Pediatric Competency Self Assessment
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- Abel Bertram Curtis
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1 Pediatric Competency Self Assessment Directions Please circle a value for each question to provide us and the interested facilities with an assessment of your clinical experience. These values confirm your strengths within your specialty and assist the facility in the selection process of the healthcare professional. 1 No 2 Some (Require Assistance) 3 Intermittent (May Require Assistance) 4 d (Performs without Assistance) 5 Very d (Able to Teach/Supervise) Print Name Last 4 Digits of SS# Date General Skills Normal growth & development Immunizations Provide safe environment for age specific care Recognize signs of failure to thrive Recognize signs of abuse/neglect Advanced directives Awareness of HCAHPS Patient/family teaching Lift/transfer devices Specialty beds Restrictive devices (restraints) End of life care/pallative care Wound assessment & care Automated Medication Dispensing System, Pyxis, Omnicell, or other Bar coding for medication administration Diabetic care & education Blood Glucose Monitoring (BGM) Insulin administration National Patient Safety Goals Accurate patient identification Effective communication Interpretation & communication of lab values Medication administration (PO,IM,IV,PR) Labeling (medications & specimens) Medication reconciliation Anticoagulation therapy Monitoring conscious sedation Pain assessment & management Use of PCA (IV, intrathecal, epidural) Infection control Universal precautions Isolation Cross Country Healthcare, Inc. Rev. 09/12 F0048 Pediatric 1 of 7
2 1 No 2 Some (Require Assistance) 3 Intermittent (May Require Assistance) 4 d (Performs without Assistance) 5 Very d (Able to Teach/Supervise) General Skills - cont. Minimize risk for falls Prevention of pressure ulcers IV Therapy Starting & maintaining peripheral IVs Blood draw: venous Central line care (includes Broviac/PICC/Groshong/Hickman) Blood draw: central line Care & management of ports TPN & lipids Administration of blood & blood products Administration of chemotherapy Monitoring chemotherapy (does not initiate) Cardiovascular Pediatric assessment Cardiac monitoring & emergency care Obtains 12 lead EKG Basic EKG interpretation Use of rapid response teams Cardiac arrest/cpr Administration of PALS protocols & medications Use of Broslow system Cogenital heart defects Congestive heart failure Post cardiac cath Post cardiac surgery Cardiomyopathy Pericarditis Shock Rheumatic fever Heart transplant Bacterial endocarditis Antidysrythmics Antihypertensives Cardiac glycoside (digoxin) Cross Country Healthcare, Inc. Rev. 09/12 F0048 Pediatric 2 of 7
3 1 No 2 Some (Require Assistance) 3 Intermittent (May Require Assistance) 4 d (Performs without Assistance) 5 Very d (Able to Teach/Supervise) Pulmonary Respiratory assessment Rate & work of breathing Oral/nasal suctioning Tracheostomy care and suctioning Chest Physiotherapy (CPT) Pulse oximeter Ventilator management O2 (NC/mask/oxyhood) Assist with chest tube insertion & management Asthma RSV (Respiratory Syncytial Virus) Bronchopulmonary Dysplasia (BPD) Cystic fibrosis Croup Pneumonia Epiglottitis Tuberculosis Alupent Aminophylline (obsolete medication) Ventolin Inhaled corticosteroids Respigam/synergis Neurological Pediatric neurological assessment Assist with lumbar puncture ICP monitoring Battered child syndrome Depression TBI (Traumatic Brain Injury) Encephalitis Meningitis Neuromuscular disease Spinal cord injury Cross Country Healthcare, Inc. Rev. 09/12 F0048 Pediatric 3 of 7
4 1 No 2 Some (Require Assistance) 3 Intermittent (May Require Assistance) 4 d (Performs without Assistance) 5 Very d (Able to Teach/Supervise) Neurological - cont. Seizures Hydrocephalus VP shunt Epilepsy Near drowning Stimulants (Ritalin, Adderall) Steroids (Decadron, Solu-Medrol) Anticonvulsants (Dilantin, phenobarbital) Orthopedics Assessment of circulation checks Devised traction (splints, casts, braces) Pinned traction Osteomylitis Fractures Post Harrington rod insertion Gastrointestinal GI assessment Abdominal girth measurement Feedings Bottle Breast Gavage Gastrostomy Nasojejunal Nasogastric and sump tubes to suction Placement of oro/nasogastric tubes Colostomy/ileostomy care Anorexia/bulimia Tracheoesophageal Fistula (TEF) Gastroschisis/omphalocele Necrotizing Enterocolitis (NEC) Crohn s disease Cross Country Healthcare, Inc. Rev. 09/12 F0048 Pediatric 4 of 7
5 1 No 2 Some (Require Assistance) 3 Intermittent (May Require Assistance) 4 d (Performs without Assistance) 5 Very d (Able to Teach/Supervise) Gastrointestinal - cont. Cleft lip/palate Gastroenteritis Pyloric stenosis Ulcerative colitis GE reflux GI bleeding Intestinal parasites Small bowel transplant Surgical abdomen Renal/GU Assessment of fluid balance Assist with suprapubic tap Peritoneal dialysis Insertion & care of Foley catheter Glomerular nephritits Ilial conduit ureteral Nephrotic syndrome Wilm s tumor UTI Hemolytic uremic syndrome Kidney transplant Endocrine System Onset diabetes Diabetic ketoacidosis Adrenal disorders Cushing s syndrome Pituitary disorders Pancreas transplant Thyroid malfunction Insulin administration Insulin pumps Thyroid Growth hormone Cross Country Healthcare, Inc. Rev. 09/12 F0048 Pediatric 5 of 7
6 1 No 2 Some (Require Assistance) 3 Intermittent (May Require Assistance) 4 d (Performs without Assistance) 5 Very d (Able to Teach/Supervise) Hematology/Oncology Assist with bone marrow aspiration Anemia Bone marrow transplant Leukemia Sickle cell disease Hemophilia Malignant tumors Spleen trauma/spleenectomy Neutropenic fever Sepsis Hodgkin s Infectious Diseases Common childhood communicable diseases HIV/CMV/AIDS Hepatitis Kawasaki disease Age Specific Competencies Newborn/neonate (birth-30 days) Infants (31 days-1 year) Toddler (ages 2-3 years) Preschool (ages 4-5 years) School age (ages 6-12 years) Adolescent (ages years) Cross Country Healthcare, Inc. Rev. 09/12 F0048 Pediatric 6 of 7
7 1 No 2 Some (Require Assistance) 3 Intermittent (May Require Assistance) 4 d (Performs without Assistance) 5 Very d (Able to Teach/Supervise) Please list any Additional Skills: Additional training: Additional equipment: Fax to: The information on this and all preceding pages is true and correct. Signature Date 2012 Cross Country Healthcare, Inc. Rev. 09/12 F0048 Pediatric 7 of 7
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