Title Page
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Audit Title
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Conducted on
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Prepared by
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Location
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Personnel
Medication
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Are there 2 sets of keys for the clinic medication cabinets and to the clinic doors? Second set of keys are retained at the campus at all times.
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Principal Medication Designation form complete for the current year.
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Medication keys and medication cabinets are secured at the time of the audit (visual inspection).
Inventory of Controlled Medications
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Are controlled medications properly secured?
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Has an inventory sheet been implemented and performed weekly for each controlled medication on file in the clinic.
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Perform an inventory review on 1 medication
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Medication sills checklist are complete for all staff assigned to administer medication
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Current clinic standing orders are visible in the front of medication binder.
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Medication Opt Out list is visible for UAP and RN Substitutes.
Health Conditions/Health Information
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Have student health histories been reviewed and entered in Skyward?
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Alerts/critical alerts have been entered and updated in Skyward.
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Notification of need to know staff has been completed? (Student Nutrition, Teachers, Campus 504 Coordinator, Transportation)
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EMS envelopes for identified students are readily available for student health emergency (Include Emergency Care Form, Student Health History, Physician Orders, Action Plans, etc.)
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Emergency Guidelines for School Staff binder readily available to school staff who assist in the clinic.
Anaphylaxis/Allergy
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Has staff allergy/anaphylaxis training been completed and documented? (Enter details of training in text box)
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Epinephrine auto-injectors are kept in an unlocked cabinet during the school day.
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Epinephrine auto-injectors are clearly labeled to allow for rapid identification.
Diabetes Care
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UDCA Principal Assignment Form is signed (annually).
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All assigned UDCAs have completed initial training (current or previous year).
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Individualized training completed and documented on appropriate skills checklists (review/return demonstration)
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Diabetes Management and Treatment Plan is current, signed by parent and physician.
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Emergency Action Plan (EAP) has been completed for quick reference by the teachers and staff.
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Diabetes emergency kits in place in classrooms/specials areas in the event of a lockdown or students carry their own emergency supplies.
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Diabetes supplies readily available and clear plan in place for evacuation with supplies.
Special Procedures
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Orders for special procedures(s) are current, signed by parent and physician. (Enter procedures in text box below)
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Initial/Baseline physical assessment has been completed for all students with special procedures/medically fragile.
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UAP/staff members are trained to perform the special procedure.
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Initial and a minimum of 3 return demonstrations have been documented in Skyward or on appropriate skills checklist.
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RN supervisory visits are performed regularly and documented (assessment of student + supervision of UAP).
Individual Health Plans
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IHPs have been created or updated for: Medically complex, medically fragile, require routine/scheduled nursing services.
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IHP review: select one IHP and review along with supportive documentation (office visit notes, medication notes, physical assessment, skills training, supervision notes, action plans, physician orders, etc)
Emergency Preparedness
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Emergency Care Forms are printed and available to be quickly accessed during an emergency.
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Evacuation plan in place for emergency medical supplies, easy to follow, and can be rapidly completed by clinic staff or RN Substitutes.
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Campus RN has evacuated with medical supplies with at least one evacuation drill.
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Emergency bag is intact, unexpired, and readily accessible.
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Plan in place for entry into locked bathroom doors in clinic or other campus locations (hex/allen key, coin, other device) and campus staff know procedure and location of device.
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AED/MERT team members with current CPR certification has been identified.
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AED/MERT drill/training for the 1st semester has been completed (Note date). Notify Health Services Coordinator of date when 2nd semester drill completed.
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AED daily and monthly checks completed and documented.
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AED annual check is completed.
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Documented evacuation chair training on file for 2 story campuses.
Substitutes and Substitute RN Binder
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Guidelines for the School RN visible/readily available.
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Does campus sub coordinator have current list/contact information of sub RNs?
Sub Binder/Information
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Current student health condition information is readily available in the purple binder.
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Emergency procedures explained and easy to follow.
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Clinic Information/Welcome sheet is current.
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Campus specific information is easily located- Schedule of the day, Specials rotations, Teacher list with phone numbers, etc)
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Location of special procedures, medications, diabetes supplies are clearly marked. Directions for special procedures are explained and easy to follow.
Comprehensive School Health Program
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Nurse is wearing name badge.
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Professional Development hours completed with content relevant to nursing.
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LVN or clinic assistant is receiving appropriate supervision by RN (documented).
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Bloodborne Pathogens course completion by campus staff is documented
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Vision and hearing screening complete and entered in Skyward.
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AN screening complete and entered in Skyward.
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Have AN results been entered in RFES for state.
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Spinal screening complete and entered into Skyward.
Classroom/student education done according to health TEKS and/or campus-student health needs.
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5th Grade Boys and girls Growth and Development presentation completed.
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Assisting with the Sexual Health and Wellness Curriculum for 6th, 7th, and 9th graders.
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Hand washing, respiratory etiquette, cold & flu prevention
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Dental education for 1st grade, and may include other grades.
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Reminders/campus-wide information for hand washing, respiratory etiquette, cold/flu prevention.
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Other (list)
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Monthly biological calibration of audiometer is documented.
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Clinic is orderly and free of clutter.
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Otoscope, pulse ox, thermometer, and sphygmomanometer are in working order.
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Special event/committee involvement?
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Professional Goals for current school year:
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Coordinator of Health Services
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School Nurse