Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Medication Procedures
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Are there 2 unique patient identifiers?
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Select all that apply
- medication bottle picture
- medication form picture
- medical concerns chart
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Follow up with corrected action will be completed by:
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All medication requests are signed by the parent (and if applicable) physician.
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Follow up with corrected action will be completed by:
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Drug information is included in the medication book.
Unlicensed Assistive Personnel
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Principal Medication Designation form is complete and easily accessible
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Follow up with corrected action will be completed by:
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Medication skills checklists are complete for all designees (initial and return demonstrations documented.
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Follow up with corrected action will be completed by:
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Special procedure skills checklists are complete for all designees (initial and return demonstrations documented.
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Follow up with corrected action will be completed by:
Anaphylaxis
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Level 1 training is completed and documented
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Follow up with corrected action will be completed by:
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Level 2 training has been completed along with training checklist (initial and return demonstrations documented)
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Follow up with corrected action will be completed by:
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Notification of need to know persons has been documented (food service, teachers, 504 coordinator.
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Follow up with corrected action will be completed by:
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Skyward has been updated to reflect critical alert if appropriate.
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Follow up with corrected action will be completed by:
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Epinephrine auto injectors are kept in an unlocked cabinet during the school day.
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Follow up with corrected action will be completed by:
Diabetes Care
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UDCA Principal Designation Form is signed
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Follow up with corrected action will be completed by:
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UDCA skills checklist has been completed (initial and return demonstrations documented).
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Follow up with corrected action will be completed by:
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Diabetes Management and Treatment Plan is current, signed by parent and physician.
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Follow up with corrected action will be completed by:
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Emergency kits available for diabetic students in the event of a lockdown or evacuation.
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Follow up with corrected action will be completed by:
Special Procedures
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Orders for special procedure(s) are current, signed by parent and physician.
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Follow up with corrected action will be completed by:
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Has a physical assessment been completed and documented in Skyward?
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Follow up with corrected action will be completed by:
Individual Health Plans
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IHPs have been created or updated for identified students.
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Follow up with corrected action will be completed by:
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IHPs include evidence of outcomes progress and goals being met (either in office visit or on IHP).
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Follow up with corrected action will be completed by:
Emergency Preparedness
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Emergency care forms are printed and available to be quickly taken during an evacuation.
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Follow up with corrected action will be completed by:
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Evacuation plan in place for medications, special procedure supplies/equipment
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Follow up with corrected action will be completed by:
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Emergency bag is intact, readily accessible.
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Follow up with corrected action will be completed by:
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AED/E-Team has been identified
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Follow up with corrected action will be completed by:
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AED/E-Team training/drills planned or held
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Was after action plan completed?
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Follow up with corrected action will be completed by:
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Emergency Procedures for Office Staff notebook available.
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Follow up with corrected action will be completed by:
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AED daily and monthly check offs done.
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Follow up with corrected action will be completed by:
Substitutes
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Current daily med worksheet available?
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Follow up with corrected action will be completed by:
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Current student health condition information is readily available.
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Follow up with corrected action will be completed by:
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Emergency procedures and contacts for campus.
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Follow up with corrected action will be completed by:
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Process for documentation clearly defined.
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Follow up with corrected action will be completed by:
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RN guidelines manual visible/available.
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Follow up with corrected action will be completed by:
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Location of special procedures, emergency supplies, diabetes supplies clearly labeled.
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Follow up with corrected action will be completed by:
Comprehensive School Health Program
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Are staff development hours complete?
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Classroom education done according to health TEKS.
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Enter TEKS addressed and presentations offered.
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Visual inspection of Hearing, Vision, and Spinal State report. Is it correct/complete?
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Special event/committee involvement?
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Enter TEKS addressed and presentations offered.
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Review of goals from previous year.
Signatures
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Coordinator of Health Services
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School Nurse
