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Intensive / Critical Care Checklist

WORK SETTING 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 *
Inpatient Acute Care Facility
Trauma Center
Academic/Teaching Facility
Outpatient Care Facility
Long term care/Skilled Nursing
Clinic/Ambulatory
Home Health Setting
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
Restrictive devices (restraints)
Lift / transfer devices
Specialty beds
End of life care / palliative care
Wound assessment & care
Automated Medication Dispensing System, Pyxis, Omnicell, or other
Bar coding for medication administration
Diabetic care and education
Blood Glucose Monitor (BGM)
Cardioversion / defibrillation
Electronic ICU
National Patient Safety Goals
Accurate patient identification
Effective communication
Interpretation & communication of lab values
Medication administration
Medication reconciliation
Labeling (medications & specimens)
Anticoagulation therapy
Monitoring conscious sedation
Pain assessment & management
Infection control
Universal precautions
Isolation
Minimize risk for falls
Prevention of pressure ulcers
Use of rapid response teams
Awareness of HCAHPS
CARDIOVASCULAR 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 heart sounds
Interpretation of arrhythmias
Performing 12 lead EKG’s
Interpretation of 12 lead EKG
Interpretation of hemodynamic monitoring
ASSIST WITH INSERTION & MANAGEMENT OF:

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 *
CVC (Central Venous Catheter)
Arterial line
Swanz Ganz catheter
Flow trac or Vigileo monitoring caths
Intra-Aortic Balloon Pump (IABP)
Ventricular Assist Device (LVAD, RVAD)
MAINTENANCE & MANAGEMENT OF:

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 *
Permanent pacemakers
Implantable Cardioverter Defibrillator (ICD)
External pacemakers
Epicardial pacemaker wires
Discontinuing venous / arterial sheaths
Femostop / vasoseal
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 *
Acute myocardial infarction
Pre / post: cardiac catheterization
Congestive heart failure
Cardiomyopathy
Dysrhythmias / conduction disturbances
Aortic aneurysm
Thoracic / abdominal surgery
Endoluminal graft
Cardiogenic shock
Hypertensive crisis
Pericarditis / endocarditis
MAZE procedure
Post open heart (CABG / valve)
Cardiac contusion / trauma
Heart transplant
Cardiac tamponade
Lumbar drains
Cerebral aneurysm
Subarachnoid hemorrhage
Status epilepticus
TBI (Traumatic Brain Injury)
Spinal cord injury
CerebroVascular Accident (CVA)
Pre / post cranial surgery
Meningitis
Myasthenia gravis
Clipping and/ or coilings of aneurysms
Pituitary Tumor
Abdominal trauma
Acute gastrointestinal hemorrhage
Esophageal varices
Balloon tamponade devices (i.e. Blakemore tube)
Peritonitis
Acute pancreatitis
Bowel obstruction
Liver / pancreas transplant
MEDICATION ADMINISTRATION:

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 *
ACLS medications and protocols
Antidysrythmics
Antihypertensives
Vasoactive / vasopressor agents
Anesthetics (propofol / precedex)
Thrombolytics (retavase / activase)
Platelet inhibitors (ReoPro / Integrilin / Aggrastat)
Flolan for pulmonary hypertension
Rapid sequence intubation drugs / protocols
Nebulizer treatments: Ventolin, Atrovent
Steroids: Decadron, Solu-Medrol
Anticonvulsants: Dilantin, phenobarbital
Paralytic Agents: Norcuron, Pavalon, Nimbex, Tracrium, vecuronium
Mannitol
Antipsychotics: Haldol
Antiemetics: Reglan, Zofran
H2 receptor antagonists
PULMONARY 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 breath sounds
AIRWAY MANAGEMENT, CARE & MAINTENANCE OF:

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 *
Oral / NT / ET airway
Tracheostomy
Arterial blood gas analysis / interpretation
Obtaining ABG blood sample / arterial line
Pulse oximetry
VENTILATOR MANAGEMENT:

