Respiratory Therapy Skills Checklist

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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 *

Electronic Documentation: Allscripts	123
Electronic Documentation: Care360	123
Electronic Documentation: Cerner	123
Electronic Documentation: ECLinical Works	123
Electronic Documentation: EPIC	123
Electronic Documentation: MACLAB	123
Electronic Documentation: McKesson	123
Electronic Documentation: Meditech	123
Electronic Documentation: PACS	123
Electronic Documentation: Soarian	123
Other Electronic Documentation:	123
Ventilator/Weaning: Bear	123
Ventilator/Weaning: Bennett7200	123
Ventilator/Weaning: CPAP	123
Ventilator/Weaning: Emerson	123
Ventilator/Weaning: EMV	123
Ventilator/Weaning: Engstrom/Erica	123
Ventilator/Weaning: MA-I	123
Ventilator/Weaning: MA-II	123
Ventilator/Weaning: Monihan	123
Ventilator/Weaning: Ohio 560	123
Ventilator/Weaning: Other	123
Ventilator/Weaning: PEEP	123
Ventilator/Weaning: Pressure Pre-set	123
Ventilator/Weaning: Servo	123
Ventilator/Weaning: Siemens	123
Other Ventilator/Weaning:	123
Universal Precautions	123
Working with patients in isolation	123
Working with patients in restraints	123
Patient/Family teaching	123
Patient Identification	123
Specialty beds	123
End of life care/palliative care	123
Knowledge of "Do Not Use Abbreviations"	123
Charge/supervisor experience?	123
Knowledge of current Joint Commission National Patient Safety Goals	123
Knowledge/familiarity with HCAHPS scores	123

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 *

Advair	123
Aerobid	123
Albuterol	123
Atropine	123
Atrovent	123
Amphotericin	123
Anectine	123
Artificial Surfactant	123
Bicarbonate	123
Colistin	123
Cremolyn Sodium ( Intal)	123
Corticosteroids	123
Digitalis	123
Digoxin	123
Dopamine	123
Duoneb	123
Foradil	123
Flonase	123
Flovent	123
Inhaled Steroids	123
Isotharine ( Bronkosol)	123
Isuprel	123
Lidocaine	123
Morphine	123
Metaproterenol ( Alupent)	123
Maxair	123
Mycomyst	123
Nipride	123
Pavulon	123
Pulmicort (Budesonide)	123
Pulmozyme ( Dornase Alfa)	123
Racemic Epinephrine ( Vaponephrine)	123
Ribaviran	123
Terbutaline Sulfate ( Bricanyl)	123
Theo-dur	123
Tilade	123
Tobramycin	123
Valium	123
Xopenex	123
Xylocaine	123

CARE OF PATIENTS 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 *

Aspiration Pneumonia	123
ARDS	123
Asthma	123
Status Asthmaticus	123
Acute/Chronic Bronchitis	123
Bronchopulmonary Dysplasia (BPD)	123
Bacterial/Viral Pneumonia	123
Bronchiectasis	123
Bronchiolitis	123
Croup	123
Cystic Fibrosis	123
Cardiac Surgery	123
Diabetic Ketoacidosis	123
Epiglottitis	123
Emphysema	123
Empyema	123
Failure to Thrive	123
Guillian Barre	123
Hyaline Membrane Disease	123
Lung Cancer	123
Meconium Aspiration	123
Myesthenia Gravis	123
Myocardial Infarction	123
Near Drowning	123
Neonatal Pneumonia	123
Pacemakers	123
Persistent Fetal Circulation	123
Pneumothorax	123
Pulmonary Interstitial Emphysema (PIE)	123
Pulmonary Edema	123
Pulmonary Emboli	123
Transient Tachypnea of the Newborn	123
Transesophageal Fistula	123
Thoracotomy	123
Tuberculosis	123

THERAPEUTICS AND 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 *

Nasal	123
Masks	123
Trach	123
Aerosol Set-up/Mask/Trach	123
Aerosol Heated/Cool	123
Oxygen Tank Set-up	123
Croup Tent Set-up/Troubleshoot	123
Infant Hood Set-up	123
Analyze Oxygen	123
Intubate Adult	123
Intubate Infant	123
Assist with Intubation	123
Extubate	123
Assist with Extubation	123
Assist with High Risk Delivery	123
Nasotracheal Suction	123
Endotracheal Suction	123
Ventilate Patient with Manual Resuscitator	123
Check Intracuff Pressures	123
Change/Clean Trach Tubes	123
Oral Airway Placement	123
Nasal Airway Placement	123
Isolation Procedures	123
Disinfection & Sterile Techniques	123
Incentive Spirometry	123
IPPB	123

THERAPEUTICS AND 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 *

Hand Held Nebulizer	123
Ultrasonic Nebulizer	123
Chest Physiotherapy/Postural Drainage	123
Splinting	123
Medihaler	123
Inhaler Reservoirs (Inspirease/Aerochamber)	123
Pursed Lip Breathing	123
Diaphragmatic Breathing	123
Segmental Breathing	123
Ventilator Set-up	123
Troubleshoot Ventilators	123
Ventilator Set-up	123
Negative Inspiratory Force	123
Vital Capacity	123
Nasal CPAP	123
BiPap nasal/mask	123
Assist/Control	123
Control	123
CPAP	123
IMV	123
SIMV	123
PEEP	123
High-Frequency Ventilator	123
Inverse Ratio Ventilation	123
Pulmonary Stress Testing	123
Pulmonary Function Testing	123
Bedside Screening	123
Peak Flow Rate	123
Apnea Monitor	123
Oximetry	123
Transcutaneous Monitoring	123
Assist with Bronchoscopies	123

ARTERIAL BLOOD GASES:

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 *

Allen Test	123
Analyzing	123
Interpretation	123
Arterial Line	123
Radial/Brachial Artery	123
Femoral Artery	123

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 *

Adult Critical Care	123
Pediatrics/PICU	123
Neonatal ICU	123
Emergency Room	123
Home Health	123
Sleep Lab	123
Pulmonary Rehabilitation	123
Transports( Air/Ambulance)	123

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 to 30 days)	123
Infant (31 days to 12 months)	123
Toddler/Preschool (13 months to 5 years)	123
School Age Child/adolescent (6 years to 18 years)	123
Young Adults/Middle Adult (19 years to 64 years)	123
Older Adults/Elderly (65+ years)	123

Attestation

ATTESTATION: *

I certify that the information provide above accurately reflects my experience in each of the clinical areas identified within the past three years.

If you agree with the Attestation above, please electronically sign your name. *