Critical Care Skills Checklist
  Critical Care Skills Checklist
   NAME    
   LAST 4 OF SSN      
   DATE    
I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.  
Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.  
Proficiency Scale: 1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

 
       
Rating Stars (Click) General Skills 1 2 3 4  
Advanced directives  
Patient/family teaching  
Restrictive devices (restraints)  
Lift/transfer devices  
Specialty beds  
End of life care/palliative care  
Wound assessment & care  
Automated Medication Dispensing System, Pyxis, Omnicell, or other  
Bar coding for medication administration  
Blood Glucose Monitor (BGM)  
Cardioversion/defibrillation  
Electronic ICU  
National Patient Safety Goals  
Accurate patient identification  
Effective communication  
Interpretation & communication of lab values  
Medication administration  
Medication reconciliation  
Labeling (medications & specimens)  
Anticoagulation therapy  
Monitoring conscious sedation  
Pain assessment & management  
Infection control  
Universal precautions  
Isolation  
Minimize risk for falls  
Prevention of pressure ulcers  
Use of rapid response teams  
Awareness of HCAHPS  
Rating Stars (Click) Cardiovascular    
Assessment of heart sounds  
Interpretation of arrhythmias  
Performing 12 lead EKG’s  
Interpretation of 12 lead EKG  
Interpretation of hemodynamic monitoring  
  Assist with Insertion & Management of:    
CVC (Central Venous Catheter)  
Arterial line  
Swanz Ganz catheter  
Flow trac or Vigileo monitoring caths  
Intra-Aortic Balloon Pump (IABP)  
Ventricular Assist Device (LVAD, RVAD)  
  Maintenance & Management of:    
Permanent pacemakers  
Implantable Cardioverter Defibrillator (ICD)  
External pacemakers  
Epicardial pacemaker wires  
Discontinuing venous/arterial sheaths  
Femostop/vasoseal  
  Care of Patients with:    
Acute myocardial infarction  
Pre/post: cardiac catheterization  
Congestive heart failure  
Cardiomyopathy  
Dysrhythmias/conduction disturbances  
Aortic aneurysm  
Thoracic/abdominal surgery  
Endoluminal graft  
Cardiogenic shock  
Hypertensive crisis  
Pericarditis/endocarditis  
MAZE procedure  
Post open heart (CABG/valve)  
Cardiac contusion/trauma  
Heart transplant  
Cardiac tamponade  
Medication Administration:  
ACLS medications and protocols  
Antidysrythmics  
Antihypertensives  
Vasoactive/vasopressor agents  
Anesthetics (propofol/presedex)  
Thrombolytics (retavase/activase)  
Platelet inhibitors (ReoPro/Integrilin/Aggrastat)  
Flolan for pulmonary hypertension  
Rating Stars (Click) Pulmonary    
Assessment of breath sounds  
  Airway Management, Care & Maintenance of:    
Oral/NT/ET airway  
Tracheostomy  
Arterial blood gas analysis/interpretation  
Obtaining ABG blood sample/arterial line  
Pulse oximetry  
  Ventilator Management:    
BiPAP (Bi-level Positive Airway Pressure)  
Oscillation/high-frequency ventilation  
Nitric  
Interpretation of weaning parameters  
Maintenance & management of pleural chest tubes  
  Care of Patient with:    
Acute respiratory failure  
Adult Respiratory Distress Syndrome (ARDS)  
Sudden Inflammation Respiratory Syndrome (SIRS)  
Inhalation injuries  
Pneumonia  
Pulmonary edema  
Near drowning  
Chronic Obstructive Pulmonary Disease (COPD)  
Pre/post thoracic surgery  
Pulmonary embolism  
Pulmonary/chest trauma  
Pulmonary hypertension  
Status asthmaticus  
Medication Administration:  
Rapid sequence intubation drugs/protocols  
Nebulizer treatments: Ventolin, Atrovent  
Rating Stars (Click) Neurology    
Cranial nerve assessment  
Glasgow coma scale  
NIH stroke scale  
NIH stroke certification  
Seizure precautions  
Skeletal traction  
Cervical spine precautions/logroll positioning  
Halo vest/halo traction  
Monitoring of neuromuscular blocking agents/paralytics  
