Skills Checklist

Home Health Checklist

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GENERAL SKILLS:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Advanced directives
Patient / family teaching
Lift / transfer devices
Specialty beds
Restrictive devices (restraints)
End of life care / palliative care
Skin / wound assessment & care
Diabetic care & education
Blood Glucose Monitoring (BGM)
General nursing assessment
Recognizing failure to thrive across the lifespan
Monitoring of vital signs
Monitoring of intake / output
Monitoring of weight
Cardiac / respiratory arrest / CPR adult
Cardiac / respiratory arrest / CPR pediatric or infant
Documentation of skilled care (written) or computerized
Medicare 485 / 486 forms
National Patient Safety Goals
Accurate patient identification
Effective communication
Interpretation & communication of lab values
Medication administration
Medication reconciliation
Anticoagulation therapy
Pain assessment & management
Infection control (nosocomial / community-acquired)
Anti-infective therapy (antibiotics, antivirals, antifungals)
Universal precautions
Awareness of HCAHPS
General Skills - cont. Experience
Isolation
Minimize risk falls
Prevention of pressure ulcers

RESPIRATORY EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Assessment / auscultation of lung sounds
Incentive spirometry
Principles of chest percussion
Establishing an airway
Assessment / auscultation of lung sounds
Incentive spirometry
Principles of chest percussion
Establishing an airway

THERAPY EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Starting & maintaining peripheral IVs
Blood draw: venous
Central line care (includes PICC / Groshong / Hickman)
Blood draw: central line
Care & management of ports
Care & management of nonvascular devices (epidural, intrathecal)
TPN & lipids
Administration of blood and blood products
Administration of chemotherapy
Monitoring of chemotherapy (does not initiate)
Infusion pumps

CARDIAC EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Cardiovascular assessment
Clinical identification of dysrythmias (AP check for rate & rhythm)

CARE OF PATIENTS WITH:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Hypertension
Coronary Artery Disease (CAD)
Acute MI
Post Coronary Artery Bypass Graft (CABG) / valve
CHF
Aneurysm (thoracic or abdominal)
Pre-post surgery
Shunts & fistulas
Straight catheterization
Self catheterization
Incontinence
Peritoneal dialysis
Hemodialysis

MEDICATION ADMINISTRATION / PATIENT TEACHING:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Antidysrhythmics (i.e., betablockers, calcium channel blockers & cardiac glycosides)
Antihypertensives
Vasoactive drugs (NTG)
Diuretics (i.e., lasix, dyazide)
Aminophylline
Bronchodilators (Bronkosol / Brethine)
Expectorants
Inhaled medications (proventil / anticholinergics / steroids / mucolytics)
Cortocosteroids
Anticonvulsant
MAOIs
Antidyskinetics
Skeletal muscle relaxants
Dopamine (blockers & stimulants)

RESPIRATORY EXPERIENCE - CARE OF PATIENT WITH:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Asthma
COPD
Pulmonary hypertension
Tracheostomy
Lung cancer
Pulmonary emboli

NEUROLOGY EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Assessment of neuro signs
Seizure precautions

CARE OF PATIENT WITH:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Coma
Cerebral tumors
Seizure activity
Spinal cord injury / paralysis (para / quad)
TBI (Traumatic Brain Injury)
TIA’s
Stroke (CVA) hemiparesis
Alzheimer’s Disease
Meningitis
Multiple sclerosis
Parkinson’s disease
ALS (Amyotrophic Laterial Sclerosis)
Arthritis
Amputation
Casts
Fractures

GI / GU EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

NG tube
Long term feeding tube (Keofeed, Dobhoff)
PEG / gastrostomy tube
Tube feeding
Drainage tubes (surgical & non- surgical)
G.I. bleed
Colostomy / ileostomy care
Ileal conduit
G.U. irrigations
Suprapubic catheter

GYNECOLOGY EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Endometriosis
Self breast exam
Mastectomy
Hysterectomy

ORTHOPEDIC EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Total joint replacements (knee / hip / shoulder)
Crutch walking
Assistive devices
Arthroscopy / arthrotomy
TENS unit

MATERNAL - CHILD CARE EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Assessment & care of complicated pregnancy
Breast feeding
Homecare of postpartum mother
Healthy baby

NEWBORN CARE:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Bulb suctioning
Cord & circumcision care
Phototherapy
NG feedings

PEDIATRICS:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Medication calculation for pedi dosing
Use of croup tent
Oxyhood

CARE OF PEDIATRIC PATIENT WITH:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Asthma
Bone marrow transplant
Bronco- pulmonary dysplasia
Cardiac surgery
Cystic fibrosis
Epiglottiditis
Near drowning
Overdose / poison ingestion
Post harrington rod insertion
Respiratory Distress Syndrome (RDS)
Reye’s syndrome
Sickle cell disease
Spina bifida

USE OF EQUIPMENT FOR ALL AGE GROUPS EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Cardiac monitors
Wound VAC
Apnea monitors
O2 administration (NC / mask)
Ultrasonic nebulizer
Ventilators

SOFTWARE PROGRAMS EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

MeDecision
TILE
OASIS

AGE-SPECIFIC COMPETENCIES EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Newborn / neonate (birth-30 days)
Infant (31 days-1 year)
Toddler (ages 2-3 years)
Preschool (ages 4-5 years)
School age (ages 6-12 years)
Adolescent (ages 13-21 years)
Young adult (ages 22-39 years)
Adult (ages 40-64 years)
Older adult (ages 65-79 years)
Elderly (ages 80+ years)