Emergency Department – Professional Nursing Service

Email*

Phone*

Years Experience in Clinical Specialty:*

Directions for Completing Skills Checklist

The following is a list of equipment and/or procedures performed in rendering care to patients. Please indicate the level of experience/proficiency with each and, where applicable, the types of equipment and/or systems with which you are familiar.

Use the following KEY as a guideline:
A) Theory Only/No Experience - Didactic instruction only, no hands-on experience.
B) Limited Experience - Knows procedure/has used equipment, but has done so infrequently or not within the last six months.
C) Moderate Experience - Able to demonstrate equipment/procedure, performs the task/skill independently with only resource assistance needed.
D) Proficient/Competent - Able to demonstrate/perform the task/skill proficiently without any assistance and can instruct/teach.

Cardiovascular

1. Assessment:*

	A	B	C	D
Normal Heart Tones (i.e.: S1, S2)
Abnormal Heart Tones (i.e.: murmur, gallop, friction rub)
Blood Pressure (non-invasive)
Pulses/Circulation via palpation
Pulses/Circulation via Doppler
12-lead EKG interpretation
EKG Changes for MI
Rhythm interpretation

2. Provision of care for:*

3. Assist with and set up: Proficiency Frequency*

PULMONARY

1. Assessment:*

	A	B	C	D
Auscultate breath sounds
Identify adventitious lung sounds
Auscultate for confirmation of ET Tube placement
Application of BiPAP
Application of CPAP
Application of Oximetry
Interpretation of Oximetry Values

2. Provision of Care for:*

3. Equipment & procedures:*

	A	B	C	D
Airway management devices/suctioning
Assist with extubation
Assist with intubation
Assist with rapid sequence intubation
Assist with thoracentesis
Assist with chest tube insertion
Care of the patient on a ventilator
Care of the patient with a chest tube
Obtaining arterial blood gases
O2 therapy & medication delivery systems
Pulse oximetry
Trouble shooting high and low pressure vent alarms

GASTROENTEROLOGY

1. Assessment:*

2. Provision of Care for:*

3. Procedures:*

ENDOCRINE

1. Assessment:*

2. Provision of Care for:*

3. Procedures:*

4. Equipment:*

NEUROLOGICAL

1. Assessment:*

2. Provision of Care:*

3. Assist with:*

ORTHOPEDICS

1. Assessment:*

2. Provision of care for:*

RENAL/GENITOURINARY

1. Assessment:*

2. Provision of Care:*

3. Procedures:*

MAXILLOFACIAL/OCULAR

1. Assessment:*

2. Equipment & procedures:*

TRAUMA/SHOCK

1. Assessment:*

2. Provision of care for:*

	A	B	C	D
Bites, animal
Bites, human
Bites, venomous snake
Bites, venomous spider
Burns, Rule of nines
Burns, First degree
Burns, Second degree
Burns, Third degree
Dehydration
Electrocution
Gunshot/stab wound
Hazardous material exposure
Heat exhaustion/stroke
Hypothermia
Major trauma
Minor trauma
Radiation exposure
Anaphylactic Shock
Cardiogenic Shock
Hypovolemic Shock
Neurogenic Shock
Septic Shock
Traumatic amputation

3. Equipment & procedures:*

INFECTIOUS DISEASES

1. Provision of Care:*

2. Equipment & procedures*

WOUND MANAGEMENT/SURGICAL

1. Assessment of:*

2. Equipment & procedures*

PAIN MANAGEMENT

1. Assessment of:*

2. Provision of Care*

OBSTETRICS/GYNECOLOGY

1. Provision of care for:*

2. Equipment & procedures:*

3. Assist with:*

PEDIATRICS

1. Provision of care for:*

2. Procedures:*

PHLEBOTOMY/IV THERAPY/INVASIVE PROCEDURES

1. Provision of care for:*

2. Equipment & procedures*

3. Labs:*

PATIENT ADVOCACY

1.*

	A	B	C	D
Provide care for end-of-life decisions that families face in ER such as withdrawal of life support
Adhere to legal procedures regarding notification of organ donation provider
Demonstrate Spiritual and Cultural Considerations for the ER patient
Demonstrate effective coping skills in caring for the ER patient

PATIENT EDUCATION

1.*

	A	B	C	D
Provides education to patient regarding medications and disease process
Provides education to patient regarding follow up care as indicated
Provides education and patient preparation for invasive procedures

