Kindergarten Health Check



Canberra Hospital and Health ServicesClinical ProcedureKindergarten Health CheckContents TOC \h \z \t "Heading 1,1,Heading 2,2" Contents PAGEREF _Toc474844189 \h 1Purpose PAGEREF _Toc474844190 \h 3Alert PAGEREF _Toc474844191 \h 3Scope PAGEREF _Toc474844192 \h 3Section 1 – Process for Kindergarten Health Check PAGEREF _Toc474844193 \h 31.1 Eligible Clients PAGEREF _Toc474844194 \h 31.2 Consent PAGEREF _Toc474844195 \h 41.3 Preparation prior to KHC PAGEREF _Toc474844196 \h 41.4 Nurses roles and responsibilities PAGEREF _Toc474844197 \h 51.5 Kindergarten ‘Catch Up’ and ‘Hearing Retest’ clinics PAGEREF _Toc474844198 \h 6Section 2 – Anthropometric Measurements PAGEREF _Toc474844199 \h 72.1 Procedure to measure Weight PAGEREF _Toc474844200 \h 72.2 Procedure to measure Height PAGEREF _Toc474844201 \h 72.3 Calculation of Body Mass Index (BMI) PAGEREF _Toc474844202 \h 72.4 Referral Pathway PAGEREF _Toc474844203 \h 8Section 3 – Vision Check Procedure PAGEREF _Toc474844204 \h 83.1 Procedure PAGEREF _Toc474844205 \h 83.2 Document results as follows: PAGEREF _Toc474844206 \h 103.3 Referral Criteria PAGEREF _Toc474844207 \h 10Section 4 – Hearing Check Procedure PAGEREF _Toc474844208 \h 114.1 Procedures PAGEREF _Toc474844209 \h 114.2 Hearing Referrals Guide PAGEREF _Toc474844210 \h 124.3 Hearing Retest Clinic PAGEREF _Toc474844211 \h 12Implementation PAGEREF _Toc474844212 \h 13Related Policies, Procedures, Guidelines and Legislation PAGEREF _Toc474844213 \h 13References PAGEREF _Toc474844214 \h 13Search Terms PAGEREF _Toc474844215 \h 14Attachments PAGEREF _Toc474844216 \h 14Attachment 1: Flowcharts and Q drive location of KHC forms and letters PAGEREF _Toc474844217 \h 15Attachment 2: Height, Weight & Body Mass Index (BMI) Measurements PAGEREF _Toc474844218 \h 19Attachment 3: Snoring and Your Child PAGEREF _Toc474844219 \h 21PurposeThis procedure provides a standard approach for nurses when performing Kindergarten Health Check’s (KHC) in government and non - government schools in the ACT. The KHC is a primary health care service that aims to identify potential health issues associated with weight, vision and hearing. Early intervention and appropriate referral/s may optimise the child’s learning, social development and general health outcomes.Back to Table of ContentsAlertKindergarten Health Check Records are confidential. The records are not to be left in the school, government cars or taken home. They are to come back to the central office and be placed in a lockable filing cabinet. The KHC must not proceed without parental/guardian consent.Back to Table of ContentsScopeThis document applies to nurses who work in the Women Youth and Children’s Community Health Programs (WYCCHP), School Health Team and deliver the KHC. Back to Table of ContentsSection 1 – Process for Kindergarten Health Check1.1 Eligible ClientsKindergarten students in the ACT will be offered a school health check at their school of enrolment. A parent or guardian must sign consent for this service, which is provided free of charge.All children in kindergarten in ACT are offered a health check during the first year of formal education (kindergarten or equivalent school program). Children exempt from the program includeJervis Bay Primary School students, andCranleigh or Malkara Special school program1.2 ConsentAt the start of the school year parents or guardians of Kindergarten students will receive the KHC Consent and Questionnaire Form (See attachment 1.2). Parents or guardians are required to sign the consent form for the KHC to proceed. Parent or guardian consent is also required for the student’s teacher to be informed of vision and/or hearing results.Parents or guardians who have nominated a General Practitioner (GP) or Medical Practice are also consenting for the results of the physical health check and the Parents’ Evaluation of Developmental Status (PEDS) and Strengths and Difficulties Questionnaire (SDQ) results to be sent to that Medical Practice. The GP may then contact the parents/guardians to discuss the results and refer to appropriate services as necessary.The 1st section of the KHC Consent and Questionnaire Form questions relate specifically to the physical health check, conducted by the School Health Team.The 2nd section of the form includes the PEDS, SDQ and questions relating to Asthma, Allergies, Parent’s perception of their child’s weight/height, Physical Activity and Nutrition. The Academic Unit of General Practice (AUGP) and Population Health collect data from both sections of the questionnaire for research and health service planning. The