LPN 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.

MEDICATIONS ADMINISTRATION

1. General Medication Administration*

	A	B	C	D
Oral Medications
Subcutaneous Injections
Intramuscular Injections
Z-Track Injections
Heparin Lock
Intrademal
Vaginal Suppositories
Ophthalmic Drops
Nasal Drops
Ophthalmic Ointments
Topical Ointments
Inhalers
Rectal Suppositories
Emergency Meds-Crash Carts

INTRAVENOUS

1. General Intravenous*

	A	B	C	D
Starting an IV
Change IV Tubing
Discontinuing an IV
Chemo-Therapy
Piggyback Administration
IV Push Drugs
Plasma
Packed RBC
Regulate Flow
Maintain IV Site
Hyperalimentation
CVP Line
Medication Addition
Whole Blood Administration
Serum Albumin
Platelets

INFECTION CONTROL

1. GENERAL ASSESSMENT*

ASSESSMENT

1. General Assessment*

	A	B	C	D
Perform Neurological Assessment
Management of the Patient with Drug
Interaction/Allergic Reaction
Management of Patient with Cardio-Pulmonary (Arrest)
Perform Cardiovascular Assessment
Perform Gastrointestinal Assessment
Perform Muskuloskelatal Assessment
Perform Genitourinary Assessment
Perform Respiratory Assessment

BODY MECHANICS/TRANSFER

1. General Body Mechanics/Transfer*

RESTRAINTS

1. General Restraints*

EQUIPMENT

1. General Equipment*

	A	B	C	D
Hemovac/Davol Suction Pump
Use of Wall Suction
Use of Corstavac Suction
Alternate Pressure Mattress
Care of Patient with PCS Pump
Infusion Devices (Volumetric Pump)
Venturi Mask
Management of Trach Collar
Knowledge of Use of Incentive Spirometer
ABG Kits
Knowledge of Use of Bed Scale
Knowledge of use of Heating Pad
Use of Hoyer Lift
Assist with/Set-up of Water Seal Suction
Pleurevac/Emerson Suction
Knowledge of Use of Egg Crate Mattress
Enteral Pump
Management of Oxygen Mask
Management of Nasal Cannula
Use of Ambu-Bag
Humidifiers
Application of TED Hose
Use of Heat Lamb
Use of Blood Glucose Monitors

SPECIMEN COLLECTION

1. General Specimen Collection*

	A	B	C	D
Obtain Urine for Specific Gravity
Obtain Urine Culture
Obtain Foley Catheter Specimen
Obtain Stool Specimen
Perform Straight Catheterization
Obtain Sputum Specimen
Instruct Patient/Assist with Clean
Catch/Midstream Urine Specimen
Collect 24 hour Urine Specimen
Obtain Stool Hemocult
Obtain Stool Ova/Parasite

PROCEDURES

1. General Procedures*

	A	B	C	D
Set-up/Instruct Patient in Sitz bath
Perform Personal Hygiene/Oral Care
Perform Wound Irrigation
Perform Catheterization (Female & Male)
Administer Tap/Saline Enema
Administer Soap Suds Enema
Administer Oil Retention Enema
Administer Fleets Enema
Administer Post-Mortem Care
Perform Wet to Dry Dressing
Perform Sterile Dressing Changes
Perform Bladder Irrigation
Perform Ostomy Care
Perform NG Tube Feeding
Perform Gastrostomy Tube Feeding
Administer Douches
Management of Levine Tube
Management of Nephrostomy Catheter
Management of Jejunostomy Tube
Management of Chest Tube
Perform Nasal Suctioning
Perform Oral Suctioning

COMMUNICATION/DOCUMENTATION

1. General Communication/Documentation*

Age Specific:

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

Date*

	A	B	C	D
Knowledge of Universal Precautions
Knowledge of Waste Disposal
Proper Disposal of Sharps
Management of Patient in Respiratory Isolation
Care of the Patient in Reverse Isolation
Cleaning of Equipment

	A	B	C	D
Lifting and Pulling
Transfer to Chair
Turning and Positioning
Transfer Patient to Wheelchair
Transfer Patient to and from Toilet
Transfer Patient to and from Gurney

	A	B	C	D
Application of Soft Limb Restraints
Application of Leather Restraints
Application of Posey Restraints
Observation of Patient in Restraints
Documentation
Knowledgeable of Safety Guidelines for Patient

	A	B	C	D
Reporting on Assigned Patients
Performing Team Leader Duties
Giving Oral Reports
Giving Tape Reports
Making Assignments
Making Rounds

	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)