PICU 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 *
Setting - Children’s hospital123
Setting - University healthcare facility123
Setting - Community hospital123
Family teaching123
Assessment of normal growth & development123
Recognize/report signs of child abuse/neglect123
Consents123
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
Awareness of HCAHPS123
Effective communication123
Interpretation & communication of lab values123
Medication administration123
Pediatric dosage calculations123
Delivery methods: eye/ear/IM/IV/SQ123
Medication reconciliation123
Labeling (medications & specimens)123
Anticoagulation therapy123
Pain assessment & management123
Steroids (inhaled/IV/PO)123
Monitoring conscious sedation123
Infection control123
Universal precautions123
Isolation123
Minimize risk falls123
Prevention of pressure ulcers123
IV THERAPY 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 *
Starting & maintaining peripheral IVs123
Blood draw: venous123
Central line care (includes PICC/Broviac/Groshong/Hickman)123
Blood draw: central line123
Care & management of ports123
Care & management of nonvascular devices (epidural, intrathecal)123
TPN & lipids123
Administration of blood & blood products123
Infusion pumps123
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 CV assessment123
ASSIST WITH INSERTION & MANAGEMENT OF:

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 *
Arterial line123
CVC (central venous catheter)123
Swanz-Ganz123
Hemodynamic monitoring123
Extra Corporeal Membrane Oxygenation (ECMO)123
Use of doppler123
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 *
Administration of PALS protocols & medications123
Broslow system123
Interpretation & treatment of dysrythmias123
Rapid response team member123
Use of rapid response teams123
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 *
Bacterial endocarditis123
DIC123
Post cardiac cath123
Cardiac transplant123
Cardiogenic shock123
Cardiomyopathy123
Congenital heart disease/defects123
Hypovolemic shock123
Myocarditis/pericarditis123
Permanent pacemaker123
Temporary pacemaker123
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
Platelet inhibitors (Aggrastat/Integrilin/ReoPro)123
Anti-rejection immunosuppressants123
Vasoactive agents123
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 assessment (rate & work of breathing)123
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 *
Metered dose inhaler123
Nebulized medications123
Assist with & manage intubation123
Tracheostomy care123
Assist with & maintain chest tube123
Obtain & interpret Arterial blood gas123
O2 therapy (NC/oxyhood/tent)123
Thoracentisis123
Ventilator management123
Use of paralytics123
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 *
Acute Respiratory Distress Syndrome (ARDS)123
Respiratory Syncytial Virus (RSV)123
Chronic respiratory disease123
Croup123
Epiglottits123
Reactive Airway Disease (RAD)123
Status asthmaticus123
Pulmonary hypertension123
Pneumonia123
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 *
Bronchodilators123
Racemic epinephrine123
Neurological Experience123
Neuro assessment123
Glascow coma scale123
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 *
Assisting with LP123
Intracranial pressure (ICP) insertion & 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 *
Muscular degenerative diseases123
Meningitis123
Coma123
Brain death/organ procurement123
Encephalitis/encephalopathy123
External ventricular drains123
VP shunts/reservoirs123
TBI (Traumatic Brain Injury)123
Status epilepticus123
Spinal cord injury123
Post nuero surgery123
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 *
Anticonvulsants123
Mannitol123
Psychostimulants (Ritalin/Adderall)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 *
Orthopedic assessment123
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 *
Traction123
Cervical traction123
Pinned fractures123
Post vertebral surgery123
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
Nutritional assessment123
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 *
Abdominal decompression (NG, sump tubes, intermittent & continuous suction)123
Colostomy/ileostomy123
Placement of feeding tubes (NG)123
G-tube/J-tube123
Gastrointestinal - cont. Experience123
FEEDINGS:

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 breastfeeding123
Breastmilk handling & storage123
Bottle123
Gavage123
Use of feeding pumps123
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 *
Abdominal trauma; bleeding123
Ascites123
Surgical abdomen123
Severe dehydration/gastroenteritis123
Hepatic failure123
Hepatitis123
Hyperbilirubinemia123
Necrotizing Entercolitios (NEC)123
Ruptured spleen123
GI bleeding123
GI organ transplants123
RENAL/GENITOURINARY 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 taps123
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 *
Acute renal failure123
Hemodialysis123
Peritoneal dialysis123
Hemolytic Uremic Syndrome (HUS)123
Post renal transplant123
Nephritis123
Ileal conduit123
SKIN 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 *
Skin assessment123
Surgical wound healing123
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 *
Burns123
Traumatic wounds123
Vacuum Assisted Device (VAC)123
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 *
Administration of chemotherapy123
Monitoring of chemotherapy (does not initiate)123
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 *
Acute anemia123
Acute tumor lysis syndrome123
Bone marrow transplant123
Leukemia123
Malignant tumors123
Neutropenia123
Radiation implant123
Sickle cell anemia123
Hemophilia123
Graft verses host disease123
Inpatient hospice123
AUTOIMMUNE DISEASES 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 *
Addison’s disease123
Cushing’s disease123
Celiac disease/gluten intolerance123
Grave’s disease123
Hypothyroidism123
Lupus123
INFECTIOUS DISEASES 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 *
Usual child diseases (mumps/measles/chicken pox)123
CMV/HIV/AIDS123
Tuberculosis123
Septic shock123
Fever management123
MEDICATION/ADMINISTRATION:

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 *
Antiinfectives123
MISCELLANEOUS 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 *
Trauma123
Craniofacial reconstruction123
ENT surgery123
Ingestions/overdose123
Suicidal ideation/attempts123
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-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: *