ED PHARMACOLOGY

1. Medications*

	A	B	C	D
Adenosine (Adenocard)
Alupent (Metaproterenol)
Amiodarone (Cordarone)
Atropine
AquaMephyton (Vitamin K)
Charcoal
Digibind (Digoxin Immune Fab)
Digoxin (Lanoxin)
Dilantin (Phenytoin)
Diltiazem (Cardizem)
Dobutamine (Dobutrex)
Dopamine (Intropin)
Epinephrine (Adrenalin)
Fentanyl
Heparin Drip
Inderal (Propranolol)
Inocor (Amrinone)
Ipecac
Lasix (Furosemide)
Lidocaine
Metoprolol (Lopressor)
Mucomyst (acetylcysteine)
Neosynephrine
Nipride (Nitroprusside)
Nitroglycerin (Tridil)
Norepinephrine Bitartrate (Levophed)
Normodyne (Labetolol)
Phenobarbital
Procainamide (Pronestyl)
Sodium Bicarbonate
Succinylcholine
Thrombolytic Therapy
Valium (Diazepam)
Vecuronium
Verapamil (Calan, Isoptin, Verelan)

2. Provision of Care*

	A	B	C	D
Rights of medication administration
Perform mathematical calculations for accurate medication administration (dosage calculations, weight calculations, metric conversions)
Perform & manage IV dosage drip calculations (formulas for fluid rate calculations)
Verification of accurate IV Pump Delivery
Administer medications through various routes of delivery (PO, IM, IV, IO, ET, SQ, Intradermal, topical, rectal, etc.)
Assess for therapeutic response, expected outcomes
Manage adverse reactions

PROFESSIONAL PRACTICE

1. Professional Issues*

	A	B	C	D
Maintain privacy and dignity for each patient
Perform all nursing functions within the RN’s scope of practice.
Maintains nursing competencies/certifications required by facility/state
Utilizes EMR for accurate patient documentation

2. Interdisciplinary Communication*

	A	B	C	D
Communicate with patient using age and cultural appropriate methods
Collaborate with interdisciplinary teams for care of patient
Maintain patient confidentiality per HIPAA guidelines
Complies with Joint Commission, CMS, and other federal/state regulations and guidelines
Utilitizes SBAR communication

Age Specific:

Please indicate the frequency with which you provide care for each age group:*

Date*

	A	B	C	D
Acute MI
Abdominal Aortic Aneurysm
Angina
Cardiac Arrest
Congestive heart failure (CHF)
Myocardial contusion
Pericardial Effusion
Pericarditis
Cardiac tamponade

	A	B	C	D
Arterial line insertion
Central line insertion
PA catheter/Swan-Ganz insertion
Temporary Pacemaker insertion
Cardioversion
Pericardial Centesis

	A	B	C	D
Aspiration
COPD
Hemopneumothorax
Laryngospasm
Pneumonia
Pneumothorax
Pulmonary edema
Pulmonary embolism
Status Asthmaticus
Tension pneumothorax
Tuberculosis

	A	B	C	D
Abdominal trauma
Bowel obstruction
GI bleed
Liver failure
Esophageal Bleed
Splenic Rupture

	A	B	C	D
Insertion and maintenance of N/G Tube
Removal of N/G Tube
Saline lavage
N/G Tube to suction

	A	B	C	D
Bowel Sounds
Nutritional status
Proper N/G Tube placement

	A	B	C	D
S/S diabetic coma
S/S insulin reaction

	A	B	C	D
Diabetes mellitus
Diabetic ketoacidosis

	A	B	C	D
Fingerstick Blood Glucose
Implementation of Sliding Scale

Emergency Department Skills Checklist

Directions for Completing Skills Checklist

Cardiovascular

PULMONARY

GASTROENTEROLOGY

ENDOCRINE

NEUROLOGICAL

ORTHOPEDICS

RENAL/GENITOURINARY

MAXILLOFACIAL/OCULAR

TRAUMA/SHOCK

INFECTIOUS DISEASES

WOUND MANAGEMENT/SURGICAL

PAIN MANAGEMENT

OBSTETRICS/GYNECOLOGY

PEDIATRICS

PHLEBOTOMY/IV THERAPY/INVASIVE PROCEDURES

PATIENT ADVOCACY

PATIENT EDUCATION

ED PHARMACOLOGY

PROFESSIONAL PRACTICE

Age Specific: