Program and Professional Highlights

  • Contributes to professional growth of peers as a mentor or preceptor.

  • Immunization banner received in previous school year for 95-100% compliance

  • Special program /nurse recognitions

  • Special event/committee involvement.

  • Participates in opportunities provided by community partners

  • Referral to School based clinic partners or mobile health care services

  • Dental Projects

  • Project Saving Smiles

  • UT School of Dentistry

  • Dental Poster Contest

  • Vision Partnership(s)

  • Kids vision for life

  • UH School of Optometry

  • Eye Care for Kids

  • Others

Estimated Program Acuity

  • Campus enrollment

  • Number of nurses on campus full time

  • Estimated % of day spent on students with chronic or invasive procedures

  • Number of students with an invasive procedure.

  • Are any procedures delegated?

  • Number of students with a documented chronic health condition requiring daily management during school hours.

  • Number of students with a documented chronic health condition at risk for emergent care during school hours.

  • Asthma

  • Risk for anaphylaxis.

  • Diabetes

  • Seizure

  • Other

  • # of students on daily medication

Medication Procedures

  • Medication requests signed by the parent and physician for each medication on hand.

  • Follow up corrective action will be completed by

  • A medication administration form is in designated binder, completed for each student and accurately reflects physician orders.

  • Follow up corrected action will be completed by:

  • Principal Medication assignment form is complete and easily accessible

  • Medication skills checklists complete for all assigned (initial and return demonstrations documented).

  • Drug information is included in the medication book.

  • Training conducted and documented for use of emergency medication (I.e Diastat, asthma rescue meds, auto injector).

  • Follow up with corrected action will be completed by:

  • There are at least 2 ways safe administration is addressed.

  • Follow up corrective action will be completed by

  • Photo ID

  • Student says his/her name.

  • Student says name of medication and/or color of pill.

  • If other, enter here

Utilizing the nursing process

  • Documents subjective data collected from the student/client

  • Assesses and documents objective data

  • Analyses all data and documents in appropriate nursing language utilizing electronic health record

  • Establishes a nursing diagnosis and plan of care

  • Determines and documents nursing intervention

  • Evaluates care with follow up as necessary

Case Management of Students with Chronic Health Conditions

  • Completed search in electronic health record (EHR) for students with medical alert/condition

  • Follow up with corrected action will be completed by:

  • Medical Alert and Conditions screen in EHR updated for all identified students.

  • Follow up with corrected action will be completed by:

  • IHP and Emergency Plan developed for each identified student.

  • Follow up with corrected action will be completed by:

Case Management of students with special healthcare needs/ invasive procedures

  • Students enrolled who require invasive procedures?

  • If no, skip to last question in this section.

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

  • Follow up with corrected action will be completed by:

  • Treatment consent form completed for each student including parent and physician signature.






  • Follow up with corrected action will be completed by:

  • Emergency plan on file for each student including evacuation procedures.

  • Follow up with corrected action will be completed by:

  • IHP completed and on file for each student.

  • Follow up with corrected action will be completed by:

  • Name of back up school

  • Office and designated staff informed of how and when to activate back up procedures in absence of nurse.

  • Follow up with corrected action will be completed by:

  • If delegated to unlicensed staff, is there evidence of training documentation?

  • Follow up with corrected action will be completed by:

  • Training conducted with Back-up Nurse.

  • Follow up with corrected action will be completed by:

  • Itinerant nurse request form available and easy to access.

  • Follow up with corrected action will be completed by:

  • Knowledgeable of whether or not there are procedures at designated back-up school.

  • Follow up with corrected action will be completed by:

Asthma management

  • School nurse shows competence with asthma management? (I.e. Demonstrates understanding of asthma action plan, accurate use of inhaler).

  • Students enrolled with asthma?

  • If no skip to next section.

  • # Asthma Action Plans equals # students on conditions report?

  • Follow up corrected action will be completed by:

  • List any challenges, trends that impact return of action plans, steps taken and any plans for follow up.

  • Self-carry medication administration orders are complete for each designated student.

  • Follow up corrected action will be completed by:

Anaphylaxis

  • Students enrolled with risk for anaphylaxis?

  • Answer next appropriate questions below and then skip to next section

  • #Allergy Action Plans equal # students on conditions report?

  • Follow up corrected action will be completed by:

  • List any challenges, trends that impact return of action plans, steps taken and any plans for follow up.

  • School nurse shows evidence of completion of food allergy training (i.e. online, CNE)

  • Follow up corrective action by stated date

  • Anaphylaxis Awareness (Level 1) training completed and documented.

  • Follow up with corrected action will be completed by:

  • Staff-specific training (Level 2) including use of auto-injector completed and documented.

  • Follow up with corrected action will be completed by:

  • Principal designated staff trained in use of epinephrine

  • Follow corrective action will be taken by

  • Epinephrine auto injectors are kept in an accessible cabinet during the school day.

  • Follow up with corrected action will be completed by:

  • IHP completed and on file for each student, updated for current school year.

  • Follow up with corrected action will be completed by:

  • Emergency plan on file for each student including transport of meds in case of evacuation

  • Follow up with corrected action will be completed by:

Diabetes Care

  • School nurse shows evidence of completion of diabetes training including intense insulin management (i.e. Online course, CNE offering, experience, attest action form).

