Emergency Room 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:

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
HIPAA123
Patient/family teaching123
Restrictive devices (restraints)123
Lift/transfer devices123
Specialty beds123
End of life care/palliative care123
Post mortem care123
Automated Medication Dispensing System, Pyxis, Omnicell, or other123
Bar coding for medication administration123
Triage123
Organ donor protocols123
Consent for treatment of a minor123
Procedure for a patient signing out AMA123
Knowledge of cobra criteria/transfer patients123
Disaster protocols123
National Patient Safety Goals123
Accurate patient identification123
Effective communication123
Interpretation & communication of lab values123
Medication administration123
Labeling123
Anticoagulation therapy123
Medication reconciliation123
Monitoring conscious sedation123
Pain assessment & management123
Infection control123
Universal precautions123
Isolation123
Minimize risk for falls123
Awareness of HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems)123
Prevention of pressure ulcers123
Wound care123
Suture tray set up123
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 dysrythmias123
Use of rapid response teams123
Cardiac arrest/CPR123
Code cart set up and shift checks123
O2 therapy & delivery123
Pulse oximetry123
Use of doppler123
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 IVs123
Blood draw: venous123
Central line care123
Blood draw: central line123
Care & management of ports123
Care & management of PICC /Groshong / Hickman123
Administration of blood / blood products123
Diabetes mellitus123
Blood Glucose Monitoring (BGM)123
Insulin administration123
TRAUMA 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 *
Trauma score123
Critical transports123
Air transport (helicopter or jet)123
Other transport experience123
Level 1 trauma123
Level 2 trauma123
Level 1 infuser123
Open chest massage123
Peritoneal lavage123
Hypovolemic shock123
H+H / stat lab test machine123
Post drowning123
Auto transfuser / warmer123
BURN 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 *
First degree123
Second degree123
Third degree123
Electrocution123
Hazardous material exposure / contamination123
Calculation of total Body Surface Area (BSA)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 *
Pulmonary edema123
C.O.P.D.123
Pulmonary emboli123
Near drowning123
Asthma123
Nebulizer123
Pneumonia123
ABG interpretation123
VASCULAR ACCESS 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 intraosseous needle insertion123
Assisting with a cut-down123
Assist with central line insertion123
Assist with arterial line insertion123
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 *
Acute MI123
Unstable angina123
Aneurysm (thoracic or abdominal)123
CHF123
Cardioversion123
Defibrillation123
Assist with insertion of a temporary pacemaker123
Application of an external pacemaker123
Cardiogenic shock123
NEUROLOGICAL 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 *
Neuro assessment / monitoring123
Use of Glasgow Coma Scale123
Traumatic Brain Injury (TBI)123
Acute T.I.A. / C.V.A.123
Acute spinal injury123
Migraine headache123
Seizure precautions / status epilepticus123
Assist with lumbar puncture123
Transport of a patient with spinal cord injuries/cervical spine precautions123
Observing for increased intracranial pressure123
GASTROINTESTINAL EXPERIENCE - 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 *
GI and GU Bleed123
Abdominal pain123
NGT insertion123
G-tube123
J-tube123
Bowel obstruction123
Acute pancreatitis123
Testicular torsion123
OBSTETRICS/GYNECOLOGY 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 pelvic exams / obtaining cultures123
Spontaneous abortion / hemorrhage123
Ectopic pregnancy123
Emergency delivery123
Placenta previa123
Preeclampsia / eclampsia123
Doppler FHT (Fetal Heart Tones)123
PEDIATRICS 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 arrest / resuscitation123
Use of Broslow resuscitation system123
Overdose / poison ingestion123
Child abuse123
Sepsis management123
Sickle cell anemia123
Peds IV periph starts123
Pediatric assessment/VS123
RENAL 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 *
Acute renal failure123
Chronic renal failure123
Peritoneal dialysis123
Fluid management / electrolyte replacement123
Renal calculi123
Foley cath / straight cath / clean cath urine123
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 *
Set up for cast application123
Set up for OCL splinting123
Assist with closed fracture / dislocation reductions123
Instruction of application of orthopedic appliances123
Assess extremity vascular circulation123
PSYCHIATRIC 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 *
Drug/ETOH withdrawal123
Care of overdose patient / gastric lavage123
Care of a suicidal patient123
Crisis intervention / management & assaultive behavior123
Sexual assault123
Rape kit123
Reporting procedures for acts of violence123
ENVIRONMENT 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 *
Hypothermia123
Heat stroke / exhaustion123
Human / animal bite123
Snake bite123
Anaphylaxis123
EENT DISORDERS 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 *
Set up for fluorescein / woods lamp123
Use of Morgan Lens / eye irrigation123
Ear irrigations / FB removal123
Assist with nasal packing123
Visual acuity123
Epiglottitis123
Nose bleed / packing123
Removal of nasal FB123
EMERGENCY MEDICATIONS 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 *
Emergency ACLS medication prepare & administer123
Tridil / nitroglycerin123
Sodium bicarb123
Heparin123
Dilantin / cerebrex123
Narcan123
Decadron123
Mannitol123
Solumedrol123
Phenobarbital123
Fibrinolytics / IIb IIIa inhibitor123
Nipride / cardene123
Inotropics (i.e. digoxin, dopamine, epinephrine)123
Rapid sequence intubation protocol & meds123
Diprivan123
Cardizem123
Vasopressin123
Romazicon123
Levophed123
Insulin / insulin GTT123
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: *