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