Acute Rehab Skills Checklist – 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.

GENERAL SKILLS

1. General*

	A	B	C	D
Care of Patient in Restraints
Automated Med Dispensing Systems
Electronic Documentation
IV Pumps
Peripheral IV Insertion, Care and Maintenance
Access/Management of Implanted Ports
Access/Management of Central Lines (CVL, Hickman, Broviac, Groshong, etc.)
Cardiac Monitoring/Interpretation
PCA/Epidural pumps
Titration of drips
Administration of Blood/Blood Products
Knowledge of "Do Not Use Abbreviations"
Charge/supervisor experience
Knowledge of current Joint Commission National Patient Safety Goals
Knowledge/familiarity with HCAHPS scores

NEUROLOGIC

1. General*

	A	B	C	D
Pre/Post Neuro Surgery
Basal Skull Fracture
Closed Head Injuries
Coma
Delirium Tremens
Encephalitis
Meningitis
Spinal Cord Injuries
Seizures
Overdose
Stroke/TIA
Guilliane Barre Syndrome
Alzheimer's Disease
Externalized AV Shunt
Post Craniotomy

CARDIAC

1. GENERAL*

	A	B	C	D
Pre/Post Cardiac Surgery
Cardiac Transplant
Abdominal Aortic Aneurysm/Bypass
Angina
Cardiac Arrest
Cardiomyopathy
Femoral Poplitieal Bypass
Myocarditis
Post Angioplasty/Stent
Thrombophlebitis
CHF
Chest Pain
Post MI
Temporary pacemaker
Permanent pacemaker

ORTHOPEDIC

1. General*

RESPIRATORY

1. General*

	A	B	C	D
Insertion/ Monitoring NG Tubes
Assessment
Lung Transplant
Bronchoscopy
Lobectomy
Tracheostomy Tube
COPD
Asthma
Pneumonia
Pre/Post Thoracic Surgery
Chest Tubes
Tuberculosis
Pneumonectomy
Pulmonary Embolism
Thoracotomy
Pulmonary Edema
Pneumothorax
Laryngospasm

GASTROINTESTINAL

1. General*

	A	B	C	D
Application of Soft Limb Restraints
Bladder Biopsy
Cystoscopy
Post Abdominal Surgery
Liver Transplant
Pancreas Transplant
Ileostomy
Colostomy
Inflammatory Bowel Disease
Bowel Obstruction
Hepatitis
GI Bleeding
Liver Failure
Paralytic Ileus
Abdominal Trauma

RENAL/GU

1. General*

	A	B	C	D
Kidney Transplant
Insertion of Catheter (Straight and Foley)
Bladder Irrigations
Peritoneal Dialysis
Hemodialysis
A-V Fistula/Shunt Care
Suprapubic Catheter
Nephrostomy Tube
Nephrectomy
Urinary Tract Infection
Pyelonephritis
Renal Failure
Renal Transplant
TURP
Ileal Conduit
Renal Trauma
Renal Calculi

ENDOCRINE

1. General*

KNOWLEDGE AND USE OF

1. General*

WOUND/SKIN

1. General*

	A	B	C	D
Multiple Abdominal Wounds and Drains
Gunshot Wound
Stab Wound
Lacerations
Dressing Changes
Pressure Relief Mattresses
Decubitus Ulcers
Traumatic Wounds
Leg Ulcers
First Degree Burns
Second Degree Burns
Third Degree Burns

ADDITIONAL MEDICAL/SURGICAL SKILLS

1. General*

INFECTIOUS DISEASE

1. General*

MEDICATIONS

1. General*

	A	B	C	D
Administer IM and SQ Medications
Antibiotics
Antihypertensives
Anticoagulants
Anticonvulsants
Narcotics
Digoxin
Diuretics
Steroids
Diltiazem
Antiemetics
Antispasmotics
Oral Hypoglycemics
Inhalers
IV Conscious Sedation
Reversal Agents (Narcan, Romazicon)

Age Specific:

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

Date*

	A	B	C	D
Total Joint Replacement Procedures
Fractures
Rheumatic/Arthritic Disease
Spinal Fusion
Amputation
Traction Devices
Walking Assistants (i.e. Crutches, Walker, Cane)

	A	B	C	D
Prosthodontics -Restorative Dentistry
Mouth Biopsy
Myringotomy
Hyperthyroidism
Hypothyroidism
Thyroidectomy
Diabetes Mellitus
Diabetes Insipidus
Diabetic Ketoacidosis

	A	B	C	D
Reporting on Assigned Patients
Insulin
Single Type
Mixed Insulins
Insulin Infusion

	A	B	C	D
Hemovacs
Jackson-Pratt Drains
Penrose Drains
Surgical Wound Irrigations & Dressings

	A	B	C	D
HIV
MRSA
CRE
VRE
C. Difficile
Hepatitis
Influenza
Isolation Precautions

	A	B	C	D
Infant (Birth to 1 year)
Toddler (1-3 years)
Pre-school (3-6 years)
School Age (6-12 years)
Adolescent ( 12-18 years)
Young Adult ( 18-30 years)
Mature Adult (30-60 years)
Elderly (>60 years)