Critical Care Skills Checklist

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.

My primary critical care experience has been in:

ICU

CCU

MICU

SICU

Neuro

Trauma

CARE OF PATIENTS WITH


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Abdominal Aortic Aneurysm
Acute MI

Angioplasty

Cardiac Arrest

Cardiac Tamponade

Cardiac Transplant

Cardiomyopathy

Congestive Heart Failure

Cor Pulmonale

Deep Vein Thrombosis - DVT

Endocarditis - Bacterial

Endocarditis - Infective

Intracoronary Stent Placement

Myocardial Contusion

Pericarditis

Acute Pneumonia

ARDS

COPD

Lung Transplant

Pulmonary Edema/Hypertension

Pulmonary Embolism

CARE OF PATIENTS WITH


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Status Asthmaticus
Tension Pneumothorax

Tuberculosis

Cerebral Aneurysm

Coma

CVA/TIA

Encephalitis

Intracranial Bleed

Meningitis

Multiple Sclerosis

Neuromuscular Disease

Seizures

Skull Fracture

Spinal Cord Injuries

VP Shunt

Acute Renal Failure

Ileal Conduit Nephrostomy

Renal Rejection Syndrome

Renal Transplant

Hepatic Failure

Hepatitis

Liver Transplant

Diabetes Insipidus

Diabetes Mellitus

Diabetic Ketoacidosis

Insulin Shock

Bowel Obstruction

Esophageal Bleed

GI Bleed

Inflammatory Bowel Disease

Pancreatitis

Paralytic Ileus

Peritonitis

TURP

Urinary Tract Infection

Adrenal Disorders

Hyperthyroidism

CARE OF PATIENTS WITH


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Hypothyroidism
Pituitary Disorders

Multisystem Organ Failure

DIC

Hypothermia

Heat Exhaustion/Stroke

Amputation

Orthopedic Injuries

Osteomyelitis

Anaphylactic Shock

Cardiogenic Shock

Hypovolemic Shock

Neurogenic Shock

Septic Shock

First Degree Burns

Second Degree Burns

Third Degree Burns

Drug Overdose

Hazardous Material Exposure

Malignant Tumors

Near Drowning

Brain Death/Organ Procurement

Chest Trauma

Gun Shot/Stab Wound-Abdomen

Gun Shot/Stab Wound-Chest

Gun Shot/Stab Wound-Head

Multiple Trauma

Electrocution

MRSA/VRE

HIV/AIDS

Leukemia

Bone Marrow Transplant

Delirium Tremens

Renal Trauma

Cardiothoracic Surgery

GI Surgery

Neurosurgery.

Vascular Surgery

Transfusion Reaction

MEDICATION ADMINISTRATION


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Adenosine
Albuterol (Ventolin)

Aminophylline

Amiodarone (Cardarone)

Amrinone (Inocor)

Aquamephyton

Atropine

Bretylium

Charcoal

Chemotherapeutic Agents

Corticosteroids

Dobutamine

Diazepam (Valium)

Digoxin

Diltiazem

Epinephrine

Esmolol

Insulin

Ipecac

Isoetharine (Bronkosol)

Kayexelate

Lactulose

Lasix

Lidocaine

Mannitol

Metaproterenol (Alupent)

Metroprolol (Lopressor)

Nitroprusside

Nitroglycerine

Paralytic Agents

Phenobarbital

Phenytoin (Dilantin)

Procainamide (Pronestyl)

Procainamide (Pronestyl)

Sodium Bicarbonate

Streprokinase

Terbutaline

TPA

MEDICATION ADMINISTRATION


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Vasopressin
Verapamil

Continuous IV Infusion

CAD Pump

Eye/ar Instillations

IM Injections

Insulin Pump

IV Push

Metered Dose Inhalers

Nebulizer

Rectal Infusion

Suppository

SQ Injections

Z Track Injections

PROCEDURES/SKILLS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Admission of Patients to Unit
A-V Fistula Care

Brace/Splint Application

Bronchoscopy (assist with)

Foley/Straight Cath Insertion & Care:

a. Male

b. Female

Bladder Irrigation

Care of Suprapubic Catheter

Cardioversion

Cast Care

Cast Application (assist with)

