Pediatrics Skills 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 Facility123
Trauma Center123
Academic/Teaching Facility123
Outpatient Care Facility123
Long term care/Skilled Nursing123
Clinic/Ambulatory123
Home Health Setting123
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 *
Normal growth & development123
Immunizations123
Provide safe environment for age specific care123
Recognize signs of failure to thrive123
Recognize signs of abuse/neglect123
Advanced directives123
Awareness of HCAHPS123
Patient/family teaching123
Lift/transfer devices123
Specialty beds123
Restrictive devices (restraints)123
End of life care/pallative care123
Wound assessment & care123
Automated Medication Dispensing System, Pyxis, Omnicell, or other123
Bar coding for medication administration123
Diabetic care & education123
Blood Glucose Monitoring (BGM)123
Insulin administration123
National Patient Safety Goals123
Accurate patient identification123
Effective communication123
Interpretation & communication of lab values123
Medication administration (PO,IM,IV,PR)123
Labeling (medications & specimens)123
Medication reconciliation123
Anticoagulation therapy123
Monitoring conscious sedation123
Pain assessment & management123
Use of PCA (IV, intrathecal, epidural)123
Infection control123
Universal precautions123
Isolation123
Minimize risk for falls123
Prevention of pressure ulcers123
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 IVs123
Blood draw: venous123
Central line care (includes Broviac/PICC/Groshong/Hickman)123
Blood draw: central line123
Care & management of ports123
TPN & lipids123
Administration of blood & blood products123
Administration of chemotherapy123
Monitoring chemotherapy (does not initiate)123
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 assessment123
Cardiac monitoring & emergency care123
Obtains 12 lead EKG123
Basic EKG interpretation123
Use of rapid response teams123
Cardiac arrest/CPR123
Administration of PALS protocols & medications123
Use of Broslow system123
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 *
Cogenital heart defects123
Congestive heart failure123
Post cardiac cath123
Post cardiac surgery123
Cardiomyopathy123
Pericarditis123
Shock123
Rheumatic fever123
Heart transplant123
Bacterial endocarditis123
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 *
Antidysrythmics123
Antihypertensives123
Cardiac glycoside (digoxin)123
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 assessment123
Rate & work of breathing123
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 *
Oral/nasal suctioning123
Tracheostomy care and suctioning123
Chest Physiotherapy (CPT)123
Pulse oximeter123
Ventilator management123
O2 (NC/mask/oxyhood)123
Assist with chest tube insertion & management123
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 *
Asthma123
RSV (Respiratory Syncytial Virus)123
Bronchopulmonary Dysplasia (BPD)123
Cystic fibrosis123
Croup123
Pneumonia123
Epiglottitis123
Tuberculosis123
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 *
Alupent123
Aminophylline (obsolete medication)123
Ventolin123
Inhaled corticosteroids123
Respigam/synergis123
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 *
Pediatric neurological assessment123
Assist with lumbar puncture123
ICP monitoring123
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 *
Battered child syndrome123
Depression123
TBI (Traumatic Brain Injury)123
Encephalitis123
Meningitis123
Neuromuscular disease123
Spinal cord injury123
Seizures123
Hydrocephalus123
VP shunt123
Epilepsy123
Near drowning123
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 *
Stimulants (Ritalin, Adderall)123
Steroids (Decadron, Solu-Medrol)123
Anticonvulsants (Dilantin, phenobarbital)123
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 *
Assessment of circulation checks123
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 *
Devised traction (splints, casts, braces)123
Pinned traction123
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 *
Osteomylitis123
Fractures123
Post Harrington rod insertion123
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 assessment123
Abdominal girth measurement123
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 *
Feedings123
Bottle123
Breast123
Gavage123
Gastrostomy123
Nasojejunal123
Nasogastric and sump tubes to suction123
Placement of oro/nasogastric tubes123
Colostomy/ileostomy care123
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 *
Anorexia/bulimia123
Tracheoesophageal Fistula (TEF)123
Gastroschisis/omphalocele123
Necrotizing Enterocolitis (NEC)123
Crohn’s disease123
Cleft lip/palate123
Gastroenteritis123
Pyloric stenosis123
Ulcerative colitis123
GE reflux123
GI bleeding123
Intestinal parasites123
Small bowel transplant123
Surgical abdomen123
RENAL/GU 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 balance123
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 *
Assist with suprapubic tap123
Peritoneal dialysis123
Insertion & care of Foley catheter123
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 *
Glomerular nephritits123
Ilial conduit ureteral123
Nephrotic syndrome123
Wilm’s tumor123
UTI123
Hemolytic uremic syndrome123
Kidney transplant123
ENDOCRINE SYSTEM 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 *
Onset diabetes123
Diabetic ketoacidosis123
Adrenal disorders123
Cushing’s syndrome123
Pituitary disorders123
Pancreas transplant123
Thyroid malfunction123
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 *
Insulin administration123
Insulin pumps123
Thyroid123
Growth hormone123
HEMATOLOGY/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 *
Assist with bone marrow aspiration123
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 *
Anemia123
Bone marrow transplant123
Leukemia123
Sickle cell disease123
Hemophilia123
Malignant tumors123
Spleen trauma/spleenectomy123
Neutropenic fever123
Sepsis123
Hodgkin’s123
INFECTIOUS DISEASES 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 *
Common childhood communicable diseases123
HIV/CMV/AIDS123
Hepatitis123
Kawasaki disease123
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)123
Infants (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

Attestation

ATTESTATION: *