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Home Health 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) | CARDIOVASCULAR | 1 | 2 | 3 | 4 | ||
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ACS/Post MI | ||||||
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Heart Failure | ||||||
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Post Cardiac Surgery | ||||||
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Cardiac Auscultation (Rate/Rhythm) | ||||||
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Peripheral Pulse/Circulation Checks | ||||||
| Rating Stars (Click) | PULMONARY | 1 | 2 | 3 | 4 | ||
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Asthma | ||||||
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COPD | ||||||
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Pneumonia | ||||||
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Lung Cancer | ||||||
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Pulmonary Emboli | ||||||
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Auscultate Lung Sounds | ||||||
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Oxygen Administration | ||||||
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Oxygen Safety | ||||||
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Oro/Nasotracheal Suctioning | ||||||
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CPAP/BiPAP | ||||||
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Ventilator Management (Specify): | ||||||
| Rating Stars (Click) | NEUROLOGICAL | 1 | 2 | 3 | 4 | ||
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CVA | ||||||
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Alzheimer's Disease/Dementia | ||||||
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Parkinson's | ||||||
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Degenerative Neurologic Disorders (ALS, MS, etc.) | ||||||
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Brain Tumor | ||||||
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Brain Injury | ||||||
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Para/Quadriplegia | ||||||
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Seizure Disorder | ||||||
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Level of Consciousness/Neuro Changes | ||||||
| Rating Stars (Click) | ORTHOPEDICS | 1 | 2 | 3 | 4 | ||
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Joint Replacement | ||||||
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DVT Prophylaxis/Recognition | ||||||
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Incision Checks | ||||||
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Staple Removal | ||||||
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Fractures | ||||||
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Cast/Brace | ||||||
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Amputation | ||||||
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Arthritis | ||||||
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Assistive Equipment/Lift Devices | ||||||
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In Home PT/INR (Specify): | ||||||
| Rating Stars (Click) | GASTROINTESTINAL | 1 | 2 | 3 | 4 | ||
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Nutritional Assessment | ||||||
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Colostomy/Ileostomy Management | ||||||
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Fecal Incontinence/Diarrhea | ||||||
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Bowel Obstruction | ||||||
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GI Bleed | ||||||
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Post GI Surgery | ||||||
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Hepatitis Liver Failure | ||||||
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NG Tubes | ||||||
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Feeding Tubes | ||||||
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Feeding Pumps (Specify): | ||||||
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Drainage Devices | ||||||
| Rating Stars (Click) | RENAL/GENITOURINARY | 1 | 2 | 3 | 4 | ||
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Hemodialysis | ||||||
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AV Fistula/Shunt | ||||||
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Peritoneal Dialysis | ||||||
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Post Bladder Surgery | ||||||
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Post Prostate Surgery | ||||||
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Urostomy | ||||||
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Urinary Incontinence | ||||||
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Bladder Catheter Insertion/Maintenance | ||||||
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Suprapubic Catheter Insertion/Maintenance | ||||||
| Rating Stars (Click) | ENDOCRINE/METABOLIC | 1 | 2 | 3 | 4 | ||
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Diabetes | ||||||
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Hyper/Hypoglycemia | ||||||
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Diabetic Skin Assessment | ||||||
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Cushing's / Addison's Disease | ||||||
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Thyroid Disease | ||||||
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Insulin Pumps | ||||||
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Glucometers | ||||||
| Rating Stars (Click) | WOUND/SKIN CARE | 1 | 2 | 3 | 4 | ||
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Braden Scale | ||||||
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Pressure Ulcer Prevention | ||||||
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Pressure Ulcer Staging | ||||||
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Pressure Ulcer Management | ||||||
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Burns | ||||||
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Wound Care | ||||||
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Wound Cultures | ||||||
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Wound Vac | ||||||
| Rating Stars (Click) | ONCOLOGY | 1 | 2 | 3 | 4 | ||
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Risk for Infection | ||||||
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Symptom Management | ||||||
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Side Effects of Treatment | ||||||
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Terminal Disease | ||||||
| Rating Stars (Click) | INFECTIOUS DISEASE | 1 | 2 | 3 | 4 | ||
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MRSA | ||||||
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VRE | ||||||
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C. Difficile | ||||||
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HIV | ||||||
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Tuberculosis | ||||||
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Isolation Precautions | ||||||
| Rating Stars (Click) | PHLEBOTOMY/IV THERAPY | 1 | 2 | 3 | 4 | ||
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Peripheral Venipuncture for Labs | ||||||
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Start Ivs | ||||||
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Peripheral Ivs | ||||||
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PICC/CVP Lines | ||||||
