MEDICAL/SURGICAL SKILLS COMPETENCY CHECKLIST 1=Theory, no practice 2=Limited experience < 1 yr 3 = 1-2 yrs experience 4 = 2 > yrs experience Date Class Name Cardiovascular Assessment 1 2 3 4 Pacemaker 1 2 3 4 Care of the patient with 1 2 3 4 Auscultation(rate, rhythm) Permanent Myocarditis Heart sounds/murmurs Temporary Post acute MI (24-48 hours) Pulses/circulation checks Care of the patient with 1 2 3 4 Post angioplasty Blood pressure/non-invasive Abdominal aortic bypass Post cardiac cath Doppler Aneurysm Post cardiac surgery Equipment & Procedures 1 2 3 4 Angina Thrombophlebitis Telemetry Cardiac arrest Medications 1 2 3 4 Basic 12 lead interpretation Cardiomyopathy Heparin drip Basic arrhythmia interpretation Carotid endarterectomy Oral anticoagulants Lead placement CHF Oral & IVP antihypertensives Femoral-popliteal bypass Oral & topical nitrates Pulmonary Assessment 1 2 3 4 Equipment & Procedures 1 2 3 4 Equipment & Procedures 1 2 3 4 Breath sounds Oropharyngeal/suctioning Removal of a chest tube Rate & work of breathing Sputum specimen collection Chest physiotherapy Intrepretation of lab results 1 2 3 4 Tracheostomy/suctioning Icentive spirometry Blood chemistry Assist with intubation O2 therapy & medication 1 2 3 4 Blood gases Assist with thoracentesis Bag and mask Equipment & Procedures 1 2 3 4 Care of a ventilator patient External CPAP Airway mgmt devices/suctioning Care of the patient with a chest tube 1 2 3 4 Face masks Endotracheal tube/suctioning Assist w/ set-up & insertion Inhalers Nasal airway/suctioning Measuring & emptying Nasal cannula
Pulmonary continued Name Date O2 therapy & medication delivery systems 1 2 3 4 Care of the patient with: 1 2 3 4 Care of the patient with: 1 2 3 4 Portable O2 tank Bronchoscopy Pneumonectomy Trach collar COPD Pneumonia Fresh tracheostomy Lobectomy Pulmonary embolism Thoracotomy Tuberculosis Neurological Assessment 1 2 3 4 Care of the patient with 1 2 3 4 Care of the patient with 1 2 3 4 Glasgow coma scale Aneurysm precautions Encephalitis Level of consciousness Basal skull fracture Externalized VP shunts Equipment & Procedures 1 2 3 4 Closed head injury Meningitis Assist w/ lumbar puncture Coma Neuromuscular disease Use of hyper/hypothermia blanket CVA Post craniotomy Administration of anticonvulsants DT s Seizures Spinal cord injury Orthopedics Assessment 1 2 3 4 Equipment & Procedures 1 2 3 4 Care of the patient with: 1 2 3 4 Circulation checks Cervical collar Amputation Gait Gait belt Arthoscopic surgery Range of motion Prosthetic Cast Skin Sling Osteoporosis Equipment & Procedures 1 2 3 4 Transfer boards Pinned fractures Continuous passive motion devices Walker Rheumatic/arthritic disease Support devices 1 2 3 4 Wheelchair Total hip replacement Cane Traction Total knee replacement
Gastrointestinal Name Date Assessment 1 2 3 4 Equipment & Procedures 1 2 3 4 Care of the patient with: 1 2 3 4 Abdominal/bowel sounds Saline lavage Bowel obstruction Fluid balance Flexible feeding tube (Corpak, Dobhoff) Colostomy/ileostomy Nutritional Management of 1 2 3 4 GI bleeding/gi surgery Interpretation of blood chemistry Gastrostomy tube Hepatitis Equipment & Procedures 1 2 3 4 Jejunostomy tube Inflammatory bowel disease Administration of tube feeding T-tube Invasive diagnostic testing Feeding pump Placement of nasogastric tube Liver failure Gravity feeding Salem sump to suction Paralytic ileus Renal/Genitourinary Arterio venous fistula/shunt Catheter care Hemodialysis Fluid balance 3-way Foley Nephrectomy Interpretation of lab results 1 2 3 4 Supra-pubic Peritoneal dialysis BUN & creatinine Bladder irrigations 1 2 3 4 Renal failure Electrolytes Continuous Renal transplant Equipment & procedures 1 2 3 4 Intermittent TURP Insertion & care of straight & Foley cath 1 2 3 4 Specimen collection 1 2 3 4 Urinary diversion Female Routine Urinary tract infection Male 24 hour
Endocrine/Metabolic Name Date Assessment 1 2 3 4 Equipment & procedures 1 2 3 4 Medications 1 2 3 4 S/S diabetic coma Indwelling Insulin pump Insulin S/S insulin reaction Care of the patient with: 1 2 3 4 Oral hypoglycemics Equipment & procedures 1 2 3 4 Diabetes mellitus Steroids Blood glucose monitoring 1 2 3 4 Disorders of adrenal gland Thyroid 1 2 3 4 Electronic measuring device Performing finger stick Visual blood glucose strips Disorders of the pituitary gland Hyperthyroidism Throidectomy Wound Management Skin for impending breakdown Air fluidized, low airloss beds Burns Stasis ulcers Sterile dressing changes Pressure ulcers Surgical wound healing Wet to dry dressing Staged decubitus ulcers Wound-Vac Packing Surgical wounds w/ drain(s) Debridement Traumatic wounds Wound care/irrigations Oncology Nutritional status Reverse isolation Leukemia Pain control Care of the patient with: Radiation implant Interpretation of lab results 1 2 3 4 Bone marrow transplant Blood chemistry Blood counts Fresh oncologic surgery Inpatient chemotherapy
Infectious Diseases Name Date Interpretation of lab results 1 2 3 4 Equipment & procedures 1 2 3 4 Care of the patient with: 1 2 3 4 Blood count Fever management AIDS Isolation Hepatitis Lyme disease IV Therapy Equipment & procedures 1 2 3 4 Administration of blood/blood products 1 2 3 4 Care of the patient with: 1 2 3 4 Drawing blood from a central line Albumin/plasma Peripheral line/dressing Drawing venous blood Cryoprecipitate Central line/catheter/dressing Starting IV s 1 2 3 4 Packed red blood cells Broviac Angiocath Whole blood Groshong Butterfly Heparin lock Hickman Portacath Quinton Pain Management Assessment 1 2 3 4 Care of the patient with: 1 2 3 4 Care of the patient with: 1 2 3 4 Pain level / tolerance Epidural Anesthesia/analgesia Narcotic analgesia IV conscious sedation Patient controlled analgesia (PCA pump)