Oncology Skills Checklist

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Requested by email:

Today's Date: * +

First Name: *

Last Name: *

Mobile Phone Number: *

Email Address: *

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SETTINGS 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 oncology unit	123
Outpatient oncology unit	123
Hospice / palliative care	123
Participation in support groups	123
Death & dying counseling	123

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	123
Advanced directives	123
Patient / family teaching	123
Restrictive devices (restraints)	123
Lift / transfer devices	123
Specialty beds	123
End of life care / palliative care	123
Automated Medication Dispensing System, Pyxis, Omnicell, or other	123
Bar coding for medication administration	123
National Patient Safety Goals	123
Accurate patient identification	123
Effective communication	123
Interpretation & communication of lab values	123
Medication administration	123
Labeling	123
Anticoagulation therapy	123
Reconciliation	123
Monitoring conscious sedation	123
Pain assessment & management	123
Use of PCA (IV, intrathecal, epidural)	123
Infection control	123
Universal precautions	123
Isolation	123
Minimize risk for falls	123
Prevention of pressure ulcers	123
Wound care	123

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 *

Obtains 12 lead EKG	123
Interpretation of rhythm strips	123
Treatment of dysrythmias	123
Use of rapid response teams	123
Cardiac arrest/CPR	123
O2 therapy & delivery	123
Pulse oximetry	123
Use of doppler	123

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 IVs	123
Blood draw: venous	123
Central line care	123
Blood draw: central line	123
Care & management of ports	123
Care & management of PICC / Groshong / Hickman	123
TPN & lipids	123
Administration of blood / blood products	123
Administration of chemotherapy	123
Continuous infusion	123
IV push	123
Oral	123
Monitoring chemotherapy (does not initiate)	123

OTHER:

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 *

Diabetes mellitus	123
Blood Glucose Monitoring (BGM)	123
Insulin administration	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 *

Cardiac assessment

123

CARE OF PATIENT 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 *

CHF	123
Cardiac disease (CAD / MI / post CABG)	123
Hypertension	123
Pacemakers	123

RESPIRATORY 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 *

Ascultation of breath sounds	123
Chest PT	123
Tracheostomy care	123
Oral or nasotracheal suctioning	123
Assist with chest tube insertion & management	123
Assist with thoracentesis	123

CARE OF PATIENT 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 *

Asthma	123
COPD	123
Pneumonia	123
Tuberculosis	123

GI/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 *

NG tube insertion	123
Long term feeding tube insertion (Dobhoff / Keofeed)	123
Care of the patient with enteral feedings	123
Gastrostomy tube	123
Jejunostomy tube	123
Colostomy & enterostomal care	123
Ileostomy	123
Peritoneal dialysis	123
Hemodialysis	123
Care of shunts & fistulas	123
Nephrostomy tube	123
Suprapubic catheter	123
Foley catheter insertion & management	123

NEURO 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 *

Comprehensive neuro assessment	123
Seizure precautions	123

CARE OF PATIENT 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 *

Post neuro surgery	123
TIA/CVA	123
Degenerative neurological disorders	123

ONCOLOGY SPECIFIC 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 *

Assist with bone marrow biopsy	123
Immuno- suppression / laminar airflow	123
Administration of chemotherapy	123

USE & ADMINISTRATION OF THE FOLLOWING:

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 *

Fluorouracil (5-FU)	123
Doxorubicin (Adriamycin)	123
Methotrexate (amethopterin)	123
Mitomycin (Mutamycin)	123
Bleomycin (blenoxane)	123
Hydroxyurea (Hydrea)	123
Melphalan (Alkeran)	123
Usulfan (Myleran)	123
Etoposide (VP- 16- 213)	123
Cistplatin	123
Vinblastine (Velban)	123
Vincristine (Oncovin)	123
Cyclo- phosphamide (Cytoxan)	123
Avastin	123
Taxol	123
Herceptin	123
Carboplatin	123
Taxotere	123
Oxaliplatin	123
Dilantin	123
Corticosteroids	123
Decadron	123
IVIG	123
Epogen / neupogen	123
Biotheraputic agents (Rituxan)	123

CARE OF THE PATIENT 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 *

Pre & post Bone Marrow Transplant (BMT)	123
BMT patient care	123
Patient & donor education	123
Peripheral blood stem cells	123
Solid tumors	123
Hematologic disorders	123
Autologous BMT	123
Allogeneic BMT	123
BMT complications	123
Infection	123
Graft rejection	123
GVHD Graft- Versus- Host Disease	123

CARE OF ONCOLOGY ADVERSE EFFECTS 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 *

Nausea / vomiting / diarrhea	123
Stomatitis	123
Neuropathy	123
Neutropenia	123
Thrombo- cytopenia	123
Nutritional needs	123
Fever	123
Infection	123
Septic shock	123

CARDIOVASCULAR COMPROMISE:

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 *

Cardiac dysrhythmias	123
Superior vena cava syndrome	123
Cardiac tamponade	123
Carotid rupture	123
Lymphedema	123

RESPIRATORY COMPROMISE:

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 *

Pneumonia	123
Atelectasis	123
Pneumothorax	123
Pleural effusion	123
Pulmonary embolism	123
Respiratory distress	123

GI/GU COMPROMISE:

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 *

Bowel obstruction	123
Renal failure	123
Pancreatitis	123
GI bleed	123

HEMATOLOGIC COMPROMISE:

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 *

DIC (Disseminated Intravascular Coagulopathy)	123
Hemorrhage	123

FLUID & ELECTROLYTES COMPROMISE:

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 *

Electrolyte imbalances	123
Hypercalcemia	123
Hypovolemia	123

SKIN & MUSCLE:

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 *

Stress fractures	123
Spinal Cord Compression (SCC)	123

CARE OF PATIENTS RECEIVING 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 *

Radiation therapy	123
External radiotherapy	123
Total body irradiation	123
Intraoperative Radiation Therapy (IORT) & implants	123
Brachytherapy	123
Radiation safety procedures	123

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
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

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. *