AUGP is responsible for the management of the 2nd section of the KHC Consent and Questionnaire, including scoring the PEDS & SDQ and collating the questionnaires.Parents will receive in a package with the KHC Consent and Questionnaire, a letter of explanation ‘Information for the Kindergarten Health Check’ and ACT Health Promotion materials, as well as an envelope in which to return the completed questionnaire to school.1.2.1 Parent or Guardian Request for Copy of Health Check ResultsA copy of the completed KHC Clinical Record is sent to the nominated GP after the health check. A parent/guardian requesting a copy of the KHC Clinical Record will be directed to ACT Health Clinical Records Department or alternatively, can consult with the GP about results. 1.3 Preparation prior to KHCThe School Health Team and AUGP work together in the preparation and processing of the KHC and work with primary schools to implement the program. The school principals receive a letter of explanation prior to the KHC and a request is made for the principal to nominate a school contact person. The principal is also sent an ‘Environmental Safety checklist’ of minimum requirements for the School Health Team to conduct a safe, effective and efficient health service. At the start of each school year the KHC Nurse Co-ordinator contacts all the school KHC contact people/school office and schedules/confirms dates for the KHC for that year.The KHC Nurse Co-ordinator liaises with AUGP Research Nurse and School Health Team Administration Officers (ASOs) to develop a calendar for KHC paperwork pickup from the AUGP to School Health Team office. The calendar enables a manageable distribution of KHC paperwork for processing between the AUGP and the School Health Team. A flow chart that outlines the responsibilities of the KHC processing between the AUGP and School Health Team is reviewed and updated annually 1.3.1 Paperwork organisation prior to KHCThe School Health Team will:Check calendar for schools scheduled for KHCRemove school to be processed from KHC filing cabinetsGather handouts including Dental Brochure, Nutrition – ‘Tuck a Talk’, Information about Height, Weight and Body Mass Index (See attachment 2) and other handouts relevant to parental concerns such as incontinence management and Your Child and Snoring (See attachment 3) On each child’s paper work check;The child’s details match including name, date of birth, addresss, phone contact on KHC Consent and Questionnaire Form, KHC Results Summary, and Parents Results Letter (See attachment 1.2, 1.3, 1.4)Check parental consent for KHC has been ticked YES Check if consent for hearing and vision results has been ticked YES, to share with the relevant teacherIf there is a NO consent for the hearing and vision results to be given to the Teacher, ensure this is highlighted on KHC Results Summary, and that it is also highlighted on the class listIf there is no parental consent, please consult with the KHC Co-ordinatorCheck in the KHC Consent and Questionnaire Form for any parental concerns regarding vision and hearingIf there are any parental concerns write them on the front of the KHC Results Summary above the results area for Vision Acuity and HearingCheck for parental concerns regarding Snoring (See attachment 3) and Incontinence. It the parent has ticked YES to any of the above, or has mentioned asthma, include the relevant handout in the parent paperwork, and TICK the corresponding box on the front of the KHC Results Summary Once all classes from the school have been processed, return school batch to KHC filing cabinet. 1.4 Nurses roles and responsibilitiesNurses will be responsible for;Checking the environment is suitable to conduct health check as per Staff Environment Checklist for Kindergarten Health Check (See attachment 1.8)Notifying the Manager/ Central CNC if there are any concerns with the venue or implementing health check activitiesTaking the equipment, student files to the schoolTransporting student files in a confidential satchel Checking that all equipment is either available or in the car e.g. scales,audiometer, vision box and stadiometer/portable height measureCollecting school mobile phone/devices Completing KHC Results Summary (See attachment 1.3)Completing ‘Parent Results Letter‘ (See attachment 1.4) ready for posting at completion of KHC Contacting parents / guardians, where necessary with results of KHCProviding Kindergarten teachers with the vision & hearing results of children of consenting parents/ guardians Ticking the relevant box on the Results Summary if the parent/guardian has been contactedRestocking the documentation, paperwork and handouts. 