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Wound Care & Ostomy 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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Acute Care – Adult | ||||||
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Clinic – Adult | ||||||
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SNF/LTAC/Subacute | ||||||
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Hospice / Palliative Care | ||||||
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Acute/Long Term Care – Pediatrics | ||||||
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Clinic – Pediatrics | ||||||
| Rating Stars (Click) | PRESSURE ULCERS | 1 | 2 | 3 | 4 | ||
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Assessment | ||||||
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Staging | ||||||
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Prevention/
Risk Assessment Tools – Adult |
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Prevention/ Risk Assessment Tools -Pediatrics | ||||||
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Support Surface Selection | ||||||
| Rating Stars (Click) | NEUROPATHIC ULCERS | 1 | 2 | 3 | 4 | ||
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Assessment | ||||||
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Management | ||||||
| Rating Stars (Click) | VENOUS STASIS ULCERS | 1 | 2 | 3 | 4 | ||
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Assessment | ||||||
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Management | ||||||
| Rating Stars (Click) | PERIPHERAL ARTERIAL ULCERS | 1 | 2 | 3 | 4 | ||
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Assessment | ||||||
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Ankle Brachial Index | ||||||
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Management | ||||||
| Rating Stars (Click) | OTHER WOUNDS | 1 | 2 | 3 | 4 | ||
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Fistulae – Pouching / Skin Care | ||||||
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Skin Care/ Management of Drains | ||||||
| Rating Stars (Click) | WOUND DEBRIDEMENT | 1 | 2 | 3 | 4 | ||
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Autolytic | ||||||
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Enzymatic | ||||||
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Mechanical | ||||||
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Sharp | ||||||
| Rating Stars (Click) | DRESSINGS/ TREATMENTS | 1 | 2 | 3 | 4 | ||
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Hydrogels | ||||||
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Hydrocolloids | ||||||
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Silver Products | ||||||
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Foams | ||||||
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Alginates | ||||||
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Vacuum Assisted Closure | ||||||
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Growth Factors | ||||||
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Skin Substitutes | ||||||
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Hyperbaric Oxygen Therapy | ||||||
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Wound Cultures | ||||||
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Electrical Stimulation | ||||||
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Enzymatic Debriding Agents | ||||||
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Mist Therapy | ||||||
| Rating Stars (Click) | COLOSTOMY / ILEOSTOMY | 1 | 2 | 3 | 4 | ||
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Ostomy Equipment Selection | ||||||
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Continence Skin Care Management | ||||||
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Loop with Rod Stoma | ||||||
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End Stoma | ||||||
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Mucous Fistula | ||||||
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Double Barrel Stoma | ||||||
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Irrigation | ||||||
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Ileal Lavage | ||||||
| Rating Stars (Click) | CONTINENT ILEOSTOMY | 1 | 2 | 3 | 4 | ||
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Knock pouch | ||||||
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Pelvic Pouch | ||||||
| Rating Stars (Click) | UROSTOMY / CONTINENT | 1 | 2 | 3 | 4 | ||
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Catherization for C&S | ||||||
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Knock Pouch | ||||||
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Neobladder | ||||||
| Rating Stars (Click) | CONTINENCE THERAPEUTIC DEVICES | 1 | 2 | 3 | 4 | ||
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Vaginal Cones | ||||||
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Penile Clamps | ||||||
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Male External Catheters | ||||||
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Internal Urethral Inserts | ||||||
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Catheters –Mgmt & Self Care Teaching | ||||||
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Magnetic Therapy | ||||||
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Urinary Incontinence Program | ||||||
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Fecal Incontinence Program | ||||||
| Rating Stars (Click) | BURNS | 1 | 2 | 3 | 4 | ||
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Burn Management | ||||||
| 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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Patient Family Teaching | ||||||
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Age Specific/Population Based Care | ||||||
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Isolation Precautions | ||||||
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Infection Precautions | ||||||
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Pain assessment & Management | ||||||
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Interpretation & Communication of Lab Values | ||||||
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EMR | ||||||
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EPIC | ||||||
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Cerner | ||||||
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Eclipsys | ||||||
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McKesson | ||||||
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Other Computerized System | ||||||
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Computerized Physician Order Entry | ||||||
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Bar coding for Medication | ||||||
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Culture | ||||||
| Rating Stars (Click) | OTHER / MISC. | 1 | 2 | 3 | 4 | ||
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Pain Management Assessment of Pain Levels without intervention | ||||||
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Pain Management Response Assessment with Intervention | ||||||
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Experience: Charge Duty | ||||||
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Experience: Preceptor | ||||||
| Rating Stars (Click) | AGE SPECIFIC CARE | 1 | 2 | 3 | 4 | ||
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Infant (Birth to 1 year) | ||||||
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Toddler (1-3 years) | ||||||
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Pre-school (3-6 years) | ||||||
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School Age (6-12 years) | ||||||
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Adolescent (12-18 years) | ||||||
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Young Adult (18-30 years) | ||||||
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Mature Adult (30-60 years) | ||||||
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Elderly (>60 years) | ||||||