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Cardiac Echo Skills Checklist | ||||||
| NAME | |||||||
| LAST 4 OF SSN | |||||||
| DATE | |||||||
| I hereby certify that ALL information I have provided to FILL IN THE BLANK 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 |
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| Rating Stars (Click) | WORK SETTINGS | 1 | 2 | 3 | 4 | ||
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Adult Acute Care | ||||||
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ED/ICU | ||||||
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Adult Outpatient | ||||||
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Pediatric Acute Care | ||||||
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Pediatric Outpatient | ||||||
| Rating Stars (Click) | ADULT ECHO | 1 | 2 | 3 | 4 | ||
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Routine | ||||||
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3-D Echo | ||||||
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Pedoff Probe | ||||||
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Transesophageal Echo | ||||||
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Stress Echo | ||||||
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Pharmacologic Stress Echo | ||||||
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Post-Cath Echo | ||||||
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Post-Surgical Echo | ||||||
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Imaging with Contrast Agents | ||||||
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Sterilization Procedures | ||||||
| Rating Stars (Click) | SPECIAL VIEWS | 1 | 2 | 3 | 4 | ||
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Pulmonary Veins | ||||||
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Hepatic Veins | ||||||
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Suprasternal Notch | ||||||
| Rating Stars (Click) | CALCULATIONS | 1 | 2 | 3 | 4 | ||
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Simpson's Rule | ||||||
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Proximal Isovelocity Surface Area | ||||||
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Distology with TDI | ||||||
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LV Strain/LV Volume | ||||||
| Rating Stars (Click) | PEDIATRIC ECHO | 1 | 2 | 3 | 4 | ||
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Routine | ||||||
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3-D Echo | ||||||
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Pedoff Probe | ||||||
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Transesophageal Echo | ||||||
| Rating Stars (Click) | PEDIATRIC ANOMALIES | 1 | 2 | 3 | 4 | ||
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Aortic Arch Abnormalities/Vascular Ring | ||||||
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Arch Sidedness | ||||||
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Coarctation of the Aorta | ||||||
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Coronary Artery Anomalies | ||||||
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Double Outlet Ventricle | ||||||
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Hypoplastic Heart Syndrome | ||||||
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Pulmonary Venous Return Anomalies | ||||||
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Tetralogy of Fallot | ||||||
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Transposition of the Great Vessels | ||||||
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Triscupid and Pulmonary Atresia | ||||||
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Truncus Arteriosis | ||||||
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Univentricular Heart Anomalies | ||||||
| Rating Stars (Click) | PEDIATRIC POST-SURGICAL SCANS | 1 | 2 | 3 | 4 | ||
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Arterial Switch | ||||||
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Blalock - Taussig | ||||||
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Damus-Kaye-Stansel | ||||||
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Fontan | ||||||
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Glenn | ||||||
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Konno | ||||||
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Mustard | ||||||
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Norwood | ||||||
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Rastelli | ||||||
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Sano | ||||||
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Sennig | ||||||
| Rating Stars (Click) | EQUIPMENT | 1 | 2 | 3 | 4 | ||
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Phillips/ATL (List Types) | ||||||
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GE (List Types) | ||||||
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Siemens (List Types) | ||||||
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Toshiba (List Types) | ||||||
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Hitachi (List Types) | ||||||
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SonoSite (List Types) | ||||||
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Other: List | ||||||
| Rating Stars (Click) | TECHNOLOGY | 1 | 2 | 3 | 4 | ||
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McKesson | ||||||
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Epic | ||||||
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Horizon | ||||||
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SCI- Imaging | ||||||
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Online Reporting | ||||||
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EMR Conversion | ||||||
| Rating Stars (Click) | MISCELLANEOUS | 1 | 2 | 3 | 4 | ||
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12 Lead ECG | ||||||
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Stress Testing | ||||||
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Holter Monitor | ||||||
| Rating Stars (Click) | PROFESSIONAL KNOWLEDGE AND SKILLS | 1 | 2 | 3 | 4 | ||
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National Patient Safety Goals | ||||||
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Supervisory /Management Experience | ||||||
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Isolation/Infection Prevention | ||||||
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Procedures for Patients on Ventilators | ||||||
| CERTIFICATIONS | |||||||
| Registered Diagnostic Cardiac Sonograp | |||||||
| Registered Cardiac Sonographer (RCS) | |||||||
| BLS | |||||||
| Rating Stars (Click) | Age Specific Competencies | 1 | 2 | 3 | 4 | ||
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Infant (Birth - 1 year) | ||||||
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Preschooler (ages 2-5 years) | ||||||
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Childhood (ages 6-12 years) | ||||||
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Adolescents (ages 13-21 years) | ||||||
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Young Adults (ages 22-39 years) | ||||||
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Adults (ages 40-64 years) | ||||||
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Older Adults (ages 65-79 years) | ||||||
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Elderly (ages 80+ years) | ||||||