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PICU 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) | WORK SETTINGS | 1 | 2 | 3 | 4 | ||
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PICU | ||||||
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Pediatric CVICU | ||||||
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Pediatric Step Down | ||||||
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Pediatric PACU | ||||||
| Rating Stars (Click) | CARDIOVASCULAR | 1 | 2 | 3 | 4 | ||
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Congenital Heart Disease/Repair | ||||||
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Post Cardiac Surgery (Directly from OR) | ||||||
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Post Cardiac Surgery (NOT Directly from OR) | ||||||
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Post Diagnostic/Interventional Cardiac Cath | ||||||
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Heart Failure/Cardiogenic Shock | ||||||
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Cardiac Transplant | ||||||
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Hemodynamic Monitoring | ||||||
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Arrhythmia Interpretation | ||||||
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Pacemaker - Temporary/Permanent | ||||||
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SVO2 Monitoring | ||||||
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Intra-Aortic Balloon Pump | ||||||
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Ventricular Assist Device | ||||||
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ECMO | ||||||
| Rating Stars (Click) | PULMONARY | 1 | 2 | 3 | 4 | ||
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Respiratory Distress Syndrome/Resp. Failure | ||||||
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Reactive Airway Disease | ||||||
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ENT Surgery | ||||||
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Epiglottis | ||||||
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Cystic Fibrosis | ||||||
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Tuberculosis | ||||||
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Intubation/Extubation | ||||||
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Endotracheal Tube Management | ||||||
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Tracheostomy Management | ||||||
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Modes of Ventilation: AC/PC/SIMV/CPAP | ||||||
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Modes of Ventilation: Jet/Oscillator | ||||||
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Nitric Oxide | ||||||
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Hemo/Pneumothorax | ||||||
| Rating Stars (Click) | NEUROLOGIC/ORTHOPEDIC | 1 | 2 | 3 | 4 | ||
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Brain Injury | ||||||
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Craniotomy | ||||||
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Spinal Cord Injury | ||||||
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Seizure Disorders | ||||||
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ICP Monitoring | ||||||
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VP Shunt | ||||||
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Meningitis | ||||||
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Neuromuscular Disease | ||||||
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Post Vertebral Surgery | ||||||
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Traction - General | ||||||
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Traction - Halo | ||||||
| Rating Stars (Click) | GASTROINTESTINAL | 1 | 2 | 3 | 4 | ||
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Acute Surgical Abdomen | ||||||
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GI Bleeding | ||||||
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Pancreatitis | ||||||
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Hepatic Failure | ||||||
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Ostomy Management | ||||||
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Management of Gastric Tubes | ||||||
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Breast Milk Handling/Storage | ||||||
| Rating Stars (Click) | RENAL/GENITOURINARY | 1 | 2 | 3 | 4 | ||
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Nephrotic Syndrome | ||||||
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Renal Transplant | ||||||
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Renal Replacement Therapy | ||||||
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Peritoneal Dialysis | ||||||
| Rating Stars (Click) | ENDOCRINE/METABOLIC | 1 | 2 | 3 | 4 | ||
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Diabetes - Hypo/Hyperglycemic Crisis | ||||||
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Diabetic Ketoacidosis | ||||||
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IV Insulin Pumps | ||||||
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Indwelling Insulin Pumps | ||||||
| Rating Stars (Click) | TRAUMA/OTHER | 1 | 2 | 3 | 4 | ||
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Blunt/Penetrating Trauma | ||||||
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Burns | ||||||
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Craniofacial Reconstruction | ||||||
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Near Drowning | ||||||
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Poison Ingestion/Overdose | ||||||
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Bites-Animal/Snake/Human | ||||||
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Suicide Precautions | ||||||
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Wound Management/VAC | ||||||
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Specialty Beds | ||||||
| Rating Stars (Click) | ONCOLOGY | 1 | 2 | 3 | 4 | ||
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Bone Marrow Transplant | ||||||
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Immunosuppressive Disorder | ||||||
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Hemophilia Crisis | ||||||
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Sickle Cell Crisis | ||||||
| Rating Stars (Click) | MEDICATIONS | 1 | 2 | 3 | 4 | ||
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Pediatric Dosage Calculations | ||||||
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Anti-Arrhythmics | ||||||
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Anticoagulants (IV, Oral & Injection) | ||||||
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Anti-Hypertensives | ||||||
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Anti-Seizure Medications | ||||||
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Benzodiazepines | ||||||
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Continuous IV Paralytics | ||||||
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Continuous IV Sedation | ||||||
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Procedural Sedation - Administration | ||||||
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Diuretics | ||||||
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Emergency Medication | ||||||
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Inhaled Medications | ||||||
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Insulin | ||||||
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IV Vasopressors | ||||||
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Narcotics/Opioid Analgesics (IV, Oral & Injection) | ||||||
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Non-Opioid Analgesics (IV, Oral & Injection) | ||||||
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Reversal Agents | ||||||
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Steroids (IV, Oral, Inhaled) | ||||||
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Automated Medication Dispensing (i.e. Pyxis, Omnicell) | ||||||
| Rating Stars (Click) | IV THERAPY | 1 | 2 | 3 | 4 | ||
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Starting Ivs | ||||||
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Central Line Blood Draw | ||||||
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Central Line/Implanted Line Care | ||||||
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TPN/Lipids | ||||||
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Blood Product Administration | ||||||
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Administration of Chemotherapy | ||||||
| Rating Stars (Click) | CARDIAC MONITORING & EMERG. RESPONSE | 1 | 2 | 3 | 4 | ||
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Dysrhythmia Interpretation | ||||||
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Dysrhythmia Management | ||||||
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Management of Cardiac Arrest | ||||||
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Shock Management | ||||||
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Malignant Hyperthermia | ||||||
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Multisystem Organ Failure | ||||||
| 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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Recognize/Report Signs of Abuse | ||||||
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EMTALA | ||||||
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Fall Risk Assessment/Prevention | ||||||
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Pressure Ulcer Risk Assessment/Prevention | ||||||
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Restraints/Use of Least Restrictive Device | ||||||
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Normal Growth and Development | ||||||
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Age Specific/Population Based Care | ||||||
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Patient Family Teaching | ||||||
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Isolation Precautions | ||||||
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Infection Prevention | ||||||
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Reporting Communicable Diseases | ||||||
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Pain Assessment & Management | ||||||
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Charge Experience | ||||||
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Interpretation and Communication of Lab Values | ||||||
| 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) | ||||||
| Rating Stars (Click) | EMR | 1 | 2 | 3 | 4 | ||
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Epic | ||||||
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Cerner | ||||||
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Eclipsys | ||||||
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McKesson | ||||||
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Meditech | ||||||
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Other Computerized System | ||||||
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Computerized Physician Order Entry | ||||||
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Bar Coding for Medication Administration | ||||||
| EMR Conversion | |||||||
| CERTIFICATIONS | Expiry Date : | ||||||
| BLS | |||||||
| PALS | |||||||
| ACLS | |||||||
| PEARS | |||||||
| ENPC | |||||||
| CEN | |||||||
| TNCC | |||||||
| Other: Specify | |||||||
| Other: Specify | |||||||