Telemetry/Monitor Tech Skills Checklist

Requested by:

Requested by email:

Today's Date: * +

First Name: *

Last Name: *

Mobile Phone Number: *

Email Address: *

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PLEASE RATE YOUR LEVEL OF SKILLS & FREQUENCY OF PERFORMANCE FOR THE FOLLOWING PROCEDURES/SKILLS:

Proficiency

I have never done the stated task.
I have performed the task/skill infrequently; I require more experience/practice to feel comfortable and proficient.
I have performed the task/skill several times and feel moderately comfortable functioning independently but would require a resource person nearby.
I have performed the task/skill frequently and would feel very comfortable and proficient performing it without supervision or practice.

Frequency

GENERAL RESPONSIBILITIES *

	SKILL		FREQUENCY
Receive report from previous shift technician
Ensure a contact list of nurses, their direct contact number, and the charge nurse for each patient on monitor is received from each unit
Ensure daily logs for issuing boxes are up to date
Monitor rhythms continually
Record, interpret, and measure HR, PR interval, QRS interval, QT interval every 4 hours and with changes from 6-second strip
Notify nurse for any change in rhythm
Correctly document recorded strip and alarm notifications
Print all recorded strips at the end of each shift and placing in appropriate logbook
Complete shift logs for alarm notifications

INITIATION OF CARE *

	SKILL		FREQUENCY
Assign box to patient and gives box to unit representative
Obtain information from unit representative via patient sticker: patient name, MRN, Diagnosis, Room no., nurse contact information
Record assigned box in the daily log with a patient identification sticker
Confer with nurse that patient is on the assigned box correctly and give preliminary rhythm report
Ensure proper location for lead placement using the standard 5 Lead system
Ensure proper location for lead placement using the EASI system

DISCONTINUATION OF CARE *

	SKILL		FREQUENCY
Verify patient's discharge or discontinuation order
Remove batteries
Clean box, leads, and pulse ox cord (if applicable) with purple or orange top wipes
Correctly print and document recorded strips
Interpret strips for the shift
Print strips for each shift
Discontinue patient from the box/system
Troubleshoot for boxes and central monitoring station

STRIPS INTERPRETATION AND EVALUATION *

ATRIAL RHYTHMS *

	SKILL		FREQUENCY
Atrial Flutter
Atrial Fibrillation
Supraventricular Tachycardia
Premature Atrial Complexes

VENTRICULAR RHYTHMS *

	SKILL		FREQUENCY
Idioventricular rhythm
Accelerated idioventricular rhythm
Agonal rhythm
Ventricular Tachycardia
Ventricular Fibrillation
Torsades de Pointes
Pulseless Electrical Activity (PEA)
Asystole - Cardiac Standstill

ELECTRONIC DOCUMENTATION *

AGE SPECIFIC COMPETENCIES *

	SKILL		FREQUENCY
Newborn/Neonate (birth to 30 days)
Infant (31 days to 12 months)
Toddler (1-3 years)
Preschooler (3-5 years)
School age children (5-12 years)
Adolescents (12-18 years)
Young adults (18-39 years)
Middle adults (39-64 years)
Older adults (64-79 years)
Elderly adults (80+ years)

Attestation

ATTESTATION: *

I certify that the information provided 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. *