneous
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Follow up with corrective action will be completed by:
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SECTION 8: Clinic Forms
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Follow up with corrective action will be completed by:
COMPREHENSIVE SCHOOL HEALTH PROGRAM
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Professional development hours completed with content relevant to school nursing.
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Classroom education done supporting health TEKS.
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Special event/committee involvement?
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Review of professional goals.
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Additional Comments
Signatures
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Coordinator of Health Services
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School Nurse
