Audit

ROOM SETUP

Bulletin Board

Will have corrected by:

Educational Information available/visible?

Will have corrected by:

Well Organized?

Will have corrected by:

Cleaner for cots available/used?

Will have corrected by:

Adequate supplies available?

Will have corrected by:

Lunch time schedules posted?

Will have corrected by:

Voicemails Updated?

Will have corrected by:

Bathroom key is easily accessible?

Will have corrected by:
Substitute Information

Location:

Substitute Information is:
Organized?
Clear?
Easy to Understand?

Will have corrected by:

Complete with list of "Alerts"?

Will have corrected by:
Medication Storage and Administration

Medication secured in a locked cabinet?

Will have corrected by:

Keys to medication secure? Duplicate set kept?

Will have corrected by:

Controlled substances count by RN documented?

Will have corrected by:

Rx label and Medication Authorization match?

Will have corrected by:

Any medications left in the clinic from last school year?

Will have corrected by:

Any expired medications on campus?

Will have corrected by:

Classroom medications secure and monitored weekly by RN?

Will have corrected by:

Any missing medications?

Protocol followed for missing medication?

Will have corrected by:

Epi-Pens accessible and clearly marked?

Will have corrected by:

Case Management SHARS
Number of medication SHARS?
Number of procedure SHARS?

Monthly SHARS up to date and on Monthly Report by 5th working day of the month?

Will have corrected by:

Copies of SHARS filed?

Will have corrected by:

IHCP/Orders
Number of Asthma students (from Alerts List)?

EAP's complete with MD orders when appropriate?

Will have corrected by:

Number of Diabetic Students?

Diabetic IHCP's complete with MD orders and signatures complete?

Will have corrected by:

Number of Seizure students?

Seizure IHCP's complete with MD orders and signatures complete?

Will have corrected by:

Number of students with Food Allergies/Severe Allergies/Anaphylaxis?

Allergy/Anaphylaxis IHCP complete with orders and signatures complete?

Will have corrected by:

Epinephrine Delivery devices clearly marked in unlocked cabinet?

Will have corrected by:

Epi-Trainers REMOVED, clearly marked, and in another location?

Will have corrected by:

PEEP's (Personal Emergency Evacuation Plan) completed and signed?

Will have corrected by:

Number of medical procedures, including but not limited to:
Tube feedings
Catheterizations
Routine nebulizer treatments
Etc

Medical procedure IHCP complete with MD orders and signature complete?

Will have corrected by:

Attend meetings as needed? (ARD's, 504, etc)

Will have corrected by:

Documentation of Competency for Staff

CPR Certified Staff-(at least 2 per campus)

Will have corrected by:

UDCA (Unlicensed Diabetic Care Assistant)
Full Time RN on campus=1 per campus minimum

Will have corrected by:

Medication Administration:2 per Campus

Will have completed by:

Special Procedures: (if needed)

Will have completed by:

All training forms are complete and have signatures for: UDCA's, Medication Adminstration Staff Members, and Special Procedures Staff.

Will have corrected by:

Medical Alert/Emergency Contact Information

Medical Alert list printed and acknowledged?

Will have corrected by:

New medical alerts entered and confirmed in Nurse Aid?

Will have corrected by:

Medical Conditions Information entered into Nurse Aid?

Will be corrected by:

Daily Log Documentation (review/Audit Nurse Aid)-Random**
Reviewer A Score
(Total of Columns A-P)
Reviewer B Score
(Total of columns A-P)
Reviewer C Score
Final Score
(Total of Columns A-P divided by Total # of columns-15)

Immunizations

Effective tracking system in place to monitor compliance of all students?

Will have corrected by:

Immunizations entered into E-school in a timely matter (2 weeks for new students)

Will have corrected by:

Process in place to deal with non-compliance of immunizations?

Will have corrected by:

Pregnant and Parenting students (Secondary)

Process in place to identify pregnant/parenting students (Notification of process to faculty/staff)

Will have corrected by:

RN refers students for necessary services

Will have corrected by:

RN provides prenatal/parenting education to students?

Will have corrected by:

RN provides regular follow-up with pregnant students

Will have corrected by:

RN collaborates with Homebound services?

Will have corrected by:

Completed case files are sent to PRS Coordinator after student returns to school or at the end of the school year?

Will have corrected by:

Campus Projects (Sports Physicals, Back to school, Presentations)

List:

Vision and Hearing

Copies of referrals available?

Will have corrected by:

Number of students NOT screened for Vision/Hearing, including new students?

Will have corrected by:

Number of Vision referrals in process (P)?
Number of Vision referrals complete?
Number of Hearing referrals in Process (P)?
Number of Hearing referrals complete (C)?

Nurse Aid data entry completed by April 1st?

Will have corrected by:

Monthly biological checks of audiometer documented and stored in audiometer ?

Will have corrected by:

Number of Nurse Aid data entries (for Vision & Hearing) in progress?
Spinal Screening
Number of 2nd semester Spinal screenings in progress?

2nd Semester Spinal screening completed by the end of March?

Will have completed by?

Number of 2nd Semester Spinal referrals in progress?

Are second semester referrals in progress (P) or completed by the end of March?

Nurse Aid data entry for Spinal Screening completed by April 1st?

Will have corrected by:

Number of Nurse Aid data entries (for Spinal screenings) in Progress?
Acanthosis Nigricans Screening

1st semester AN screenings completed by end of December?

Will have corrected by:

Number of 1st Semester AN screenings in progress?

1st Semester AN Referrals* in Progress (P) or Completed (C) by end of December?

Will have corrected by:

2nd Semester AN screenings done by the end of February?

Will have completed by:

Number of 2nd Semester AN screenings in Progress?

2nd Semester AN Referrals* in Progress (P) or completed (C) by the end of February?

Will have corrected by:

ANTES Data* entry in progress (P) or completed (C) by April 1st?

Will have corrected by:

Risk Management

Accident and Incident reports completed per HEBISD protocol?

Will have completed by:

RN follows communicable disease protocols (% of absenteeism, TCHD reportable diseases, exclusion criteria)?

Will have corrected by:

Campus Concerns/Issues:

NOTES
Signature of RN/LVN:
Signature of Evaluator:
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.