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, thermometer, phone, computer) 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 documentation 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 authorization forms are signed by the parent. "To carry" meds have signature of parent and physician.

  • Follow up with corrective action will be completed by:

  • All medication orders entered in skyward. RN has double checked by signing off med admin forms.

  • 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 authorization forms/requests are kept in red notebook alphabetically 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, front office relief person) and are filed in the front of the red notebook.

  • Follow up with corrected action will be completed by:

DIABETES CARE

  • Diabetes Management Plan current and signed by the parent and physician.

  • Follow up with corrective action will be completed by:

  • UDCA authorization form present with diabetes management plan.

  • Follow up with corrective action will be completed by:

  • UDCA checklists completed and readily accessible in front of red notebook.

  • 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 in front of red notebook.

  • 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 in front of red notebook.

  • 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.

  • 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

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

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

  • Follow up with corrective action will be completed by:

  • 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 in front of the red notebook.

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

  • Follow up with corrected action will be completed by:

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

  • 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 with with assistance of Coordinator's Assistant.

  • Follow up with corrected action will be completed by:

  • AN screening updated and documented in RFES website.

  • 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)

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

  • Follow up with corrected action will be completed by:

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

  • Follow up with corrective action will be completed by:

  • 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:

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:

  • Emergency info and phone numbers updated on iPad and available to be quickly accessed during an emergency.

  • Follow up with corrected action will be completed by:

  • Have Heart Team has been identified.

  • Follow up with corrected action will be completed by:

  • Have Heart Team DRILLS/TRAINING:
    First semester drill completed and documented. Date:

  • Have Heart 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 corrective action will be completed by:

  • 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. Is there a plan for a student in a wheelchair?

  • 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: intro, table of contents, your role, and help numbers.

  • Follow up with corrective action will be completed by:

  • SECTION : CISD clinic staff phone number list, school phone list, campus emergency info, HHT, and daily schedule.

  • Follow up with corrective action will be completed by:

  • SECTION 3: Sending student home, clinic office pass, medications, Med error instructions, Med administration, diabetic info, special procedures, and guidelines.

  • Follow up with corrective action will be completed by:

  • SECTION 4: Include emergency care plans, daily Med list, and other essential info as needed.

  • Follow up with corrective action will be completed by:

  • SECTION 5: Clinic Forms

  • Follow up with corrective action will be completed by:

COMPREHENSIVE SCHOOL HEALTH PROGRAM

  • Special event/committee involvement?

  • Additional Comments

Signatures

  • Coordinator of Health Services

  • School Nurse

  • Clinic personnel

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.