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RESPIRATORY THERAPIST 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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Care of Patient in Restraints | ||||||
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Electronic Documentation | ||||||
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Isolation Precautions | ||||||
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Medicare Documentation | ||||||
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Patient/Family Education | ||||||
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Written Documentation | ||||||
| Rating Stars (Click) | Care of Patients With | 1 | 2 | 3 | 4 | ||
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Acute/Chronic Bronchitis | ||||||
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ARDS | ||||||
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Aspiration Pneumonia | ||||||
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Asthma | ||||||
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Atelectasis | ||||||
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Bacterial/Viral Pneumonia | ||||||
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Bronchiectasis | ||||||
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Broncho-Pulmonary Dysplasia | ||||||
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Cardiac Surgery | ||||||
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Congestive Heart Failure | ||||||
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Croup | ||||||
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Cystic Fibrosis | ||||||
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Diabetic Ketoacidosis | ||||||
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Emphysema | ||||||
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Epiglottitis | ||||||
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Failure to Thrive | ||||||
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Fem-pop Bypass | ||||||
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Gullian Barre | ||||||
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Hayaline Membrane Disease (HMD/IRDS) | ||||||
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Lung Cancer | ||||||
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Meconium Aspiration | ||||||
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Myasthenia Gravis | ||||||
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Myesthena Gravis | ||||||
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Myocardial Infarction | ||||||
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Near Drowning | ||||||
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Neonatal Pneumonia | ||||||
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Open Hearts | ||||||
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Pacemakers | ||||||
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Persistant Fetal Circulation | ||||||
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Pulmonary Interstitial Emphysema (PIE) | ||||||
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Pleural Effusion | ||||||
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Pulmonary Edema | ||||||
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Pulmonary Embolism | ||||||
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Respiratory Failure | ||||||
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Respiratory Syncytial Virus | ||||||
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Respiratory Distress Syndrome | ||||||
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Respiratory Distress Syndrome | ||||||
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Tracheo-Esophageal Fistula | ||||||
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Transient Tachpnea | ||||||
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Thoracotomies | ||||||
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Tuberculosis | ||||||
| Rating Stars (Click) | Therapy and Procedures | 1 | 2 | 3 | 4 | ||
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Apnea Monitor | ||||||
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Assessment of Breath Sounds | ||||||
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Carbogen Delivery | ||||||
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Diaphragmatic Breathing | ||||||
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Disinfection and Sterilization | ||||||
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End-Tidal CO2 Monitoring | ||||||
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Nasal-Oral Airway Placement | ||||||
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Oximetry | ||||||
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Pursed Lip Breathing | ||||||
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Transcutaneous Monitoring | ||||||
| Oxygen Administration: | |||||||
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Acapella | ||||||
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Aerosol Set Up/Mask/Trach | ||||||
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Analyze Oxygen | ||||||
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BiPAP Nasal/Mask | ||||||
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Bronchial Hygiene Therapy | ||||||
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Chest Physical Therapy/Postural Drainage | ||||||
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CPAP Nasal/Mask | ||||||
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Continuous Medication Nebulizer | ||||||
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Cough Assisted machine | ||||||
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Croup Tent Set Up | ||||||
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EzPAP Expansion Therapy | ||||||
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Flutter Valve Therapy | ||||||
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Hand Held Nebulizer | ||||||
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Heated Aerosol Mask/Trach Collar | ||||||
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Heliox Delivery | ||||||
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Incentive Spirometry (IS) | ||||||
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Infant Hood Set Up | ||||||
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Intrapulmonary Percussive Ventilation (IPV) | ||||||
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Metered Dose Inhaler | ||||||
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Nasal Cannula | ||||||
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Nitric Oxide Delivery | ||||||
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Oxgen Tank Set Up/Change Tank | ||||||
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Partial Rebreather/Non-Rebreather Mask | ||||||
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PEP Mask/PEP Valve Therapy | ||||||
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Positive Pressure Breathing (IPPB) | ||||||
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Simple Mask | ||||||
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Splint Cough | ||||||
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Sputum Induction | ||||||
