Labor and Delivery

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.

Maternal Factors

1. General*

2. Recognize patients with signs/symptoms of:*

3. Implement patient safety interventions for:*

4. Perform comprehensive maternal nursing assessments:*

5. Knowledge of appropriate interventions when abnormal signs and symptoms are present:*

6. Recognize the need for and communicate results of expected obstetrical diagnostic procedures:*

7. Assess and care for common acute illnesses:*

8. Perform/complete:*

	A	B	C	D
Admission, transfer, and discharge process
Advanced directives
Education to patient/family
Flu screenings
Follow up care
Hand-off communication
Immunization screenings
Medication reconciliation
Multiple referral screenings
Obtains blood specimens from peripherally inserted or central access device
Social service referral, as appropriate
Suicide risks

9. Perform, evaluate and record the results of diagnostic testing and intervene as needed:*

Fetal Assessment

1. Knowledge of how to perform routine bedside nursing procedures:*

2. Operate and troubleshoot equipment common to the Labor & Delivery area*

	A	B	C	D

3. Interpret fetal heart strips:*

4. Auscultate Fetal Heart Rate:*

5. Assess and:*

6. Identify uterine contraction patterns:*

7. Recognize signs and symptoms of non-reassuring fetal heart rate pattern:*

8. Appropriate interventions when abnormal signs and symptoms are present*

	A	B	C	D

1. General*

	A	B	C	D
Verify informed consent and patient’s understanding of planned use of inductive/augmentive medications
Perform facility-specific diagnostic testing to confirm ruptured membrane
Assist with patient positioning during epidural placement
Adhere to HIPAA laws specific to the Labor and Delivery specialty setting
Adhere to regulations(state and federal)applicable the Labor and Delivery specialty setting
Determine cervical dilatation, effacement, station, and presentation by use of landmarks, assessment data, and other information presented by the patient
Implement problem solving and conflict resolution techniques
Interpret multiple types of charts and graphs used during routine care of the Labor and Delivery patient and neonates
Independently and collaboratively solve complex problems seen in Labor and Delivery

2. Perform routine bedside nursing procedures:*

	A	B	C	D
Assess or perform Leopold's maneuver as indicated
Assist with Rupture of Membranes
Amnioinfusion
Foley catheter
Insertion of peripheral IV catheter
Perform Nasogastric tube insertion
Perform oral or nasopharyngeal suctioning
Performs set up and ongoing maintenance of gastric irrigation,lavage and suction

3. Application of:*

4. Ability to operate and troubleshoot equipment common to the Labor & Delivery area:*

5. Ability to perform Basic Life Support measures:*

6. Follow and implement facility policy and procedure for blood product administration:*

	A	B	C	D
Timeframe for administration (beginning with pick up from lab)
Verifying information with another nurse
Frequency of vital sign assessment
Signs and symptoms of transfusion reaction
Interventions used during and after transfusion reaction

7. Ability to:*

	A	B	C	D
Coach patient through each stage of labor
Function as the circulating OR nurse during a Cesarean delivery
Function as the circulating OR nurse during other operative procedures
Identify patient’s current stage of labor
Perform a sterile digital vaginal exam
Perform a sterile vaginal exam with speculum

8. Perform tasks during procedures such as:*

9. Implements:*

	A	B	C	D
Biohazardous waste disposal(proper)
Facility read back policies for verbal and/or telephone order from a Physician or Licensed Independent Provider
Isolation precautions
Personal protective equipment
Universal precautions

10. Use different types of electronic devices:*

11. Proper collection, handling, and labeling of specimens:*

12. Identify and interpret normal and abnormal laboratory values/results:*

13. Implements interventions (non-pharmacologic) used as adjunct for pain management:*

14. Performs and documents multiple tasks associated with epidural catheters:*

	A	B	C	D
Assess Drug infusion rates associated with epidural
Assess Patient response
Determine equipment required when epidural is in place i.e.: pump
Frequent assessment of catheter & insertion site
Removal of epidural catheter when indicated

16. Assess Stage 3 Labor:*

17. Assess for Stage 4 of labor and assist client in recovery after delivery of placenta:*

	A	B	C	D
Assess fundal height and position
Measure Quantitative Blood Loss (QBL), including weight to volume conversion, 1gm=1ml
Assess perineum for discharge, clots, and tears, hematomas, swelling, or bruising
Bladder status for distention
Lochia and amount of bleeding
Promote and Assist with Infant Bonding

