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Surgical Tech 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 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 *
Awareness of HCAHPS
Patient/family teaching
Restrictive devices (restraints)
Lift/transfer devices
Patient positioning
National Patient Safety Goals
Accurate patient identification
Effective communication
Infection control
Universal precautions
Care of the patient in isolation
Medication administration on sterile field
Labeling (medications & specimens) on sterile field
Time out protocol
GENERAL SURGERY 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 *
Abdominal perineal resection
Adrenalectomy
Bowel resection
Cholecystectomy/cholangiogram
Colostomy/ileostomy
Gastrectomy
Herniorrhaphy-femoral/inguinal
Hiatal herniorrhaphy transabdominal
Pancreatectomy
Organ procurement
Radical mastectomy
Saphenous vein ligation/stripping
Splenectomy
Thyroidectomy
Vagotomy
Breast biopsy
Mastectomy
Common bile duct explorations
Open appendectomy
Jejunostomy tube replacement
Liver biopsy
Excision of lipoma
Parathyroidectomy
Parathyroidectomy with transplant
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 *
Caesarean section
Dilation & curettage
Hysterectomy - vaginal
Hysterectomy - abdominal
Radium insertion
Shirodkar procedure
Termination of pregnancy
Tubal ligation
Vaginectomy
Vaginal anterior repair surgery
Vaginal posterior repair surgery
Salpingo-oopherectomy
ENDOSCOPIC PROCEDURES 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 *
Bronchoscopy
Endo/colonoscopy
Culdoscopy
Cystoscopy
Esophagoscopy
Gastroscopy
Hysteroscopy
LAPAROSCOPIC 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 *
Appendectomy
Cholecystectomy
Colon resection
Hernia repair
Salpingo-oophorectomy
Tubal ligation
Vaginal hysterectomy
Laryngoscopy
Mediastinoscopy
Pelviscopy
Sigmoidoscopy
Thoracoscopy
UROLOGY 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 *
Circumcision
Cystoscopy/ureteroscopy
Cystectomy
Hypospadias repair
Implants
Lithotripsy
Nephrectomy
Orchiectomy
Prostatectomy
Ureterolithotomy
TURP
Vasectomy
Implants - penile
Uteroplasty
Transurethral Resection of Bladder Tumor (TURBT)
Testicular tortion
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 *
Achilles tendon repair
Amputation
Arthroscopy/arthrotomy
Closed pinning & reduction of extremities
External compression devices
Hip compression nails & lag screws
Total joint replacement - knee, hip, shoulder
Spica cast
ORIF - shoulder, hip, humerus
Repair of dislocation
Patellectomy
Tendon implants & reanastomosis
External fixator
ORIF - ankle
ORIF - radius/ulna
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 *
A-V malformation
Laparoscopic spine procedures
Burr holes for subdural hematoma
Carotid ligation
Cervical sympathectomy
Cranioplasty
Craniotomy
Discectomy/laminectomy
Halo traction application
Insertion of nerve stimulator devices
Myelomeningocele repair
Shunt procedure VP/ VA/LP
Spinal fusions
Ventriculostomy
Kyphoplasty
Spinal cord stimulator insertion
Cervical laminectomy
Lumbar laminectomy
Spinal fusion - cervical
Spinal fusion - lumbar
Panniculectomy
PLASTICS 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 *
Abdominal lipectomy
Blepharoplasty
Face lift
Mammoplasty
Augmentation
Reduction
Reconstructive
Liposuction
Otoplasty
Scar revisions
Skin grafting
OPHTHALMOLOGY 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 *
Cataract extraction
IOL implants
Corneal transplant
Orbital implant
Enucleation
Repair orbital blowout fracture
Repair of retinal detachment
Scleral buckle
EAR, NOSE & THROAT 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 *
Caldwell-luc
Cleft lip/palate repair
Laryngectomy
Radial neck disection/resection
Tonsillectomy & adenoidectomy
Mandibulectomy
Mastoidectomy
Rhinoplasty/septoplasty
Sinusotomy
Tracheostomy
VASCULAR 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 *
Angiography
A-V access graft
Aortic aneurysm: abdominal
Endarterectomy: carotid
Peripheral vascular bypass procedures
Thrombectomy
Embolectomy
Vena cava ligation
THORACIC/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 *
Aortic femoral bypass graft
Femoral popliteal bypass
Pacemaker implantation/explantation
Care of patients with pacemakers
Care of patients with IABP
Septal defects, ASV, VSD
Coronary artery bypass graft
Valve replacement
Aortic aneurysm: thoracic
Thoracotomy
Lobectomy
Rib resection
Endoscopic vein harvesting
Off pump bypass
TRANSPLANT 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 *
Bone
Bone marrow
Corneal
Harvesting
Heart/lung
Kidney
Liver
Multi organ
Pancreas
Skin
TRAUMA 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 *
Burns
Gunshot/stab wound
Motor vehicle accidents
Traumatic amputations
EQUIPMENT 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 *
Camera/video systems
Cell saver
Cidex soak
Cryo-ophthalmic unit
CUSA
Drills & saws
Electrosurgical unit
Fiber optic laminator
Cavitron
Autoclave
Autoclave
Stapling devices
Mesh graft/dermatone
Microscopes
Nitrogen tank
Pneumatic tourniquet
Steris unit
Pulsevac irrigation
Autotransfusion systems
Laser equipment
Care of scopes & fiberoptic equipment
Venodyne robotics (DaVinci)
Robotics
Robotics systems
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)