1.4.1 DocumentationNurses to check the forms for consent, parental concerns and child’s history prior to health check Health check results, recommendations, referrals and handouts enclosed with results to recorded in KHC Results Summary (see attachment 1.3)Parents Results Letter (See attachment 1.4) is completed with appropriate referrals and handoutsA second nurse rechecks the BMI calculation, referral/s and health promotion information before posting to parent/guardianThe Parent Results Letter (see attachment 1.4) and health promotion handouts are placed in envelopes ready to be postedTeachers Results Sheet (See attachment 1.5) identified concerns for hearing and/or vision only of students with parental consent for teacher to be informedAbsent Letter (See attachment 1.1) is posted to parent’s postal address with the offer of a catch up KHC appointment.1.4.2. On Return to BaseFile KHC Results Summary by school name in strict alphabetical orderPhotocopy KHC Results Summary of students who require hearing retest and referral then file under Hearing Retest, in filing cabinet File the Results Summary paperwork of students who were absent or have moved interstate and file under ‘Absent’, in filing cabinetPrepare/restock equipment, documentation, handouts and files for next day.1.5 Kindergarten ‘Catch Up’ and ‘Hearing Retest’ clinicsAppointments for ‘Catch Up’ clinic and ‘Hearing Retest clinics are made through Community Health Intake (CHI) 6207 9977KHC ‘Catch Up’ appointments are for children who were absent at school on the day of the KHC, or for parents/carers that prefer to be present during the check (30 minute appointments)KHC Hearing Retest clinics are for kindergarten children who did not reach the ‘normal’ hearing level threshold (15 minute appointments)Kindergarten Health Check ‘catch up’ clinics are scheduled according to demand and in a centrally located health centre. Back to Table of ContentsSection 2 – Anthropometric MeasurementsNurses will adhere to ‘Hand Hygiene and Infection Control’ measures as per the Healthcare Associated Infections Clinical Guideline.Height, Weight and Body Mass Index2.1 Procedure to measure Weight Digital scales are annually calibrated and are for use on hard level surfaceAsk the child to remove shoes, jumper and /or jacketEnsure digital scales are reading zero Ask the child to stand on centre of scaleRecord the weight in KHC Results Summary (See attachment 1.3)Results to be kept confidential from child and other children.2.2 Procedure to measure HeightUse a stadiometer (or height rule) with attached headboardAsk the child to remove shoes and hair ornamentsAsk the child to stand with back to stadiometer, stand straight so that their heels, buttocks and shoulders are in contact with the measuring rod. The heels should also be touching each other and arms by the sides. The child should look straight ahead. Ask the child to take a deep breath and stand tall before taking the measurement. Lower the headboard to lightly rest on the child’s head and bend to child’s height for accurate recordRecord the height to the nearest 0.1cm in KHC Results Summary (see attachment 1.3)Results to be kept confidential from child and other children.2.3 Calculation of Body Mass Index (BMI)2.3.1 Calculate BMI using Electronic DeviceCalculate BMI with electronic device using Centre for Disease Control (CDC) children’s BMI calculator at Calculate BMI with calculator and BMI index percentile chartsFormula:BMI =Weight (kg)(Height X Height)Example:Weight: 18.2 kg, Height: 108.3BMI =18.2BMI=18.2(1.083 x 1.083)117.2BMI = 15.52Use CDC ‘BMI-for-Age Percentile Chart’ to plot BMI result, according to gender and age.2.4 Referral PathwayDocument results on KHC Results Summary (see attachment 1.3)BMI Results that are outside the “Healthy Weight” range, it is recommended that parent/guardian see their GP and/or dietitianA nurse will phone the parent if there are significant weight concerns, guided by clinical judgement and/or following discussion with Kindergarten Co-ordinator or CNC. Refer to BMI referral flow chart for KHC (see attachment 1.6) as a guide.Alert: BMI percentiles are a guide only and are not diagnostic of weight status categories but contribute to the overall clinical impression (Government of Western Australia, 2014).Back to Table of ContentsSection 3 – Vision Check Procedure3.1 ProcedureSelect a quiet area free from distractions as per Staff Environment Checklist for Kindergarten Health Check (See attachment 1.8)Check if parent has any concerns with child’s vision