Skills Checklist

Medical Surgical/Telemetry Checklist

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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
Automated Medication Dispensing System, Pyxis, Omnicell, or other
Bar coding for medication administration
National Patient Safety Goals
Accurate patient identification
Effective communication
Interpretation & communication of lab values
Medication administration
Labeling
Anticoagulation therapy
Reconciliation
Monitoring conscious sedation
Pain assessment & management
Use of PCA (IV, intrathecal, epidural)
Infection control
Universal precautions
Isolation
Minimize risk for falls
Prevention of pressure ulcers
Wound care
Wound vacs
Awareness of HCAHPS

CARDIAC MONITORING & EMERGENCY 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 *

Obtains 12 lead EKG
Interpretation of rhythm strips
Treatment of dysrhythmias
Use of rapid response teams
Cardiac arrest/CPR
O2 therapy & delivery
Pulse oximetry
Use of doppler
Automatic/manual blood pressure checks

IV THERAPY:

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
Blood draw: central line
Care & management of ports
Care & management of PICC / Groshong / Hickman
TPN & lipids
Administration of blood / blood products
Administration of chemotherapy
Monitoring chemotherapy (does not initiate)
Management of IV Pumps ( Alaris , Baxter,)
Management of elastomeric infusion
Management of intrathecal pumps

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 *

Diabetes mellitus
Blood Glucose Monitoring (BGM)
Insulin administration
Sepsis
External and temporary pacemakers
Management of permanent pacemaker/AICD
Care of patient with sepsis
Oncology
Chemotherapy
Radiation therapy
Radiation implants
Inpatient hospice
Suicide precautions
Burn patients
Leadership skills (team leader or charge nurse)

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 *

Assessment of heart sounds
Pacemakers – permanent

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 *

Aneurysm
Angina
Acute MI
Angioplasty (pre/post)
CHF
Carotid endarterectomy
Post MI
Pre/post cardiac cath
Pre/post cardiac surgery (CABG & valves)
Pre/post vascular surgery (abdominal or thoracic AA, fem-pop, carotid)
Cardiogenic shock
Pulmonary edema
Pneumothorax
Pneumonia
Asthma
Thoracentesis/paracentesis
CVA/TIA
Overdose/DT’s
Spinal cord injury/trauma
TBI (Traumatic Brain Injury)
Pre/post neuro surgery
Delirium tremors
Meningitis
Neuromuscular diseases
Degenerative neurological disorders
CMS Infection
Metastatic Tumor/ tumor resection
Encephalitis
Alzheimer’s
Laminectomy
Traumatic Brain Injury
Pancreatitis
Hepatitis
G.I. bleed
Esophageal bleeding
Bowel obstruction
Bowel resection
Colostomy / ileostomy
IBD(Crohn’s/Ulcerative Colitis
Liver failure/cancer
Chronic/acute renal failure

USE & ADMINISTRATION OF THE FOLLOWING:

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 *

Antiarrhythmic
Antihypertensives
Beta blockers
Diuretics
Nitrates
Fibrinolytics / IIb IIIa inhibitors
Preparation & administration of emergency (ACLS) meds
Antilipemic’s (Statins)
Inotropic’s (i.e. digoxin, dopamine. epinephrine)
Bronchodilators
Steroids
Expectorants & Antitussives
Antihistamines
Use of nebulizer treatments
Antiepileptics
Corticosteroids
Steroids
Anticonvulsants (Dilantin/Neurontin/phenobarbital)
Anti-depressants
Anticholinergics (antispam, Bentyl or Robinul)
Antiemetics
Antacids
Digestive enzymes
Cathartics

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 of breath sounds
Airway management/suctioning (ETT, oral,trach)
Chest tubes (Emerson / Pleuravac)
Interpretation of ABG
Incentive spirometer
Mechanical ventilation
Ambu Bag
Nasal Canula
Non-rebreather
Bronchoscopy
Venti Mask
Oral suctioning
Nasotracheal suctioning
Tracheostomy care
Heimlich Valve

GYNECOLOGY/GYN MALIGNANCIES 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
Gyn exam / pap
Self-breast exam
Tubal ligation
Ectopic pregnancy
Mastectomy / lumpectomy
Hysterectomy (vaginal or TAHBSO)
Repair of cystocele / rectocele
Pelvic inflammatory disease
Abnormal uterine bleeding
Management of D&C

EXPERIENCE 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 *

Adenosine administration
Insertion
& management of arterial line
Chest tube insertion & management
Femoral hemostasis devices (femStop/vasoseal)
Ventilator management
Interpretation weaning parameters

DRUG DOSE CALCULATION FOR:

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 *

Non-titrated IV vasoactive agents (Dobutrex/ dopamine)
Nitrates (IV nitroglycerine)
Platelet inhibitors (reopro)
Fibrinolytics/IIb IIIa inhibitors
Anti-arrhythmic agents (amiodarone/ Cardizem/lidocaine)
Patient Monitoring (Pre/Post Procedure)
Cardioversion
TEE
Cardiac catheterization
Bronchoscopy
EGD
PEG placement

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 *

Glasgow coma scale
Seizure precautions
Assist with lumbar puncture
Halo traction
Comprehensive neuro assessment

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 *

NG tube insertion
Management of small-bore feeding tubes (Dobhoff, Keofeed)
Jejunostomy tube
PEG tube
Management of post-surgery drains

GENITOURINARY/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 *

Catheter insertion
GU irrigations
Nephrostomy tube
Suprapubic tube
Fluid & electrolyte disturbance

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 replacement
Arthroscopic surgery
Bucks extension
Fasciotomy
Fractures
Spika cast/body cast
Splints
CPM
TENS unit
Cast care & removal
Amputation
Skeletal traction
Ortho trauma
Cervical fusion
Laminectomy

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)