Medication Procedures and Medication Binder

  • FRONT OF BINDER: Current clinic standing orders

  • Principal designation forms for medication administration are completed.

  • Follow up with corrective action will be completed by:

  • DIABETES

  • DMTP current, signed by parent and physician, with student photo attached.

  • Follow up with corrective action will be completed by:

  • EAPs (extracurricular, teacher, specials) completed for each student, as needed.

  • Follow up with corrective action will be completed by:

  • UDCA authorization (present on signed DMTP or UDCA Authorization form).

  • Follow up with corrective action will be completed by:

  • EMS--extra copies in labeled envelope for EMS personnel.

  • Follow up with corrective action will be completed by:

  • Transportation plan, if bus riders

  • SEIZURES

  • Seizure action plans, parent questionnaires, and/or information about seizure condition is present and current.

  • Diastat orders are complete and emergency action plan in place with need-to-know staff.

  • Transportation plan completed, copy given to bus driver and to Transportation Supervisor, if bus riders.

  • SCHEDULED MEDICATIONS AND PROCEDURES
    All medication requests are signed by the parent.
    OTC medications have a physician order if going to be kept longer than 5 days.

  • Follow up with corrective action will be completed by:

  • Two (2) unique patient identifiers are present on each medication permission form.

  • Select all that apply:

  • SECTION 1: CAMPUS CONTACT INFORMATION
    (Substitute information form completed)

  • Follow up with corrective action will be completed by:

  • Current telephone lists with campus RN phone numbers included.

  • Follow up with corrective action will be completed by:

  • Administration of medication is documented daily in Skyward (WISD Electronic Medical Record-EMR)

  • Follow up with corrective action will be completed by:

  • Medication organized and stored with controlled substances placed in double locked cabinet.

  • Follow up with corrective action will be completed by:

  • Permission for Self-Carry/Administration of medication competed and filed in Medication Binder.

  • Follow up with corrective action will be completed by:

  • Scheduled Medications:

  • Physician orders current and written permission from parent has been completed on order form or medication permission form.

  • Follow up with corrective action will be completed by:

  • Procedure flowsheets, if needed.

  • Scheduled Procedures:

  • Physician orders current and written permission from parent has been completed on order form or medication permission form.

  • Follow up with corrective action will be completed by:

  • Procedure flowsheets, if needed.

  • SEVERE ALLERGY/EPIPEN

  • Anaphylaxis action plans (AAP) or medication permission forms completed and signed by parent/physician.

  • Follow up with corrective action will be completed by:

  • Student photo added to AAPs/Medication Permission forms

  • Follow up with corrective action will be completed by:

  • BACK OF BINDER: Discontinued medications/procedures for current school year only. Discontinued forms may also be filed in student health file.

  • PRN MEDICATIONS
    PRN meds organized by alpha tabs.

  • Follow up with corrective action will be completed by:

  • All medication requests are signed by the parent. All OTC medications have a physician order if kept longer than 5 days

  • Two (2) unique patient identifiers are present on each medication permission form.

  • Select all that apply:

Unlicensed Assistive Personnel

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

  • Follow up with corrective action will be completed by:

  • Office Staff protocols are located where UAPs can readily access them.

Diabetes Care

  • UDCA skills checklists have been completed.

  • Return demonstration/ review of UDCA skills will be performed and documented:

  • Has a physical assessment been completed and documented in Skyward for students with diabetes?

  • Follow up with corrective action will be completed by:

  • Emergency kits available for students with diabetes, or students self-carry, in the event of a lockdown or evacuation.

  • Follow up with corrected action will be completed by:

Severe Allery/Anaphylaxis

  • Level 2 training has been completed along with epinephrine auto-injector and/or medication skills training checklist.

  • Follow up with corrective action will be completed by:

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

  • 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:

Special Procedures

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

  • Follow up with corrected action will be completed by:

  • Has a physical assessment been completed and documented in Skyward?

  • Follow up with corrected action will be completed by:

  • Special procedure skills checklists are completed for any staff member who assists with special procedures.

  • Training and competency for any UAP performing a skilled procedure will be assured through initial training and a minimum of three return demonstrations prior to independent performance.

Heath 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:

  • Has a physical assessment been completed and documented in Skyward for students with health plans, significant medical needs, or cared for routinely.

  • 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:

  • 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 uploaded and or created in Skyward.

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:

  • AED/MERT has been identified.

  • Follow up with corrected action will be completed by:

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

  • Follow up with corrective action will be completed by:

  • AED/MERT 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:

  • Evacuation plan in place for 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.

  • Plan for practice with next scheduled fire/evacuation drill, with follow up in:

  • AED monthly and annual checks are performed.

  • Follow up with corrective action will be completed by:

  • Documented evacuation training on file for 2 story campuses

Substitutes and Sub RN Binder

  • SECTION 1: CAMPUS CONTACT INFORMATION
    (Substitute information form completed)

  • Follow up with corrective action will be completed by:

  • Current telephone lists with campus RN phone numbers included.

  • SECTION 2: EMERGENCY AND EVACUATION

  • School map with AED locations marked.

  • Copy of campus Emergency Operations Plan (EOP)

  • Copy of AED/MERT Response Plan

  • SECTION 3: HEALTH CONDITIONS (Skyward report divided by grades, special care lists).

  • SECTION 4: PROCEDURES
    Information about each procedure; equipment and supplies locations; equipment manuals/where to access; diabetes emergency kit locations.

  • Follow up with corrective action will be completed by:

  • SECTION 5: ALPHA ROSTERS

  • SECTION 6: CLASS BELL SCHEDULE
    (include teacher phone list if not located on desk).

  • SECTION 7: FORMS
    (extra copies of pertinent forms for subs and UAPs.)

  • RN Guidelines reference visible and readily accessible.

Comprehensive School Health Program

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

  • Follow up with corrective action will be completed by:

  • Office Visits are documented daily in Skyward.

  • Follow up with corrective action will be completed by:

  • Immunization compliance report is up to date.

  • Documentation of parent contact for getting students up to date.

  • Follow up with corrective 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 corrective action will be completed by:

  • Documented monthly biological calibration of audiometer

  • Follow up with corrective action will be completed by:

  • AN screening is completed and entered into RFES.

  • Follow up with corrective action will be completed by:

  • Clinic is orderly and free of clutter.

  • Otoscope, pulse ox, thermometer, and sphygmomanometer are in working order.

Follow Up

  • Is follow up necessary?

  • Follow up date:

  • Select date

  • Supervising RN Signature

  • Campus RN Signature

Signatures

  • Coordinator of Health Services

  • School Nurse

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