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 *
BiPAP (Bi-level Positive Airway Pressure)
Oscillation / high-frequency ventilation
Nitric
Interpretation of weaning parameters
Maintenance & management of pleural chest tubes
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 *
Acute respiratory failure
Adult Respiratory Distress Syndrome (ARDS)
Sudden Inflammation Respiratory Syndrome (SIRS)
Inhalation injuries
Pneumonia
Pulmonary edema
Near drowning
Chronic Obstructive Pulmonary Disease (COPD)
Pre / post thoracic surgery
Pulmonary embolism
Pulmonary / chest trauma
Pulmonary hypertension
Status asthmaticus
Acute renal failure
Chronic renal failure
AV fistulas, shunts & dialysis catheters
Nephrectomy
Renal transplant
Renal / urinary tract trauma
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 *
Cranial nerve assessment
Glasgow coma scale
NIH stroke scale
NIH stroke certification
Seizure precautions
Skeletal traction
Cervical spine precautions / logroll positioning
Halo vest/halo traction
Monitoring of neuromuscular blocking agents / paralytics
Assist with lumbar puncture
INTRACRANIAL/CEREBRAL PERFUSION PRESSURE MONITORIN

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 *
Ventriculostomy
Subarachnoid screw / bolt
TRAUMA & BURNS 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 *
Mass casualty
Electrocution
Amputation
Gangrene
Multiple fractures
Thermo- regulation: hypothermia / hyperthermia
BURNS: CALCULATION OF TOTAL BODY SURFACE AREA (BSA

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 *
Berdow Formula / “Rule of Nines”
Lund and Browder chart
Fluid resuscitation
Care & management of burns
GASTROINTESTINAL 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 *
Small bore feeding tube insertion (Dobhoff or Keofeed)
Nasogastric tube insertion
Post pyloric feeding tube insertion
Gastric lavage
Use of activated charcoal
Maintenance of gastric / jejunostomy tube
Stoma care
Maintenance & management of enteral tube feedings
Assisting / monitoring bedside procedures: endo / chest tubes / bronchs / trach insertion / PEG tubes
RENAL 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 *
Foley catheter insertion
Suprapubic tube
Nephrostomy tube
Peritoneal dialysis
Continuous Arteriovenous Hemofiltration (CAVHD, CVVHD, SCUF, CRRT)
Hemodialysis of the critically ill patient
ENDOCRINE 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 *
Diabetic Ketoacidosis (DKA)
Hyperosmolar Hyperglycemic Nonketotic Coma (HHNK)
Diabetes Insipidus (DI)
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Administration & monitoring of insulin infusion
Use of Endo tool
INTRAVENOUS MANAGEMENT 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 peripheral IV’s
Care of patient with Peripherally-Inserted Central Catheter (PICC)
Administration / monitoring of Total Parenteral Nutrition (TPN)
Administration of blood / blood products
Administration of narcotics / sedatives: (fentanyl, Valium, Ativan, Versed, morphine)
Bispectral monitoring
TELE-ICU (ICU-E) 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 *
Mentoring
Communication
Video assessment
Utilize tele-ICU system
Multi-tasking
Troubleshoot equipment
Giving directions over AV system
Interpretation of data
Critical thinking
Diplomacy
OTHER 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 *
Drug or chemical overdose (TCA, ethanol, ASA)
Poisoning (CO, cyanide)
Substance abuse (ETOH, stimulants, narcotics)
Human Immuno- deficiency Virus (HIV)
Multisystem Organ Dysfunction Syndrome (MODS)
Anaphylaxis
Disseminated Intravascular Coagulation (DIC)
Septic shock
Cancer
Administration of chemotherapy
Monitoring of chemotherapy (does not initiate)
Hyperbaric oxygenation
Organ / tissue donation procedures
Suicide precautions
AGE-SPECIFIC 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)