School Health Services Clinic Audit

• 2022-2023 Mansfield ISD Clinic Walk Through

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Medication Administration FFAC (local)

• Principal designee for medication administration form completed and filed in Medication binder

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

• Permission forms from parent/MD completed, signed and filed in Medication binder

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

• Medications organized and stored according to MISD policy with controlled substances placed in locked cabinet.

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

• Students Epinephrine auto-injectors stored in unlocked cabinet marked "Emergency Medications"

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

• Inhalers are accessible, clearly marked, and unlocked during the school day.

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

• Permission for self-administration/self-carry of medication completed and filed in Medication binder

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

• Administration of medication is documented daily in Skyward

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

• Medication counts and paper documentation match Skyward inventory.

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

• Rx label and medication permission forms match.

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

Office Visit Documentation

• Office visits are documented daily Skyward

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

Immunization Documentation

• Immunization compliance report is up to date (as medically possible)

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

• Immunization exemption certificates and MD letters are filed in student file and documented in Skyward

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

Clinic Management

• Clinic is orderly and free of clutter

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

• Documented monthly biological calibration of audiometer

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

• Supplies are easily accessible

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

• Otoscope, pulse ox., thermometer, glucose monitor, and sphygmometer are in working order

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

• AED checklists current (inspected monthly)

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

• Unassigned Epinephrine auto-injectors checklist current, inspected monthly

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

Substitute Notebook

• Organized according to MISD guidelines found in health services drive

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

• Updated with current campus specific information, including map, classroom phone numbers, and critical alert information on students.

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

• Daily Medication Administration Record included

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

Special Services

• Current orders (updated annually) for special procedures

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

• Current IHPs/Acton Plans for identified students

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

Diabetes

• Diabetic orders are scanned into Skyward

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  Yes

  No

  N/A

• Campus has at least one assigned UDCA

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  Yes

  No

  N/A

• Name of UDCA

• Principal UDCA delegation form signed and filed in Diabetes binder

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

• Signed Parent Permission for UDCA

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

Emergency Preparedness

• Emergency trauma bag properly stocked and easily accessible

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

• MRT Team identified

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

• Campus training documented for: Auto Injector Epi, Stop the Bleed, and Evac Chair ( 2nd floor)

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

• Hep B Forms completed for Staff.

  Yes

  No

  N/A

• Follow up with corrected action will be completed by

  2 weeks

  3 months

  6 months

Audit Results

• Auditor's Signature

  Sign

• Additional Remarks

• Campus Registered Nurse Signature

  Sign