  • Follow up will be completed by

  • Utilizes appropriate medication administration form for intense insulin management.

  • Follow up corrective action completed by

  • Diabetes Management and Treatment Plan is current, signed by parent and physician.

  • Follow up with corrected action will be completed by:

  • Diabetes Awareness Training (level 1) completed for designated staff?

  • Staff-specific training (level 2) completed and documented.

  • Follow up with corrected action will be completed by:

  • Principal designated staff trained in diabetes care.

  • Follow up with corrected action will be completed by:

  • UDCA skills checklist has been completed (initial and return demonstrations documented) (level 3)

  • Follow up with corrected action will be completed by:

  • IHP completed and on file for each student, updated for current school year.

  • Follow up with corrected action will be completed by:

  • Emergency plan on file for each student including procedures in case of evacuation.

  • Follow up with corrected action will be completed by:

Emergency Preparedness

  • Emergency care forms are printed and available to be quickly taken during an evacuation.

  • Follow up with corrected action will be completed by:

  • Evacuation plan in place for medications, special procedure supplies/equipment

  • Follow up with corrected action will be completed by:

  • Personal protective equipment (PPE) supply available

  • Follow up corrective action completed by

  • Emergency bag is intact, readily accessible.

  • Follow up with corrected action will be completed by:

  • Crisis Team has been identified with at least persons trained in CPR.

  • Follow up with corrected action will be completed by:

  • AED procedures current including checklist and unexpired pads and batteries.

  • Follow up with corrected action will be completed by:

  • Location of AED

  • Location

  • AED
  • Wall mounted

  • Documents 911 assessment. Retains on campus. Available upon request.

Substitutes

  • Medication administration binder available.

  • Follow up with corrected action will be completed by:

  • Current student health condition information is readily available.

  • Follow up with corrected action will be completed by:

  • Emergency procedures and contacts for campus.

  • Follow up with corrected action will be completed by:

  • Process for documentation clearly defined.

  • Follow up with corrected action will be completed by:

  • Location of special procedures, emergency supplies, diabetes supplies clearly labeled.

  • Follow up with corrected action will be completed by:

Professional Accountabilty

  • Wears RN insignia as required by nursing licensure.

  • Years of experience in HISD

  • Licensure renewal date

  • Select date

  • Professional attire appropriate for school setting reflecting personal safety and safe delivery of care.

  • Continuing nursing education hours current.

  • Vision/hearing re certification due before December.

  • Knowledgeable of department goals.

  • Follow up with corrected action will be completed by:

  • Established individual goals for current school year.

  • Follow up with corrected action will be completed by:

  • Completed ANTES training

  • Follow up with corrected action will be completed by:

  • Completed SHARS training.

  • Follow up with corrected action will be completed by:

  • Self-assessment of skill level for invasive procedures

  • Female cath

  • Male cath

  • G tube/button feeding

  • Trach suctioning

  • Vent care

  • Seizure management using Diastat

  • Seizure management using VNS

  • Anaphylaxis management using auto injector

Clinic equipment and procedures

  • Clinic environment neat with student appeal and easy access to supplies and materials.

  • Follow up with corrected action will be completed by:

  • Audiometer annual calibration current

  • Follow up with corrected action will be completed by:

  • Audiometer biological calibration current.

  • Follow up with corrected action will be completed by:

  • Serial number

  • Audiometer
  • Enter name of model

  • Enter serial #

  • Audiometer properly labeled.

  • Follow up with corrected action will be completed by:

  • Age-appropriate vision screening tools.

  • Follow up with corrected action will be completed by:

  • Utilizes Chancery and HEALTH HMS reports to document clinic activities.

  • Follow up with corrected action will be completed by:

  • Reference books readily accessible

  • Health Services Handbook

  • Individualized Health plans

  • Guidelines for Care of Student With Specialized Procedures

Communicable Disease Surveillance

  • Student documentation reflects appropriate assessment of communicable disease risk.

  • Follow up with corrected action will be completed by:

  • Utilizes influenza-like illness electronic submission as appropriate.

  • Follow up with corrected action will be completed by:

Comprehensive School Health Program

  • Greater than 90% of students compliant for immunizations based on review of Chancery report and RN feedback.

  • Process in place to monitor immunization compliance?

  • Follow up with corrected action will be completed by:

  • Screening programs complete for current school year?

  • Visual inspection of Hearing, Vision, and Spinal State report/s/planning is correct/complete /reasonable

  • Follow up with corrected action will be completed by:

  • # students unresolved for vision from previous school year

  • # students unresolved for hearing from previous school year?

  • # students unresolved for acanthosis from previous school year?

  • # students unresolved for spinal screening from previous school year?

  • If participated in dental screening program, # of students remaining unresolved for dental followup in current school year ?

  • Process in place to monitor screening referral and followup?

  • Follow up with corrected action will be completed by:

  • Participates in student assessment and academic placement

  • Utilizes Easy IEP

  • Collects and analyzes health information

  • Attends ARD, presenting pertinent health information

  • Participates in 504 process, presenting pertinent health information

  • Growth and Development education conducted according to health TEKS.

  • Enter TEKS addressed and presentations offered.

Signatures

  • Comments

  • Program Specialist, Health and Medical Services

  • Select date

  • School Nurse

  • Comments

  • Select date

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