School Health Services Walkthrough Spring

• Campus Nurse

• Conducted on

  Date

• Prepared by

• Location
  Address

Comprehensive School Health Program

• School health office orderly and free of clutter.

  Yes

  No

  N/A

• Equipment (audiometer, otoscope, scales, pulse ox, sphygmometer, thermometer, phone, computer) in working order

  Yes

  No

  N/A

• Gloves are readily accessible in clinic.

  Yes

  No

  N/A

• Visual inspection of Immunization Out of Compliance Report. Are all students compliant or in progress (notes of parent contact are present for students being considered for exclusion)?

  Yes

  No

  N/A

• Visual inspection of Vision report. Is it correct/complete?

  Yes

  No

  N/A

• Visual inspection of Hearing report. Is it correct/complete?

  Yes

  No

  N/A

• Visual inspection of Spinal State report. Is it correct/complete?

  Yes

  No

  N/A

• Visual inspection of AN report. Is it correct/complete in RFES?

  Yes

  No

  N/A

• Audiometer monthly biological check offs done.

  Yes

  No

  N/A

• Clinic stats reported every month.

  Yes

  No

  N/A

• Records are bundled for shredding. Bundled records are shredded in a timely fashion (no excessive amounts of records overdue for shredding are present on campus).

  Yes

  No

  N/A

• Special Procedure Orders are uploaded in Skyward under Medication

  Yes

  No

  N/A

• Sharps container is securely stored and safely accessible when needed. Full Sharps need to be sent to ESC.

  Yes

  No

  N/A

Health Conditions and Individual Health Plans

• IHPs include evidence of outcomes progress and goals being met (either in office visit or on IHP).

  Yes

  No

  N/A

• Plan to communicate health needs to next nurse

  Yes

  No

  N/A

Medication and Special Procedures. FFAC (legal and local)

• Monthly check offs of standing order medications is complete.

  Yes

  No

  N/A

• Current Medication Opt out list is present in the medication cabinet and/or sub binder.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are controlled medications properly secured in a double locked cabinet?

  Yes

  No

  N/A

Inventory of Controlled Medications

• Has an inventory sheet been implemented and performed weekly for each controlled medication on file in the clinic. Inventory reconciliation documents should be kept in the medication binder.

  Yes

  No

  N/A

• Perform inventory check on meds. Medication counts are accurate.

  Yes

  No

  N/A

Anaphylaxis

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Emergency Preparedness

• Emergency care forms are printed and available to be quickly taken during an evacuation OR forms are saved to campus nurse laptop.

  Yes

  No

  N/A

• Emergency bag/cart is intact, readily accessible.

  Yes

  No

  N/A

• Laptop power cord located in emergency go box.

  Yes

  No

  N/A

• AED daily, monthly, annual check offs done.

  Yes

  No

  N/A

• Campus Response Team training/drills held

  Yes

  No

  N/A

• AED(s) have clear signage

  Yes

  No

  N/A

• Plan in place for entry into locked clinic bathroom door.

  Yes

  No

  N/A

Professional Nursing Practice

• Professional Development Plan for summer

  Yes

  No

  N/A

• Documentation of completed goal in Strive.

  Yes

  No

  N/A

• Nurse is wearing name badge with credentials displayed.

  Yes

  No

  N/A

Staff Signatures

• School Nurse

  Sign

• Coordinator of Health Services

  Sign