Observe child’s general appearance, head posture, evidence of eye infectionAvoid glare in the child’s eyes3.1.1 Equipment required for vision screening Pen torch3 metre measureVision box (3 metre) and light remote control Stycar- 7 letter cardEye patchFixation stick3.1.2 Vision Screening Procedures – Sequence of EventsExplain the procedure in age appropriate termsCorneal Light ReflexesHold torch level with child’s eyes, about 30cm from faceObserve position of the corneal light reflection in either eyeCover/ Uncover TestsOne eye is occluded with nurse’s hand taking care not to touch the child’s faceThe nurse observes for any movement in the child’s uncovered eye whilst fixing the child’s attention on a near objectAs the eye is uncovered the nurse watches for any movementOcular MovementsHold stick about 30cms from child’s faceWatch the child’s eyes to see if they have moved to fix on targetContinue to observe the child’s eyes to see if fix is maintainedTo confirm fixation, the target can be moved slightly and the child’s eyes observed for correctional fixation movementsTrackingHold stick about 30cms from the child’s faceMove the stick in either the following pattern below, observing the child’s movements at all times for any deviation Ensure the child’s head remains still and they are not turning their head towards the fixation stick. You may place your hand under the child’s chin to stabilise the head.Repeat the cover test looking at an object 6 metres away (if environment amenable)(note: either methods are acceptable) ConvergenceHold fixation stick at forearm distance from the child, move the stick at a steady pace towards the child’s nose and observe for equal convergence of both eyesVisual Acuity (Stycar 7 letters)Sit the child 3 metres from the vision chart ensuring the distance is accurateAsk the child to hold the vision card on their lap and question the child about the name of the letters. If the child’s responses are not reliable, introduce it as a ‘matching game’Always test the right eye first to avoid errors in recording.Point to the letters from below, ensuring the pointer does not obstruct the letters Start at the top of the chart and move down quickly, only 1-2 letters per line until the 3/3 line Ask the child to read the entire line If the child is unsure, go back up a line and have the child read the whole line and come back downThe child does not pass the line if 2 or more letters are incorrectly named or matched The child passes the line if all letters are correctly read or matched.1(-1) letter variance is acceptable.Record the vision results for the right eye before repeating the process for the left eyeChildren who wear glasses should be tested with their glasses on, it is not necessary to test without glasses. Results recorded in the KHC Results Summary. 3.2 Document results as follows:Testing distance (3m) / Level of accurate vision achievedR) 3/3 or L) 3/3 = Normal3/3 -1 = Normal3/ 4.5 > 6 years = Refer 3/ 4.5 < 6 years = Retest when over 6 yearsUnequal vision acuity results = Refer3/6 + = ReferMovement, tracking, convergence irregularities = Refer3.3 Referral CriteriaProvide parent with Parent Results Letter and School Health Team referral (white original & pink). Green referral copy is attached to KHC Results Summary. The parent needs to contact Community health Intake (CHI) for Orthoptist appointment Referral options include Orthoptists, Optometrist or GP for further assessment and managementRetest at OptometristA nurse will phone the parent if there are significant vision concerns, guided by clinical judgement and/or following discussion with Kindergarten Co-ordinator or CNCBack to Table of ContentsSection 4 – Hearing Check Procedure4.1 ProceduresSelect a quiet area free from distractions: as per Staff Environment Checklist for Kindergarten Health Check (See attachment 1.8)Turn the audiometer on for 10 minutes and check for normal functionExplain the procedure in age appropriate termsGive clear instructions to the child to listen for ‘beep’ or ‘buzz’ sounds and to respond by clapping their handsSeat the child in a comfortable position so that the child’s hands can be clearly seen by the nurse Assist child to remove glasses, clips and place hair behind their earsPrior to placing the headphones on the child, conduct a trial test by presenting a few signals at different frequencies and demonstrating the correct response. Ensure the volume is turned down to no higher than 60dBs before testing with headphones. Face the child front on and place the headphones, red to right and blue to left earEnsure the headphones are