Wound Care & Ostomy Skills Checklist
  Wound Care & Ostomy 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) WORK SETTINGS 1 2 3 4  
Acute Care – Adult  
Clinic – Adult  
SNF/LTAC/Subacute  
Hospice / Palliative Care  
Acute/Long Term Care – Pediatrics  
Clinic – Pediatrics  
Rating Stars (Click) PRESSURE ULCERS 1 2 3 4  
Assessment  
Staging  
Prevention/ Risk Assessment Tools –
Adult
 
Prevention/ Risk Assessment Tools -Pediatrics  
Support Surface Selection  
Rating Stars (Click) NEUROPATHIC ULCERS 1 2 3 4  
Assessment  
Management  
Rating Stars (Click) VENOUS STASIS ULCERS 1 2 3 4  
Assessment  
Management  
Rating Stars (Click) PERIPHERAL ARTERIAL ULCERS 1 2 3 4  
Assessment  
Ankle Brachial Index  
Management  
Rating Stars (Click) OTHER WOUNDS 1 2 3 4  
Fistulae – Pouching / Skin Care  
Skin Care/ Management of Drains  
Rating Stars (Click) WOUND DEBRIDEMENT 1 2 3 4  
Autolytic  
Enzymatic  
Mechanical  
Sharp  
Rating Stars (Click) DRESSINGS/ TREATMENTS 1 2 3 4  
Hydrogels  
Hydrocolloids  
Silver Products  
Foams  
Alginates  
Vacuum Assisted Closure  
Growth Factors  
Skin Substitutes  
Hyperbaric Oxygen Therapy  
Wound Cultures  
Electrical Stimulation  
Enzymatic Debriding Agents  
Mist Therapy  
Rating Stars (Click) COLOSTOMY / ILEOSTOMY 1 2 3 4  
Ostomy Equipment Selection  
Continence Skin Care Management  
Loop with Rod Stoma  
End Stoma  
Mucous Fistula  
Double Barrel Stoma  
Irrigation  
Ileal Lavage  
Rating Stars (Click) CONTINENT ILEOSTOMY 1 2 3 4  
Knock pouch  
Pelvic Pouch  
Rating Stars (Click) UROSTOMY / CONTINENT 1 2 3 4  
Catherization for C&S  
Knock Pouch  
Neobladder  
Rating Stars (Click) CONTINENCE THERAPEUTIC DEVICES 1 2 3 4  
Vaginal Cones  
Penile Clamps  
Male External Catheters  
Internal Urethral Inserts  
Catheters –Mgmt & Self Care Teaching  
Magnetic Therapy  
Urinary Incontinence Program  
Fecal Incontinence Program  
Rating Stars (Click) BURNS 1 2 3 4  
Burn Management  
Rating Stars (Click) PROFESSIONAL KNOWLEDGE AND SKILLS 1 2 3 4  
National Patient Safety Goals/ Core Measures  
Patient Family Teaching  
Age Specific/Population Based Care  
Isolation Precautions  
Infection Precautions  
Pain assessment & Management  
Interpretation & Communication of Lab Values  
EMR  
EPIC  
Cerner  
Eclipsys  
McKesson  
Other Computerized System  
Computerized Physician Order Entry  
Bar coding for Medication  
Culture  
Rating Stars (Click) OTHER / MISC. 1 2 3 4  
Pain Management Assessment of Pain Levels without intervention  
Pain Management Response Assessment with Intervention  
Experience: Charge Duty  
Experience: Preceptor  
Rating Stars (Click) AGE SPECIFIC CARE 1 2 3 4  
Infant (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)