Medical/Surgical Skills Checklist

 +
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 *
Advanced directives123
Awareness of HCAHPS123
Patient/family teaching123
Computerized Documentation123
Restraints123
Lift/Transfer Devices123
Specialty Beds123
End of Life/Palliative Care123
Automated Medication Dispensing Systems (Pyxis, Omnicell)123
Bar Coding for medication administration123
National Patient Safety Goals123
Accurate Patient Identification123
Interpretation and communication of lab values123
Medication Administration 5 rights123
Labeling (specimens, labs)123
Medication Reconciliation123
Pain Assessment and management123
Infection Control123
Universal Precautions123
Isolation123
Minimize risk for falls123
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 EKG123
Interpretation of rhythm strips123
Treatment of dysrhythmias123
Rapid Response Teams123
Cardiac Arrest/ CPR123
Oxygen therapy and delivery123
Pulse oximetry123
Use of Doppler/pulse checks123
Automatic/manual Blood Pressure checks123
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 and maintaining peripheral Iv’s123
Blood Draw: venous123
Multi Lumen Central line care and dressing changes123
Blood Draw Central line123
IV Push123
Care & Management of Port a catheter123
Care & Management of PICC/ Groshong/Hickman123
TPN and Lipids123
Administration of blood/blood products123
Administration of Chemotherapy123
Monitoring Chemotherapy (does not initiate)123
IV drip calculations123
IV fluids123
Management of IV Infusion Pumps (Alaris, Baxter)123
Management of elastomeric infusion123
Management of intrathecal pumps123
CARDIAC EXPERIENCE & CARE OF A 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 *
Auscultation of Irregular of Heart Sounds123
Angina123
Anticoagulation therapy123
arrhythmias123
Abdominal Aortic Aneurysm123
Carotid Endarterectomy123
Congestive heart Failure123
Cardiomyopathy123
Coagulation123
Endocarditis123
Femoral Popliteal Bypass123
Hypertension123
Pulse oximetry123
Pericarditis123
Peripheral Edema123
Pulse/Circulation checks123
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 *
Antihypertensive medications (Beta Blockers, Antiarrhythmics, Ace Inhibitors, Calcium Channel Blockers)123
Inotropic: (digoxin)123
Antiarrhythmics (Pacerone, Rythmol)123
Beta Blockers (Sotalol, metroprolol)123
Ace Inhibitors (Catopril, Ramipril, Vasotec)123
Antianginals (isordil/nitrates)123
Antilipemic: statins123
Anticoagulation medications (heparin, Coumadin,123
Diuretics123
PULMONARY EXPERIENCE & CARE OF A 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 *
Assessment of abnormal breath sounds123
Aspiration123
Asthma123
Emphysema123
Airway management/suctioning (Oral, trach)123
ABG’s recognition and treatment of abnormal values123
Acute Pneumonia123
Pneumothorax123
Chest Tube care and management123
COPD123
Incentive spirometer123
Pre/Post Thoracic Surgery123
Lobectomy123
Thoracentesis123
Lung transplant123
Oxygen administration123
Ambu bag123
Nasal Canula123
Nebulizer treatments123
Non-rebreather123
Trach collar123
Venti mask123
TB123
Tracheostomy Care123
Bronchoscopy123
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 *
Antihistamines123
Bronchodilators123
Expectorants and anti-tussins123
inhalers123
Steroids123
NEUROLOGY EXPERIENCE & CARE OF A 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 *
Level of Consciousness123
Comprehensive neuro assessment123
Glasgow Coma Scale123
CVA/ TIA123
Intercranial Hemorrhage & hematoma123
Reflex motor deficits123
Visual communication deficit123
CNS infection123
Meningitis123
Encephalitis123
Alzheimer’s Disease123
Delirium Tremens123
Overdose123
Neuromuscular disease123
Multiple Sclerosis123
Metastatic Tumor123
Tumor resection123
Pre/Post Neuro Surgery123
Laminectomy123
Assist Lumbar Puncture123
Halo Traction123
Seizure Disorder123
Spinal Cord Injury123
Traumatic Brain Injury123
MEDICATION ADMINISTRATION 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 *
Anticonvulsants (Dilantin/ Phenobarbital)123
Antidepressants123
Antiparkinson’s (Cogentin/Levodopa/Sinemet)123
Corticosteroids123
GASTROINTESTINAL EXPERIENCE & CARE OF A 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 *
Assessment of Bowel Sounds123
Nutritional Status123
Interpretation of labs and electrolyte imbalance123
Bowel Obstruction123
EGD123
Insertion and management of NG tube123
Bowel Prep/Colonoscopy123
ERPC123
Nausea/vomiting123
Constipation/impaction123
diarrhea123
Insertion and management of small-bore feeding tubes (Dubhoff, Keofeed)123
Management and care of PEG tub/feed123
Management and care of gastrostomy tube/feed123
Management and care of jejunostomy tube/feed123
Gravity/bolus feedings123
Kangaroo pump123
Management and care of ostomy123
Abdominal wounds123
Pre/Post abdominal surgery123
Paralytic Ileus123
Management of post-surgical drains123
Gastric Bypass123
Peritonitis123
GI bleed (upper/lower)123
Hepatitis123
Inflammatory Bowel Disease123
Liver Failure123
Liver Cancer123
Paracentesis123
Pancreatic Cancer123
MEDICATION ADMINISTRATION 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 *
Antiemetics123
Antispasmodics123
Anticholinergics123
Laxatives123
GENITOURINARY/RENAL EXPERIENCE & CARE OF A 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 *
Insertion and maintenance of urethral catheter123
Care of Nephrostomy tube123
Care of Suprapubic catheter123
Fluid and Electrolyte disturbance123
GU irrigation123
Kidney Failure (acute/Chronic)123
Measurement of Intake and Output Monitoring123
Urine Retention123
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 *
Pyelonephritis/UTI123
BPH123
TURP123
Prostate Cancer123
Nephrectomy123
Ileoconduit123
Renal Surgery123
Hemodialysis123
Peritoneal Dialysis123
Shunts/Fistulas123
Obstructions123
Renal Trauma123
Testicular Torsion123
GYNECOLOGICAL EXPERIENCE & CARE OF A 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 *
Assess Range of Motion123
Assessment of color, warmth, movement, sensation123
Amputation123
Cast Care123
Fractures123
Splints123
Traction123
Trauma123
Strains/Sprain123
immobilization123
METABOLIC/ENDOCRINE EXPERIENCE & CARE OF A 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 *
Diabetes123
Blood Glucose Monitoring123
Cushing’s Syndrome123
Thyroid Disease123
Post Thyroidectomy Care123
SKIN/INTEGUMENTARY & CARE OF A 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 *
Skin assessment123
Skin Breakdown monitoring123
Staged Pressure Ulcers123
Stasis Ulcers123
Sterile dressing changes123
Wound Vac maintenance and dressing changes123
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: *