comfortable and covering the ear completely Test the right ear first unless there is a known hearing loss, in which case start with the better hearing ear The sequence for testing is 1000 Hertz (Hz), 2000Hz, 4000Hz then 500Hz. Begin testing at 40 decibels (dBs) and press tone/pulse button for up to 2 secondsDecrease by 10dBs, at varying and irregular intervals, until 20dBs is reachedTwo out of three positive responses at 20dBs must be achieved at each frequency for hearing to be within normal limits. If the child is unable to get two out of three responses at 20dBs, it is documented at the dB level where two out of three positive responses occurred at the frequency tested. The child will be referred for a hearing retest or Audiometry Clinic (See below for Hearing Pathway Referral)Repeat same procedure for the left earRecord results on KHC Results Summary (see attachment 1.3)The dB level is recorded over the frequency leveli.e. Normal Hearing is recorded as;Right: 20/500 20/1000 20/2000 20/4000 Left: 20/500 20/1000 20/2000 20/4000 Indicate in the Right column of the KHC Results Summary, if the hearing isNormal Hearing or Hearing Retest Clinic or Audiometry ReferralA nurse will phone the parent if there are significant hearing concerns, guided by clinical judgement and/or following discussion with Kindergarten Co-ordinator or CNC. Hearing Referral Pathway Flowchart (See attachment 1.7).4.1.1Assist children to understand instructionThere may be some 5-6 year olds who have difficulty understanding the instructions for a hearing check.These are some useful strategies to help them:Present the sounds at a louder frequency and role model the response Switch ears to see if you can get a response.4.2 Hearing Referrals GuideFollow referral pathway if retest or referral is required:Hearing Retest: For students who respond;25 - 30dBs at 500 Hzand/ or25 dBs at any other frequency(i.e.1000, 2000 and 4000 Hz)andNo parental concernsIf the child has a cold, it is preferable that there is a minimum gap of 4 weeks between screening and hearing retest.Refer to Audiometry Nurse:For students who respond;35dBs (or more) at 500Hzand/or 30 dBs (or more) at any other frequency(i.e. 1000, 2000 and 4000Hzs) Screening not passed and Parent or nurse concerns and/orLanguage, speech concernsRecord on:KHC Results SummaryParent Results Letter Teacher Results Form (if parent/guardian consented)See Hearing Referral Pathway Flowchart (See attachment 1.7)4.3 Hearing Retest ClinicAudiometry hearing screen is repeated in a centrally located Health Centre. Students who do not PASS at 20dBs across frequencies (i.e. 1000, 2000, 4000and 500Hzs) are referred to the Audiometry Clinic. The Nurse completes the ‘Hearing Retest’ form and attaches to the student’s KHC Clinical Record.The parent is given a form that ‘denotes’ the results as ‘Normal Hearing’ or Audiometry Clinic referral. The form provides information about booking appointment at the Audiometry Clinic through CHI. Back to Table of ContentsImplementationThis procedure will be incorporated into training of new staff at orientation and will be referenced in the annual credentialing of clinical skills for all nurses working in the School Health Team, in particular vision and hearing screening techniques.The document will be communicated in clinical team meeting and referred to as the framework for clinical discussion for the Kindergarten Health Check.Back to Table of ContentsRelated Policies, Procedures, Guidelines and LegislationPolicies Consent and Treatment PolicyCHHS Patient Identification and Procedure Matching PolicyIncident Management PolicyWork Health and Safety policyProcedures and Guidelines Australian Audiometry Nurse Association Clinical Standards, 2015CHHS Healthcare Associated Infections, CHHS 15/072Clinical Records, Records Management Manual DGD12-048Paediatric Anthropometric MeasurementsLegislationACT Government Occupational Health and Safety Act 1989Health Records (Privacy and Access) Act 1997Back to Table of ContentsReferencesCommonwealth of Australia, 2009 National Children’s Vision Screening Project Final Report, accessed 2nd October 2012 Screening Final Report May 2009.pdfCommunity Health Manual Procedure, School aged children, Govt of Western Australia, department of Health, 2014Early Childhood Vision Screening School of Applied Vision Sciences Faculty of Health Sciences University of Sydney, 2003Martin, F.N. and Clark, J.D. 2000. Pure-Tone Audiometry. In Martin, F.N. and Clark, J.D. Introduction to Audiology, 7th Ed. Chapter 4, pages 73-8National Centre for Health Statistics, 2000. Centres for Disease