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Endoscopy 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) | Procedures | 1 | 2 | 3 | 4 | ||
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Assist with EGD’s | ||||||
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Assist with endoscopic ultrasound | ||||||
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Assist with active GI bleed | ||||||
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Cautery devices | ||||||
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Assist with manometry studies | ||||||
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Assist with variceal banding | ||||||
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Assist with esophageal dilatations | ||||||
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Assist with esophageal ballooning | ||||||
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Assist with scelrotherapy | ||||||
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Assist with TEE | ||||||
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Assist with bronchoscopy | ||||||
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Assist with colonoscopy | ||||||
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Assist with polypectomy | ||||||
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Assist with ERCP’s | ||||||
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Assist with PEG placements | ||||||
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Assist with liver BX | ||||||
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Assist with collection of hot & cold BX’s | ||||||
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Specimen collection & labeling | ||||||
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Set up of scopes & video equipment | ||||||
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Apply external abdominal pressure to assist with scope movement | ||||||
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Scope cleaning | ||||||
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Assist with mobile cases, ICU, ER, etc. | ||||||
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Radiation safety | ||||||
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Automated Medication Dispensing System, Pyxis, Omnicell, or other | ||||||
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Takes call for emergency cases | ||||||
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National Patient Safety Goals | ||||||
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Awareness of HCAHPS | ||||||
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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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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 | ||||||
| Administer Conscious Sedation | |||||||
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Fentanyl | ||||||
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Propofol | ||||||
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Demerol | ||||||
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Presedex | ||||||
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Versed | ||||||
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Reversal agents | ||||||
| Pre Procedure | |||||||
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Pre procedure phone calls | ||||||
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Electronic documentation | ||||||
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Patient assessment | ||||||
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Colon prep or re-prep | ||||||
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Pre procedure checklist/consent | ||||||
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IV start, med admin | ||||||
| Post Procedure | |||||||
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Assess for air movement post colonoscopy | ||||||
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Assess for pain | ||||||
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Assess for bowel sounds | ||||||
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Assess for gag reflex post EGD | ||||||
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Assess for gag reflex post bronchoscopy | ||||||
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Recover from MAC | ||||||
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Recover from (moderate) conscious sedation | ||||||
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Discharge outpatients to home | ||||||
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Post procedure phone calls | ||||||
| Rating Stars (Click) | Age Specific Competencies | 1 | 2 | 3 | 4 | ||
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Newborn/neonate (birth-30 days) | ||||||
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Infant (31 days-1 year) | ||||||
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Toddler (ages 2-3 years) | ||||||
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Preschool (ages 4-5 years) | ||||||
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School age (ages 6-12 years) | ||||||
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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) | ||||||