Obstetric Complications

1. Implement facility specific obstetrical emergency response:*

2. Recognize signs/symptoms for high risk conditions and medical emergencies:*

	A	B	C	D
Abruption
Amniotic fluid disorders
Diabetes
DIC
Eclampsia
Fetal demise
High-Risk Delivery
Malpresentation
Multiple gestation
Non-reassuring fetal heart rate patterns
Placenta previa
Post partum hemorrhage
Pre-eclampsia
Preterm labor
Prolapsed cord
Teen pregnancy
Uterine prolapse
Vaginal Birth After Cesearan (VBAC)

3. Perform:*

	A	B	C	D
Effective communication techniques to ensure calm, competent care under a variety of conditions, including emergency and stressful events
Post-mortem care for mother, fetus and/or infant per facility protocol
Tasks/procedures/interventions necessary to deliver newborn without the presence of a Physician/Licensed Independent

Postpartum Care

1. Perform:*

	A	B	C	D
Assessment of wound/incision site for intactness, bleeding or trauma following removal of wound closure devices i.e.: sutures, staples, steri-strips
Dressing changes
Proper collection, handling, and labeling of wound drainage

2. Assess and care for post-surgical obstetric patients:*

Newborn Care

1. Perform:*

	A	B	C	D
Appropriate APGAR score assignment to neonates immediately post delivery and at specific time intervals
Interventions per NRP guidelines, including suctioning, stimulation, respiratory support of newborn
Procedures to ensure correct patient and newborn identification
Actions that facilitate infant bonding, including assisting with breastfeeding
Assessment for microcephaly, anencephaly, etc
Administration of medications for the newborn, such as Vitamin K, erythromycin ointment, etc.
Infant safety protocols

Professional/Ethical Issues

1. Adherence to emergency response plans:*

2. Data collection for Performance Improvement Program/ PI process*

	A	B	C	D

3. Follows acceptable guidelines in supervision and delegation of tasks/duties:*

4. Professional Considerations:*

	A	B	C	D
Clearly, and concisely document patient information and nursing documentation in the patient’s medical record
Make appropriate referrals to community resources available to patient and/or family
Assess patient/family educational needs, educational aptitude, and identification of appropriate learning methods.
Assess for and obtain interpretive services appropriate for effective patient/family communication.
Adhere to the Emergency Medical Treatment and Labor Act (EMTALA), with regards to admission, transfer, and discharge of patients
Adapt interventions based upon client response

5. Adhere to facility specific procedures regarding obstetrical patients with specialty circumstances:*

L&D Medication Admin/Pharmacology

1. Implement appropriate measures/interventions for patient experiencing pre-term labor:*

2. Procedures regarding controlled substances:*

3. Evaluate indication for and/or effectiveness of medications:*

Age Specific:

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

Date*

	A	B	C	D
Abuse/neglect
Drug/alcohol dependence
Suicide risk
Withdrawal Toxicities

	A	B	C	D
Aspiration precautions
Bleeding precautions
High risk falls
Suicide precautions

	A	B	C	D
Bowel sounds
Cranial nerves
Deep Tendon reflexes(DTR’s)
Fluid status Intake/output
Heart sounds
Level of consciousness
Lung sounds
Palpating for uterine contractions
Vital signs

	A	B	C	D
Changing patient position
Communicate appropriate and timely information to Physician/Licensed Independent Provider
IV bolus
Oxygen administration

	A	B	C	D
Appendicitis
Asthma
Diabetes
Gallbladder disease
Influenza

	A	B	C	D
Doppler flow studies
EKG
Ultrasound studies

	A	B	C	D
Amni-sure
Blood glucose meter results
Electrocardiogram
Lab Results
Non stress test
Occult blood test
Pulse oximeter
Sterile speculum exams

	A	B	C	D
External fetal heart monitor
Fetal scalp electrode

	A	B	C	D
Normal/Abnormal
Non-reassuring fetal heart tracing
Category I, II, III

OB/Labor and Delivery Skills Checklist

Directions for Completing Skills Checklist

Maternal Factors

Fetal Assessment