Control and prevention growth charts USA accessed from May 2016NHMRC Endorsed 15 March 2002. Child Health Screening and Surveillance. A Critical Review of the Evidence. Report prepared by the Centre for Community health, Royal Children’s Hospital Melbourne for the NHMRC. pp 88-105.NHMRC 2010. Management of overweight and obesity in adults, adolescents and children in Australia, pp 81 - 99.Back to Table of ContentsSearch Terms Body Mass Index, Children, Community, Kindergarten Health Check, Paediatrics, School Screening, School Vision, School Hearing, SurveillanceBack to Table of ContentsAttachments Attachment 1: Q drive location of KHC forms and lettersAttachment 2: Parent information handout ‘Height, weight & BMI (Body Mass Index)’Attachment 3: Parent information handout ‘Snoring and your Child’Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Service specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.Date AmendedSection AmendedApproved ByEg: 17 August 2014Section 1ED/CHHSPC ChairAttachment 1: Flowcharts and Q drive location of KHC forms and lettersAbsent Letter Q:\CH\CY&W\CY&W_General\RegionalTeams\Central\School Health Team\School Imm.& Kindys\Immunisation and Kindy 20--\Kindy 20--\LettersandHandoutsKHC Consent and Questionnaire FormHYPERLINK "C:\\Users\\Erin cronin\\AppData\\Local\\Microsoft\\Windows\\Temporary Internet Files\\Content.Outlook\\ITQZW03J\\Kindergarten Health Check clinical document.doc"Q:\CH\CY&W\CY&W_General\RegionalTeams\Central\School Health Team\School Imm.& Kindys\Immunisation and Kindy 20--KHC Results Summary Q:\CH\CY&W\CY&W_General\RegionalTeams\Central\School Health Team\School Imm.& Kindys\Immunisation and Kindy 20--\Kindy 20--\LettersandHandoutsKHC Parent Results LetterHYPERLINK "C:\\Users\\Erin cronin\\AppData\\Local\\Microsoft\\Windows\\Temporary Internet Files\\Content.Outlook\\ITQZW03J\\Kindergarten Health Check clinical document.doc"Q:\CH\CY&W\CY&W_General\RegionalTeams\Central\School Health Team\School Imm.& Kindys\Immunisation and Kindy 20--\Kindy 20--\Letters andHandoutsTeachers Results SheetHYPERLINK "C:\\Users\\Erin cronin\\AppData\\Local\\Microsoft\\Windows\\Temporary Internet Files\\Content.Outlook\\ITQZW03J\\Kindergarten Health Check clinical document.doc"Q:\CH\CY&W\CY&W_General\RegionalTeams\Central\School Health Team\School Imm.& Kindys\Immunisation and Kindy 20—BMI referral flow chart for KHCQ:\CH\CY&W\CY&W_General\RegionalTeams\Central\School Health Team\School Imm.& Kindys\Immunisation and Kindy 20—\kindy\datesHearing Referral Pathway Flowchart Q:\CH\CY&W\CY&W_General\RegionalTeams\Central\School Health Team\School Imm.& Kindys\Clinical Staff Environment Checklist for Kindergarten Health checkHYPERLINK "C:\\Users\\Erin cronin\\AppData\\Local\\Microsoft\\Windows\\Temporary Internet Files\\Content.Outlook\\ITQZW03J\\Kindergarten Health Check clinical document.doc"Q:\CH\CY&W\CY&W_General\RegionalTeams\Central\School Health Team\School Imm.& Kindys\Immunisation and Kindy 20—School: ...............................................Date: …………………………………………...Name: …………………………………………….Signed: .............................................Date Checked:Requirements meetRequirementsYesNoParking to be as close as possible to the room the nurses will be using for the Kindergarten Health CheckThe Rooms for Kindergarten Health CheckTwo rooms are required one for vision and one for hearing; they need to be in close proximity to each other and close to the Kindergarten classroomThe nurses will need exclusive use of the room/s while at the school to carry out the health checks and be able to secure the room when unattendedTo carry out the vision testing they require a distance of 3 meters this area must allow for uninterrupted viewing/matching of letters by the child and be free of distractions to ensure accurate testingThe room/area to carry out the hearing testing must be quiet enough to allow for the nurses to test hearing that will give accurate resultsThe room should provide adequate lighting and heating/cooling as appropriate2 -3 tables of a good working height for adults4 adult sized chairs for the nurses. This is a Work Safety requirement to reduce the risk of injuryHand washing facilities nearbyNeed to be easy access to power points in both rooms for the hearing and vision equipmentStaff aware of emergency exits, Fire Extinguishers & Evacuation Assembly PointsAttachment 2: Height, Weight & Body Mass Index (BMI) MeasurementsAccessed from the Policy Register () Attachment 3: Snoring and Your ChildAccessed from the Policy Register () ................
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