School Health Services Clinic Inspection

• Audit Title

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Medication

• 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.

  Yes

  No

  N/A

• Principal Medication Designation form complete for the current year.

  Yes

  No

  N/A

• Medication keys and medication cabinets are secured at the time of the audit (visual inspection).

  Yes

  No

  N/A

Inventory of Controlled Medications

• Are controlled medications properly secured?

  Yes

  No

  N/A

• Has an inventory sheet been implemented and performed weekly for each controlled medication on file in the clinic.

  Yes

  No

  N/A

• Perform an inventory review on 1 medication

  Documentation of medication counts complete

  Documentation of medication counts not complete

• Medication sills checklist are complete for all staff assigned to administer medication

  Initial & review/return demo

  Initial check off complete

  Training not documented

• Current clinic standing orders are visible in the front of medication binder.

  Yes

  No

  N/A

• Medication Opt Out list is visible for UAP and RN Substitutes.

  Yes

  No

  N/A

Health Conditions/Health Information

• Have student health histories been reviewed and entered in Skyward?

  Yes

  No

  N/A

• Alerts/critical alerts have been entered and updated in Skyward.

  Yes

  No

  N/A

• Notification of need to know staff has been completed? (Student Nutrition, Teachers, Campus 504 Coordinator, Transportation)

  Yes

  No

  N/A

• EMS envelopes for identified students are readily available for student health emergency (Include Emergency Care Form, Student Health History, Physician Orders, Action Plans, etc.)

  Yes

  No

  N/A

• Emergency Guidelines for School Staff binder readily available to school staff who assist in the clinic.

  Yes

  No

  N/A

Anaphylaxis/Allergy

• Has staff allergy/anaphylaxis training been completed and documented? (Enter details of training in text box)

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Epinephrine auto-injectors are clearly labeled to allow for rapid identification.

  Yes

  No

  N/A

Diabetes Care

• UDCA Principal Assignment Form is signed (annually).

  Yes

  No

  N/A

• All assigned UDCAs have completed initial training (current or previous year).

  District-Level Initial Training

  Campus-Based Initial Training

  No Initial Training Completed

• Individualized training completed and documented on appropriate skills checklists (review/return demonstration)

  Initial & review/return demo

  Initial check off complete

  Training not documented

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

  Yes

  No

  N/A

• Emergency Action Plan (EAP) has been completed for quick reference by the teachers and staff.

  Yes

  No

  N/A

• Diabetes emergency kits in place in classrooms/specials areas in the event of a lockdown or students carry their own emergency supplies.

  Yes

  No

  N/A

• Diabetes supplies readily available and clear plan in place for evacuation with supplies.

  Yes

  No

  N/A

Special Procedures

• Orders for special procedures(s) are current, signed by parent and physician. (Enter procedures in text box below)

  Yes

  No

  N/A

• Initial/Baseline physical assessment has been completed for all students with special procedures/medically fragile.

  Yes

  No

  N/A

• UAP/staff members are trained to perform the special procedure.

  Yes

  No

  N/A

• Initial and a minimum of 3 return demonstrations have been documented in Skyward or on appropriate skills checklist.

  Yes

  No

  N/A

• RN supervisory visits are performed regularly and documented (assessment of student + supervision of UAP).

  Yes

  No

  N/A

Individual Health Plans

• IHPs have been created or updated for: Medically complex, medically fragile, require routine/scheduled nursing services.

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

Emergency Preparedness

• Emergency Care Forms are printed and available to be quickly accessed during an emergency.

  Yes

  No

  N/A

• Evacuation plan in place for emergency medical supplies, easy to follow, and can be rapidly completed by clinic staff or RN Substitutes.

  Yes

  No

  N/A

• Campus RN has evacuated with medical supplies with at least one evacuation drill.

  Yes

  No

  N/A

• Emergency bag is intact, unexpired, and readily accessible.

  Yes

  No

  N/A

• 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.

  Yes

  No

  N/A

• AED/MERT team members with current CPR certification has been identified.

  Yes

  No

  N/A

• AED/MERT drill/training for the 1st semester has been completed (Note date). Notify Health Services Coordinator of date when 2nd semester drill completed.

  Date

• AED daily and monthly checks completed and documented.

  Yes

  No

  N/A

• AED annual check is completed.

  Yes

  No

  N/A

• Documented evacuation chair training on file for 2 story campuses.

  Yes

  No

  N/A

Substitutes and Substitute RN Binder

• Guidelines for the School RN visible/readily available.

  Yes

  No

  N/A

• Does campus sub coordinator have current list/contact information of sub RNs?

  Yes

  No

  N/A

Sub Binder/Information

• Current student health condition information is readily available in the purple binder.

  Yes

  No

  N/A

• Emergency procedures explained and easy to follow.

  Yes

  No

  N/A

• Clinic Information/Welcome sheet is current.

  Yes

  No

  N/A

• Campus specific information is easily located- Schedule of the day, Specials rotations, Teacher list with phone numbers, etc)

  Yes

  No

  N/A

• Location of special procedures, medications, diabetes supplies are clearly marked. Directions for special procedures are explained and easy to follow.

  Yes

  No

  N/A

Comprehensive School Health Program

• Nurse is wearing name badge.

  Yes

  No

  N/A

• Professional Development hours completed with content relevant to nursing.

  Yes

  No

  N/A

• LVN or clinic assistant is receiving appropriate supervision by RN (documented).

  Yes

  No

  N/A

• Bloodborne Pathogens course completion by campus staff is documented

  Yes

  No

  N/A

• Vision and hearing screening complete and entered in Skyward.

  Yes

  No

  N/A

• AN screening complete and entered in Skyward.

  Yes, Collection of referral results in progress

  Screening complete, but not charted

  Screening not completed

• Have AN results been entered in RFES for state.

  Yes

  No

  N/A

• Spinal screening complete and entered into Skyward.

  Yes, Collection of referral results in progress

  Screening complete, but not charted

  Screening not completed

Classroom/student education done according to health TEKS and/or campus-student health needs.

• 5th Grade Boys and girls Growth and Development presentation completed.

• Assisting with the Sexual Health and Wellness Curriculum for 6th, 7th, and 9th graders.

• Hand washing, respiratory etiquette, cold & flu prevention

• Dental education for 1st grade, and may include other grades.

• Reminders/campus-wide information for hand washing, respiratory etiquette, cold/flu prevention.

• Other (list)

• Monthly biological calibration of audiometer is documented.

  Yes

  No

  N/A

• Clinic is orderly and free of clutter.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Special event/committee involvement?

  Yes

  No

  N/A

• Professional Goals for current school year:

• Coordinator of Health Services

  Sign

• School Nurse

  Sign