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Venous Access Ports | ||||||
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Infusion Pump Set up and Management | ||||||
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Specify Infusion Pump Type: | ||||||
| Rating Stars (Click) | PSYCHIATRIC | 1 | 2 | 3 | 4 | ||
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Cognitive Disorders | ||||||
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Mood Disorders | ||||||
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Schizophrenia/Psychotic Disorders | ||||||
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Medication Compliance | ||||||
| Rating Stars (Click) | WOMEN'S HEALTH/MATERNAL-INFANT CARE | 1 | 2 | 3 | 4 | ||
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Pregnancy Related Complications | ||||||
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Fetal Heart Tones | ||||||
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Contractions | ||||||
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Post Partum Mother/Baby Visit | ||||||
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Newborn Care | ||||||
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Phototherapy | ||||||
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Breast Feeding Support | ||||||
| Rating Stars (Click) | PEDIATRICS | 1 | 2 | 3 | 4 | ||
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Growth and Development | ||||||
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Respiratory Distress Syndrome | ||||||
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Bronchopulmonary Dysplasia | ||||||
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Cystic Fibrosis | ||||||
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Muscular Dystrophy | ||||||
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Spina Bifida | ||||||
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Spinal Surgery | ||||||
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Sickle Cell Disease | ||||||
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Trach Care/Suctioning | ||||||
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Ventilator Management | ||||||
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Ventilator Type (Specify): | ||||||
| Rating Stars (Click) | PAIN MANAGEMENT | 1 | 2 | 3 | 4 | ||
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Verbal/Nonverbal Pain Scales | ||||||
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Response to Pain Management Interventions | ||||||
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PCA Pump | ||||||
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Epidural Cath/Site Monitoring/Pump | ||||||
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Non-Pharmacologic Pain Measures | ||||||
| Rating Stars (Click) | PALLIATIVE AND END OF LIFE CARE | 1 | 2 | 3 | 4 | ||
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Palliative Symptom Management | ||||||
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Pain Management/Response | ||||||
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Family Support/Teaching | ||||||
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After Death Protocols | ||||||
| Rating Stars (Click) | MEDICATIONS | 1 | 2 | 3 | 4 | ||
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Alzheimer's Medications | ||||||
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Antiarrhythmics | ||||||
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Antibiotics/Antivirals | ||||||
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Anti-Depressants | ||||||
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Anti-Hypertensives | ||||||
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Anti-Psychotics | ||||||
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Anti-Seizure Medications | ||||||
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Benzodiazepines | ||||||
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Calculation of Pediatric Dosages | ||||||
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Coumadin | ||||||
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Diuretics | ||||||
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Enoxaparin | ||||||
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Inhaled Medications | ||||||
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Nebulizer Medications | ||||||
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Insulin | ||||||
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Opioid and Non-Opioid Analgesics | ||||||
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Oral Chemotherapy | ||||||
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Oral Hypoglycemics | ||||||
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Oral & Topics Nitrates | ||||||
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Rivaroxaban | ||||||
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Sedative/Hypnotics | ||||||
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Steroids | ||||||
| Rating Stars (Click) | HOME HEALTH | 1 | 2 | 3 | 4 | ||
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Intake/Admissions | ||||||
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Case Manager | ||||||
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Case Load - Pts/Day(specify) | ||||||
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Supervise LVNs/HHAs | ||||||
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Medicare/Medicaid | ||||||
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Long/Short Term Disability | ||||||
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Private Insurance | ||||||
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Telephonic Assessments | ||||||
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Management of Complaints | ||||||
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APS Reports | ||||||
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OASIS | ||||||
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Diagnosis Coding | ||||||
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Document Plan of Care | ||||||
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Clinical Assessment Documentation | ||||||
| Rating Stars (Click) | PROFESSIONAL KNOWLEDGE AND SKILLS | 1 | 2 | 3 | 4 | ||
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National Patient Safety Goals/Core Measures | ||||||
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Safety Assessment | ||||||
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Fall Assessment and Prevention | ||||||
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Patient/Family Teaching | ||||||
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Age Specific/Population Based Care | ||||||
| Rating Stars (Click) | EMR | 1 | 2 | 3 | 4 | ||
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Allscripts | ||||||
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Cerner | ||||||
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Epic | ||||||
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HomeCare Home Base | ||||||
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McKesson | ||||||
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Meditech | ||||||
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Other Computerized Documentation System | ||||||
| EMR Conversion | |||||||
| 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) | ||||||
| CERTIFICATIONS | Expiry Date : | ||||||
| BLS | |||||||
| ACLS | |||||||
| PALS | |||||||
| IV Certification | |||||||