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Venturi Mask | ||||||
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Vest Airway Clearance | ||||||
| Obtaining Arterial Blood Gases: | |||||||
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ABG Interpretation/Analyzer | ||||||
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Airway Pressure Release Ventilation (ARPV) | ||||||
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Allen Test | ||||||
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Arterial Blood Gas Analysis | ||||||
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Arterial Line Insertion | ||||||
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Arterial Line Maintenance | ||||||
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Bronchoscopies/Assist | ||||||
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Change, Clean Trach Tubes | ||||||
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Check Intracuff Pressures | ||||||
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Continuous Positive Airway Pressure (CPAP) | ||||||
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Endotracheal | ||||||
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Extubations | ||||||
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Perform Independently | ||||||
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Assist Only | ||||||
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Femoral Artery | ||||||
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Flow/Volume/Pressure Waveform Interpretation | ||||||
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High Frequency Ventilator | ||||||
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Independent Sychronous Lung Ventilation | ||||||
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Inhaler Reservoirs | ||||||
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Intra Aortic Balloon Pump (IABP) | ||||||
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Intubations | ||||||
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Perform Independently | ||||||
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Assist Only | ||||||
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Inverse Ratio Ventilation | ||||||
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Nasotracheal | ||||||
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Negative Inspiratory Force | ||||||
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Peak Flow Rat Monitoring | ||||||
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Positive End Expiratory Pressure (PEEP) | ||||||
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Pressure Assist/Control | ||||||
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Pressure Regulated Volume Control (PRVC) | ||||||
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Pressure Support Ventilation (PSV) | ||||||
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Pulmonary Function Testing | ||||||
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Pulmonary Stress Testing | ||||||
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Radial/Brachial Artery | ||||||
| Ventilator Management: | |||||||
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Intermittent Mandatory Ventilation (IMV) | ||||||
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Inverse Ratio Ventilation | ||||||
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Pressure Release Modes/Techniques | ||||||
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Suctioning | ||||||
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Synchronized Intermittent Mandatory Ventilation (SIMV) | ||||||
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Ventilate Patient with Manual Resuscitator | ||||||
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Ventilator Modes | ||||||
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Ventilator Set Up/On Tanks | ||||||
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Volume Assist/Control | ||||||
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Other: | ||||||
| Rating Stars (Click) | Settings | 1 | 2 | 3 | 4 | ||
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Acute Care | ||||||
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Adult Critical Care Unit | ||||||
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Burn ICU | ||||||
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Emergency Room | ||||||
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Home Care | ||||||
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Medical/Surgical General Floor Care | ||||||
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Neonatal ICU Level II | ||||||
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Neonatal ICU Level III | ||||||
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Pediatric General Floor Care | ||||||
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Pediatric ICU | ||||||
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Pediatric ICU Level II | ||||||
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Pediatric ICU Level III | ||||||
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Pulmonary Rehabilitation | ||||||
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Pulmonary Function Lab | ||||||
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Skilled Nursing | ||||||
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Sleep Lab | ||||||
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Transplant | ||||||
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Transports | ||||||
| Rating Stars (Click) | Equipment | 1 | 2 | 3 | 4 | ||
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Bird/Avea | ||||||
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Drager | ||||||
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Puritan-Bennett | ||||||
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Sechrist-Infant Star | ||||||
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Servo | ||||||
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Siemens | ||||||
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SIMS | ||||||
| Rating Stars (Click) | Age | 1 | 2 | 3 | 4 | ||
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Newborn (birth – 30 days) | ||||||
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Infant (30 days – 1 year) | ||||||
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Toddler (1 – 3 years) | ||||||
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Preschooler (3 – 5 years) | ||||||
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School Age (5 – 12 years) | ||||||
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Adolescents (12 – 18 years) | ||||||
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Young Adults (18 – 39 years) | ||||||
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Middle Adults (39 – 64 years) | ||||||
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Older Adults (64+ years) | ||||||
| Please list any Additional Skills: | |||||||
| 1 | |||||||
| 2 | |||||||
| 3 | |||||||
| 4 | |||||||
| Additional training: | |||||||
| 1 | |||||||
| 2 | |||||||
| 3 | |||||||
| 4 | |||||||
| Additional tools and equipment: | |||||||
| 1 | |||||||
| 2 | |||||||
| 3 | |||||||
| 4 | |||||||