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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 *
Experienced in diagnostic catheterizations123
Experienced in interventional catheterizations123
Automated Medication Dispensing System, Pyxis, Omnicell, or other123
Awareness of HCAHPS123
GENERAL SKILLS - PHYSIOLOGIC MONITORING

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 *
Monitoring / recording of LHC/RHC123
Monitoring / recording of aortic / mitral valve cases123
Monitoring / recording of PCI (Percutaneous Coronary Interventions)123
Monitoring / recording valve cases123
Monitoring / recording ASD closures123
Monitoring / recording of EP / ablation cases123
Monitoring / recording of permanent pacemaker insertions123
National Patient Safety Goals123
Accurate patient identification123
Effective communication123
Interpretation & communication of lab values123
Medication administration123
Medication reconciliation123
Labeling (medications & specimens)123
Anticoagulation therapy123
Monitoring conscious sedation123
Pain assessment & management123
Infection control123
Universal precautions123
Isolation123
Minimize risk for falls123
Prevention of pressure ulcers123
Use of rapid response teams123
GENERAL SKILLS - CIRCULATES

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 *
LHC/RHC123
IABP insertions123
FFR (radi wire)123
IVUS/volcano123
Thrombectomies123
Valvuloplasty123
ASD closures123
Atherectomy123
Filter wires123
Embolic protection devices123
EP/ablations123
Permanent pacemaker insertions123
Places leads & pads for cardiac mapping123
Electronic charting123
GENERAL SKILLS - SCRUBS

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 *
LHC/RHC123
IABP insertions123
Filter wires123
Embolic protection devices123
ASD closures123
Valvuloplasty123
Atherectomy123
PCI123
EP/ablations123
Permanent pacemaker insertions123
Maintain temporary pacemaker123
GENERAL SKILLS - EQUIPMENT

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 *
Hemochron123
ABG analysis machines123
Laser123
Power injectors123
INTERVENTIONAL RADIOLOGY RN 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 *
Circulates for interventional procedures123
Scrubs for interventional procedures123
Angiogram / aortogram123
Angioplasty123
Vascular stenting123
Declotting123
Embolization123
TIPS123
Port placement123
Dialysis catheter placement123
Retrieval of foreign body123
UAE (Uterine Arterial Embolization)123
EVLT (Endovascular Laser Therapy)123
Vertebro / kyphoplasty123
Neuroradiology123
Discogram123
AAA endograft repair123
Carotids123
Extremities123
AGE-SPECIFIC CHECKLIST

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)123
Infant (31 days-1 year)123
Toddler (ages 2-3 years)123
Preschool (ages 4-5 years)123
School age (ages 6-12 years)123
Adolescent (ages 13-21 years)123
Young adult (ages 22-39 years)123
Adult (ages 40-64 years)123
Older adult (ages 65-79 years)123
Elderly (ages 80+ years)123
ATTESTATION *