Assist with lumbar puncture  
Intracranial/Cerebral Perfusion Pressure Monitoring (ICP/CPP) via:  
Ventriculostomy  
Subarachnoid screw/bolt  
Care of Patients with:  
Lumbar drains  
Cerebral aneurysm  
Subarachnoid hemorrhage  
Status epilepticus  
TBI (Traumatic Brain Injury)  
Spinal cord injury  
CerebroVascular Accident (CVA)  
Pre/post cranial surgery  
Meningitis  
Myasthenia gravis  
Clipping and/or coilings of aneurysms  
Pituitary Tumor  
Medication Administration:  
Steroids: Decadron, Solu-Medrol  
Anticonvulsants: Dilantin, phenobarbital  
Paralytic Agents: Norcuron, Pavalon, Nimbex, Tracrium, vecuronium  
Mannitol  
Antipsychotics: Haldol  
Rating Stars (Click) Trauma & Burns    
Mass casualty  
Electrocution  
Amputation  
Gangrene  
Multiple fractures  
Thermoregulation: hypothermia/hyperthermia  
  Burns: Calculation of Total Body Surface Area (BSA):    
Berdow Formula/ “Rule of Nines”  
Lund and Browder chart  
Fluid resuscitation  
Care & management of burns  
Rating Stars (Click) Gastrointestinal 1 2 3 4  
Small bore feeding tube insertion (Dobhoff or Keofeed)  
Nasogastric tube insertion  
Post pyloric feeding tube insertion  
Gastric lavage  
Use of activated charcoal  
Maintenance of gastric/jejunostomy tube  
Stoma care  
Maintenance & management of enteral tube feedings  
Assisting/monitoring bedside procedures: endo/chest tubes/bronchs/trach insertion/PEG tubes  
  Care of Patients with:    
Abdominal trauma  
Acute gastrointestinal hemorrhage  
Esophageal varices  
Balloon tamponade devices (i.e. Blakemore tube)  
Peritonitis  
Acute pancreatitis  
Bowel obstruction  
Liver/pancreas transplant  
  Medication Administration:    
Antiemetics: Reglan, Zofran  
H2 receptor antagonists  
Rating Stars (Click) Renal 1 2 3 4  
Foley catheter insertion  
Suprapubic tube  
Nephrostomy tube  
Peritoneal dialysis  
Continuous Arteriovenous Hemofiltration (CAVHD, CVVHD, SCUF, CRRT)  
Hemodialysis of the critically ill patient  
  Care of Patient with:    
Acute renal failure  
Chronic renal failure  
AV fistulas, shunts & dialysis catheters  
Nephrectomy  
Renal transplant  
Renal/urinary tract trauma  
Rating Stars (Click) Endocrine 1 2 3 4  
Diabetic Ketoacidosis (DKA)  
Hyperosmolar Hyperglycemic Nonketotic Coma (HHNK)  
Diabetes Insipidus (DI)  
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)  
Administration & monitoring of insulin infusion  
Use of Endo tool  
Rating Stars (Click) Intravenous Management 1 2 3 4  
Starting peripheral IV’s  
Care of patient with Peripherally-Inserted Central Catheter (PICC)  
Administration/monitoring of Total Parenteral Nutrition (TPN)  
Administration of blood/blood products  
Administration of narcotics/sedatives: (fentanyl, Valium, Ativan, Versed, morphine)  
Bispectral monitoring  
Rating Stars (Click) Tele-ICU (ICU-E) 1 2 3 4  
Mentoring  
Communication  
Video assessment  
Utilize tele-ICU system  
Multi-tasking  
Troubleshoot equipment  
Giving directions over AV system  
Interpretation of data  
Critical thinking  
Diplomacy  
Rating Stars (Click) Other 1 2 3 4  
Drug or chemical overdose (TCA, ethanol, ASA)  
Poisoning (CO, cyanide)  
Substance abuse (ETOH, stimulants, narcotics)  
Human Immunodeficiency Virus (HIV)  
Multisystem Organ Dysfunction Syndrome (MODS)  
Anaphylaxis  
Disseminated Intravascular Coagulation (DIC)  
Septic shock  
Cancer  
Administration of chemotherapy  
Monitoring of chemotherapy (does not initiate)  
Hyperbaric oxygenation  
Organ/tissue donation procedures  
Suicide precautions  
Rating Stars (Click) Age Specific Competencies 1 2 3 4  
Adolescent (ages 13-21 years)  
Young adult (ages 22-39 years)  
Adult (ages 40-64 years)  
Older adult (ages 65-79 years)  
Elderly (ages 80+ years)  
  Please list any Additional Skills:    
   
   
   
   
  Additional training:  
   
   
   
   
  Additional equipment: