Respiratory Therapist Skills Checklist "*" indicates required fields Name* First Last 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.1. Acute Care:*ABCDRoutine Therapy & TreatmentChest Physical TherapyAdult Intensive CareAdult Surgical Intensive CareAdult Coronary CareGeneral PediatricsTraumaRoutine Therapy & TreatmentChronic Obstructive Pulm. DiseaseRestrictive Pulmonary DiseasesNeurological DisordersSmoke Inhalation & BurnsPneumothoraxChest TraumaCystic FibrosisCroupEpliglottitisInfant Resp Distress SyndromeRespiratory Syncytal VirusMeconium AspirationPersistent Fetal Circulation2. EQUIPMENT & PROCEDURES:*ABCDAdult Ventilator ManagementPediatric Ventilator ManagementInfant Ventilator ManagementNeonatal Ventilator ManagementVent. Management Via ParametersAdult High Frequency VentilationNeonatal High Freq. VentilatorsPressure Controlled VentilationVolume Controlled VentilatorsTime Cycled VentilatorsBronchoscope AssistanceArterial Blood Gas SamplingArterial Line InsertionArterial Line MaintenanceArterial Blood Gas Analysis3. HOME HEALTH CARE:*ABCDRoutine Therapy & TreatmentChest Physical TherapyChronic Obstructive Plum. DiseaseRestrictive Pulmonary Diseases4. LONG TERM CARE:*ABCDRoutine Therapy & TreatmentChest Physical TherapyLong Term Ventilator CareChronic Obstructive Plum. DiseaseRestrictive Pulmonary Diseases5. REHABILITATION:*ABCDRoutine Therapy & TreatmentChest Physical TherapyLong Term Ventilator CareChronic Obstructive Plum. DiseaseRestrictive Pulmonary Diseases6. SKILLED NURSING:*ABCDRoutine Therapy & TreatmentChest Physical TherapyLong Term Ventilator CareChronic Obstructive Plum. DiseaseRestrictive Pulmonary Diseases7. EQUIPMENT AND PROCEDURES:*ABCDIntubation AssistanceIntubation PerformanceHemodynamic MonitoringCapnographySleep Apnea StudiesTranscutaneous MonitoringHyperbaric TherapyCardiogramsCardiac Stress TestingBedside Pulm. Function TestingComplete Plum. Function TestingLung Volume StudiesDiffusion StudiesPulmonary Exercise TestingECMO AssistanceECMO Operation8. Age Specific: Please indicate the frequency with which you provide care for each age group:*ABCDInfant (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)* The information I have given is true and accurate to the best of my knowledge. I hereby authorize Professional Nursing Service to release my Skills Checklist to Client facilities of PNS in relation to consideration of employment as a Traveler with those facilities.Date* MM slash DD slash YYYY