Charge Nurse Responsibilities

Chemotherapy

Chest Physiotherapy

Chest Tube & Drainage System:

a. Set up

b. Assist with Insertion

c. Care & Maintenance

d. Troubleshooting

e. Removal

CAVH

EKG Intrepretation:

a. 12 lead

b. Arrhythmias

c. Lead Placement

Emergency Tracheostomy-assist

Extubation

Continuous Tube Feeding

Gavage, Intermittent Tube Feeding

Femoral Artery Sheath Mgmt/Removal

Gastric Lavage, Iced Saline

Gastric Suction:

a. Intermittent

b. Continuous

Glascow Coma Scale

Halo Traction/Cervical Tongs

Hemodialysis - Care During/Post

PROCEDURES/SKILLS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Hemodynamic Monitoring, Invasive:
a. Swan-Ganz Cath Insertion Assist

b. Swan-Ganz Cath Care

c. MAP

d. CVP

e. PAWP/Wedge/PA

f. Cardiac Output

g. Cardiac Index

h. SVO2

i. Arterial Line Insertion Assist

j. Arterial Line Care

Hemodynamic Monitoring, Non-Invasive:

a. Auscultation

b. Doppler

c. Automatic BP Cuff

d. Palpation

Interpretation of Lab Results:

a. Blood Gases

b. Blood Chemistry

c. Cardiac Enzymes/Isoenzymes

d. CBC

e. Coagulation Studies

f. Cultures

g. Electrolytes

h. Urine Dipstick

Intestinal Tract Tube Insertion/Care:

a. Gastrostomy Tubes

b. Jejunostomy Tubes

c. Nasogastric Tubes

d. Orogastric Tubes

e. T-tubes (care only)

Intraaortic Balloon Pump

Intracranial Pressure Monitoring

PROCEDURES/SKILLS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Intravenous Infusions:
a. Blood & Blood Products:

i. Albumin

ii. Auto Infusion

iii. Cryoprecipitate

iv. Fresh Frozen Plasma

v. Packed RBCs

vi. Whole Blood

b. Central Line Care:

i. Broviac

ii. Groshong

iii. Hickman

iv. PICC

v. Portacath

vi. Quinton

c. Hyperalimentation

d. Intralipids

e. Peripheral IV insertion & care

i. Angiocath

ii. Butterfly

f. Saline Lock/Heparin Lock

Intubation (assist with)

Isolation Procedures

Lumbar Puncture (assist with)

Nerve Stimulators

Neurological Assessments

Nursing Assessment Care Planning

Oral Airway Insertion

Oxygen Therapy Administration

a. Bag & Mask

b. ET Tube

c. External CPAP

d. Face Mask

e. Nasal Cannula

f. Trach Collar

g. BiPAP

h. Ambu Bag

PROCEDURES / SKILLS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Pacemaker
a. External

b. Permanent

c. Temporary

d. Transthoracic

Peritoneal Dialysis

a. Automatic Cycler

b. Manual

Peritoneal Lavage

Restraints

Specimen Collection

a. Blood

i. Femoral Arterial Stick

ii. Radial Arterial Stick

iii. Arterial Line

iv.Central Line

v. Venous Stick

b. Cultures

c. Sputum

d. Urine

Suctioning:

a. ET Tube - Closed

b. ET Tube - Open

c. Nasal-Pharyngeal

d. Tracheostomy

e. Oral/Yankauer

Temperature:

a. Axillary

b. Oral

c. Tympanic

Suicide Precautions

Thoracentesis/Paracentesis-assist

Ventricular Assist Device (RVAD,LVAD)

Vent Weaning/Interpret Parameters

PROCEDURES / SKILLS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Wound/Ostomy Care:
a. Colostomy Care/Bag Change

b. Ileostomy Care/Bag Change

c. Irrigations

d. Pressure Ulcers

i. Staging

ii. Care

e. Stasis Ulcers

f. Staple Insertion - assist

g. Sterile Dressing Changes

h. Steristrip Application

i. Surgical Wounds with Drains

j. Suturing - assist with

PAIN MANAGEMENT


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Pain Assessment Using Pain Scales
Epidural Analgesia

Amiodarone (Cardarone)

IV Conscious Sedation

Narcotic Agents

Non-Narcotic Agents

Narcotic Agents

Non-Narcotic Agents

Non-Pharmacological Measures

EQUIPMENT


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Automatic BP Cuffs
Cardiac Monitor

Amiodarone (Cardarone)

Centrifuge

Defibrillator

Femoral Hemostasis Devices

Glucometer

Hypo/Hyperthermia Blanket

Infusion Pumps (specific brands):

Oxygen Analyzer

Oxygen Blender

Pulse Ox

Specialty Beds

a. Air Fluidized

b. Low Air Loss

c. Rotating

d. Stryker

Ventilator:

a. CPAP

b. High Frequency Jet

c. Pressure

d. T-piece

e. Volume

Computer Charting Systems

If you use any other Equipment, Please Specify mention below

Infusion Pumps (specific brands)

Specialty Beds

Do you speak any languages other than English?

Yes

No

If yes, which language(s)?

Age Specific Skills

Check the box under EACH age group that you have experience with and are comfortable with for each skill below.

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the different communication needs for the age group & changes communication methods and terminology accordingly

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the different medications, dosages and possible side effects for the age group and administers medications appropriately

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the different safety risks for the age group and alters the environment accordingly

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the normal growth and development for the age group and adapts care accordingly

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

*

I hereby certify that ALL information I have provided to Clover Health Services, 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.