PACU Skills Checklist
  PACU 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) CARDIOVASCULAR 1 2 3 4  
Open Heart Recovery  
AAA Repair  
Vascular Surgery  
Pacemaker-Permanent & Temporary  
Cardioversion  
AICD Insertion  
Cardiac Arrest  
Cardiac Tamponade  
CHF/Pulmonary Edema  
Abnormal Heart Sounds/Murmurs  
Pulses/Circulation Checks  
Rating Stars (Click) PULMONARY 1 2 3 4  
Ventilator Management  
Fresh Tracheostomy  
Thoracotomy/Lobectomy/Pneumonectomy  
Pneumothorax/Hemothorax  
Laryngospasm  
Pulmonary Embolism  
COPD  
ABG Interpretation  
Rating Stars (Click) NEUROLOGIC 1 2 3 4  
Post Craniotomy  
Anterior/Posterior Spinal Fusion  
Carotid Endardarectomy  
Spine Surgery  
CVA  
Stroke Scale  
Glascow Coma Scale  
Spinal Precautions  
Hypothermia Protocol  
Hypo/Hyperthermia Blanket  
Sedation Scales/Levels  
Rating Stars (Click) GASTROINTESTINAL 1 2 3 4  
Pancreas/Liver Transplant  
Colon Surgery  
Colostomy/Ileostomy  
ERCP  
G Tube/J Tube Management  
T Tube Management  
Rating Stars (Click) RENAL/GENITOURINARY 1 2 3 4  
Renal Surgery  
TURP  
Arteriovenous Fistula/Shunt  
Nephrostomy Tubes  
Rating Stars (Click) ENDOCRINE METABOLIC 1 2 3 4  
Diabetes - Hypo/Hyperglycemic Crisis  
IV Insulin Protocols  
Rating Stars (Click) ORTHOPEDIC 1 2 3 4  
Laminectomy  
Total Joint Replacement  
Amputation  
Open Reduction/Internal Fixation  
General Orthopedic Surgeries  
CPM/Traction  
Circulation Checks  
Rating Stars (Click) WOUND MANAGEMENT 1 2 3 4  
Surgical Drains  
Wound Vac  
Surgical Wound Assessment  
Skin Assessment for Breakdown  
Staging Decubitus Ulcers  
Rating Stars (Click) MEDICATIONS 1 2 3 4  
Procedural Sedation  
Anesthesia Medications  
Anti-Arrhythmics  
Anticoagulants  
Anti-Hypertensives  
Anti-Seizure Medications  
Benzodiazepines  
Emergency Medications  
Insulin  
Narcotics/Opioid Analgesics  
Nitrates  
Non-Opioid Analgesics  
Reversal Agents  
Steroids  
Automated Medication Dispensing (i.e. Pyxis, Omnicell)  
Rating Stars (Click) IV THERAPY 1 2 3 4  
Starting Ivs  
Central Line Blood Draws  
Central Line/Implanted Line Care  
Blood Product Administration  
Rating Stars (Click) CARDIAC MONITORING & EMERG. RESPONSE 1 2 3 4  
Malignant Hyperthermia  
Dysrhythmia Interpretation  
Dysrhythmia Management  
12 Lead EKG  
Rating Stars (Click) PROFESSIONAL KNOWLEDGE AND SKILLS 1 2 3 4  
National Patient Safety Goals/Core Measures  
Fall Risk Assessment/Prevention  
Pressure Ulcer Risk Assessment/Prevention  
Age Specific/Population-Based Care  
Pain Assessment & Management  
Charge Experience  
Interpretation and Communication of Lab Values  
Specialty Beds  
Rating Stars (Click) EMR 1 2 3 4  
Epic  
Cerner  
Eclipsys  
McKesson  
Meditech  
Other Computerized System  
Computerized Physician Order Entry  
Bar Coding for Medication Administration  
PULMONARY  
  EMR Conversion
   
CERTIFICATIONS   Expiry Date :  
BLS  
ACLS  
PALS  
Certification: CAPA or CPAN  
  Other: Specify  
  Other: Specify  
Rating Stars (Click) Age Specific Competencies 1 2 3 4  
Infant (Birth - 1 year)  
Preschooler (ages 2-5 years)  
Childhood (ages 6-12 years)  
Adolescents (ages 13-21 years)  
Young Adults (ages 22-39 years)  
Adults (ages 40-64 years)  
Older Adults (ages 65-79 years)  
Elderly (ages 80+ years)