PACU 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 *
Advanced directives123
Awareness of HCAHPS123
Patient / family teaching123
Lift / transfer devices123
Specialty beds123
Restrictive devices (restraints)123
End of life care / palliative 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
Effective communication123
Interpretation & communication of lab values123
Medication administration123
Labeling (medications & specimens)123
Medication reconciliation123
Anticoagulation therapy123
Pain assessment & management123
Monitoring conscious sedation123
Infection control123
Universal precautions123
Isolation123
Minimize risk for falls123
Prevention of pressure ulcers123
Universal protocol (site / side verification)123
Normothermia123
Beat blocker (preop)123
Anesthesia: General Knowledge Experience123
Moderate sedation / protocols & procedures123
Local anesthetics123
Regional blocks (intrathecal / epidural / spinal)123
General anesthesia (IV anesthetic agents / inhalation anesthesia agents)123
Administer & monitor paralytic agents123
Administer & monitor reversal agents123
Assessment of dermatomes123
Neuromuscular blocking agents (depolarizing, non- depolarizing, reversal agents)123
Benzodiazepines / reversal123
Opioids / reversal123
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 *
Assessment of breath sounds / rate / effort123
AIRWAY MANAGEMENT, CARE & MAINTENANCE:

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 *
Head positioning to ensure airway patency123
Oral / NT airway123
Laryngeal Mask Airway (LMA)123
Endotracheal tube123
Tracheostomy123
Use of ambu bag123
O2 therapy (NC / mask)123
Use of CO2 monitoring devices123
SVO2 monitoring123
Oral / NT suctioning123
Assisting with intubation123
Assisting with extubation123
Measuring tidal volume123
Arterial blood gas interpretation / analysis123
Obtaining ABG blood sample (art line, arterial puncture)123
Pulse oximetry123
Mechanical ventilation123
Pleural chest tubes123
POSTOPERATIVE CARE (RESPIRATORY):

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 *
Tracheostomy123
Laryngeal procedures / laryngectomy123
Lung transplant123
Video- assisted thoracoscopic surgery (VATS)123
Radical neck dissection123
Penetrating/open chest trauma123
Sinus surgery123
Adeno- tonsillectomy (T&A)123
Thoracotomy / lobectomy / pneumonectomy123
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 *
Cardiovascular assessment123
Interpretation of arrhythmias123
Performing 12 lead EKG's123
Care of patient with VAD (ventricular assist device)123
SET UP & INTERPRETATION 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 *
Hemodynamic monitoring (CVC / aline / PA catheter)123
External / temporary pacemaker123
Cardiac arrest / CPR123
Cardioversion / defibrillation123
POSTOPERATIVE CARE (CARDIOVASCULAR):

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 *
Permanent pacemaker / AICD insertion123
Vascular bypass / grafting123
Embolectomy / thrombectomy123
Abdominal aortic aneurysm (AAA) repair123
Thoracic aortic aneurysm repair123
Endoluminal stenting123
Vena cava filter123
Postoperative myocardial infarction123
NEUROLOGY 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 *
Baseline neurological assessment123
Glasgow coma scale123
Cranial nerve assessment123
Seizure precautions123
Cervical spine precautions123
POSTOPERATIVE CARE (NEURO SURGERY):

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 *
Craniotomy123
Burr holes123
Aneurysm clipping / coiling123
Evacuation of hematoma (subdural, epidural)123
Carotid endarterectomy123
Intracranial tumor excision123
Spinal tumor excision123
Laminectomy123
Spinal fusion123
Ventricular peritoneal shunt123
Tether Cords123
SET UP & CARE OF INTRACRANIAL/CEREBRAL PERFUSION PRESSURE MONITORING (ICP/CPP) VIA:

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 *
Ventriculostomy123
Subarachnoid screw / bolt123
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 *
Gastric tubes (NG/G)123
Jejunostomy tube123
Assessment & management of wound drains (self- suction / irrigation / drainage)123
Endoscopic procedures123
POSTOPERATIVE CARE (GI):

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 *
Laparoscopic123
Exploratory laparotomy123
Nissen fundoplication123
Esophageal procedures123
Abdominal trauma123
Gastroplasty / bypass (bariatric surgery)123
Gastrectomy (partial / complete)123
Whipple procedure123
Pyloroplasty123
Vagotomy123
Appendectomy123
Bowel / colon resection123
Colostomy / ileostomy123
Hernia repair123
ENDOCRINE 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 *
Transphenoidal hypophysectomy123
Adrenalectomy123
Thyroidectomy123
Parathyroidectomy123
INTRAVENOUS MANAGEMENT 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 peripheral IV's123
Care of patient with peripherally- inserted central catheter (PICC) Groshong / Hickman123
Administration of blood / blood products123
Autotransfusion of blood / blood products123
Administration of volume expanders (albumin, dextran, etc)123
MISCELLANEOUS 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 *
Aldrette scoring123
Experience with level 1 trauma patients123
Management of patient with malignant hyperthermia123
Anaphylaxis123
Care of patients with latex allergies123
Phlebotomy: peripheral123
Drawing blood from invasive lines123
PHARMACOLOGY - USE & ADMINISTRATION 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 *
H2 receptor antagonists: (Zantac, Pepcid, Carafate)123
Antiemetics (Zofran, Phenergan, Reglan)123
Steroids: (decadron, Solu-Medrol)123
Emergency meds (ACLS protocols)123
Anticonvulsants: (Dilantin, phenobarbital)123
Inotropes / vasoactive drips123
Calcium channel blockers: (Cardizem)123
Antihypertensives: (nipride)123
Antiarrhythimics: (amiodarone, lidocaine, procan)123
Diuretics: (Lasix, edecrin sodium, Bumex)123
Fibrinolytics123
Glycoprotein IIb / IIIa receptor inhibitors: (Integrilin, Aggrastat)123
Nebulizer treatments: (Ventolin, Atrovent, racemic, ephinephrine)123
OTHER 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 *
Post orthopedic / musculoskeletal procedures123
Post ENT procedures123
Post breast procedures (mastectomy / lumpectomy)123
Post GYN procedures123
Post prostate procedures123
Post wound care (I&D / debridement)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: *