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PICU Checklist

GENERAL SKILLS 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 *
Patient / family teaching
Lift / transfer devices
End of life care / palliative care
Universal protocol (site / side verification)
Moderate sedation / protocols & procedures
Regional blocks (intrathecal / epidural / spinal)
General anesthesia (IV anesthetic agents / inhalation anesthesia agents)
Benzodiazepines / reversal
Opioids / reversal
Setting - Children’s hospital
Setting - University healthcare facility
Setting - Community hospital
Family teaching
Assessment of normal growth & development
Recognize/report signs of child abuse/neglect
Consents
End of life care/pallative care
Pediatric dosage calculations
Delivery methods: eye/ear/IM/IV/SQ
Steroids (inhaled/IV/PO)
Minimize risk falls
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
IV 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/Broviac/Groshong/Hickman)
Blood draw: central line
Care & management of ports
Care & management of nonvascular devices (epidural, intrathecal)
TPN & lipids
Administration of blood & blood products
Infusion pumps
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 *
Pediatric CV assessment
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 *
Arterial line
CVC (central venous catheter)
Swanz-Ganz
Hemodynamic monitoring
Extra Corporeal Membrane Oxygenation (ECMO)
Use of doppler
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 *
Administration of PALS protocols & medications
Broslow system
Interpretation & treatment of dysrythmias
Rapid response team member
Use of rapid response teams
CARE OF CHILD 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 *
Bacterial endocarditis
DIC
Post cardiac cath
Cardiac transplant
Cardiogenic shock
Cardiomyopathy
Congenital heart disease/defects
Hypovolemic shock
Myocarditis/pericarditis
Permanent pacemaker
Temporary pacemaker
Acute Respiratory Distress Syndrome (ARDS)
Respiratory Syncytial Virus (RSV)
Chronic respiratory disease
Croup
Epiglottits
Reactive Airway Disease (RAD)
Status asthmaticus
Pulmonary hypertension
Pneumonia
Near drowning
Muscular degenerative diseases
Meningitis
Coma
Brain death/organ procurement
Encephalitis/encephalopathy
External ventricular drains
VP shunts/reservoirs
TBI (Traumatic Brain Injury)
Status epilepticus
Spinal cord injury
Post nuero surgery
Traction
Cervical traction
Pinned fractures
Post vertebral surgery
Abdominal trauma; bleeding
Ascites
Surgical abdomen
Severe dehydration/gastroenteritis
Hepatic failure
Hepatitis
Hyperbilirubinemia
Necrotizing Entercolitios (NEC)
Ruptured spleen
GI bleeding
GI organ transplants
Abdominal trauma; bleeding
Ascites
Surgical abdomen
Severe dehydration/gastroenteritis
Hepatic failure
Hepatitis
Hyperbilirubinemia
Necrotizing Entercolitios (NEC)
Ruptured spleen
GI bleeding
GI organ transplants
Acute renal failure
Hemodialysis
Peritoneal dialysis
Hemolytic Uremic Syndrome (HUS)
Post renal transplant
Nephritis
Ileal conduit
Burns
Traumatic wounds
Vacuum Assisted Device (VAC)
Acute anemia
Acute tumor lysis syndrome
Bone marrow transplant
Leukemia
Malignant tumors
Neutropenia
Radiation implant
Sickle cell anemia
Hemophilia
Graft verses host disease
Inpatient hospice
MEDICATIONS:

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 *
Antidysrythmics
Antihypertensives
Cardiac glycoside (digoxin)
Platelet inhibitors (Aggrastat/Integrilin/ReoPro)
Anti-rejection immunosuppressants
Vasoactive agents
Anticonvulsants
Mannitol
Psychostimulants (Ritalin/Adderall)
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 *
Respiratory assessment (rate & work of breathing)
EQUIPMENT/PROCEDURES:

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 *
Metered dose inhaler
Nebulized medications
Assist with & manage intubation
Tracheostomy care
Assist with & maintain chest tube
Obtain & interpret Arterial blood gas
O2 therapy (NC/oxyhood/tent)
Thoracentisis
Ventilator management
Use of paralytics
Abdominal decompression (NG, sump tubes, intermittent & continuous suction)
Colostomy/ileostomy
Placement of feeding tubes (NG)
G-tube/J-tube
Gastrointestinal - cont. Experience
Assist with suprapubic taps
Insertion & care of foley catheter
NEUROLOGICAL 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 *
Bronchodilators
Racemic epinephrine
Neurological Experience
Neuro assessment
Glascow coma scale
PROCEDURES:

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 *
Assisting with LP
Intracranial pressure (ICP) insertion & monitoring
ORTHOPEDICS 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 *
Orthopedic 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 *
GI assessment
Nutritional assessment
FEEDINGS:

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 *
Assist with breastfeeding
Breastmilk handling & storage
Bottle
Gavage
Use of feeding pumps
RENAL/GENITOURINARY 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 fluid balance
SKIN 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 *
Skin assessment
Surgical wound healing
ONCOLOGY 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 *
Administration of chemotherapy
Monitoring of chemotherapy (does not initiate)
Assist with bone marrow aspiration
AUTOIMMUNE DISEASES 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 *
Addison’s disease
Cushing’s disease
Celiac disease/gluten intolerance
Grave’s disease
Hypothyroidism
Lupus
INFECTIOUS DISEASES 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 *
Usual child diseases (mumps/measles/chicken pox)
CMV/HIV/AIDS
Tuberculosis
Septic shock
Fever management
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 *
Antiinfectives
MISCELLANEOUS EXPERIENCE - CARE OF CHILD 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 *
Trauma
Craniofacial reconstruction
ENT surgery
Ingestions/overdose
Suicidal ideation/attempts
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)