CVICU

Cardiovascular
AssessmentsProficiencyFrequency

Normal Heart Tones (i.e.:S1,S2)

1

2

3

4

1

2

3

4

Abnormal heart tones(i.e.: murmur, gallop,
friction rub)

1

2

3

4

1

2

3

4

Identification of PMI (Point Maximal Intensity)

1

2

3

4

1

2

3

4

Blood Pressure (non-invasive)

1

2

3

4

1

2

3

4

Pulses/Circulation via palpation

1

2

3

4

1

2

3

4

Pulses/Circulation via doppler

1

2

3

4

1

2

3

4

Inspection insertion site invasive lines

1

2

3

4

1

2

3

4

12-lead EKG interpretation

1

2

3

4

1

2

3

4

EKG Changes for MI

1

2

3

4

1

2

3

4

Rhythm interpretation

1

2

3

4

1

2

3

4

Incisional wound assessment

1

2

3

4

1

2

3

4

S/S DVT

1

2

3

4

1

2

3

4

Provision of Care for:ProficiencyFrequency

Fresh Post-op CABG

1

2

3

4

1

2

3

4

Fresh Post-op AVR

1

2

3

4

1

2

3

4

Fresh Post-op MVR

1

2

3

4

1

2

3

4

AAA Repair

1

2

3

4

1

2

3

4

Heart Transplant

1

2

3

4

1

2

3

4

Post cardiac surgery complications

1

2

3

4

1

2

3

4

Fem-Pop Bypass

1

2

3

4

1

2

3

4

Fem-Fem Bypass

1

2

3

4

1

2

3

4

Myocardial contusion

1

2

3

4

1

2

3

4

Pericardial Window

1

2

3

4

1

2

3

4

Post AICD Insertion

1

2

3

4

1

2

3

4

Carotid Endarterectomy

1

2

3

4

1

2

3

4

Cardiac Arrest

1

2

3

4

1

2

3

4

MI

1

2

3

4

1

2

3

4

CHF

1

2

3

4

1

2

3

4

Pericardial Effusion

1

2

3

4

1

2

3

4

Cardiac Tamponade

1

2

3

4

1

2

3

4

Pericarditis

1

2

3

4

1

2

3

4

LVAD(Left Ventricular Assist Device)

1

2

3

4

1

2

3

4

RVAD(Right Ventricular Assist Device)

1

2

3

4

1

2

3

4

Procedures:ProficiencyFrequency

Obtain Cardiac Output

1

2

3

4

1

2

3

4

PCWP Measurement

1

2

3

4

1

2

3

4

Obtain CVP Measurement

1

2

3

4

1

2

3

4

Removal of radial arterial line

1

2

3

4

1

2

3

4

Removal of femoral sheath

1

2

3

4

1

2

3

4

Venipuncture

1

2

3

4

1

2

3

4

Obtain lab specimens from A-line

1

2

3

4

1

2

3

4

Obtain lab specimens from Central Line

1

2

3

4

1

2

3

4

Perform 12-lead EKG

1

2

3

4

1

2

3

4

Proper Cardiac Monitor lead placement

1

2

3

4

1

2

3

4

Incisional Wound Care as applicable

1

2

3

4

1

2

3

4

Management of:ProficiencyFrequency

IV conscious sedation

1

2

3

4

1

2

3

4

Blood and blood products

1

2

3

4

1

2

3

4

Identify blood transfusion reactions

1

2

3

4

1

2

3

4

Hemodynamic Monitoring:ProficiencyFrequency

Management of Arterial Line

1

2

3

4

1

2

3

4

Management of PA/Swan-Ganz

1

2

3

4

1

2

3

4

Management of CVP Line

1

2

3

4

1

2

3

4

Management of multiple invasive lines

1

2

3

4

1

2

3

4

Zero and calibration of transducers

1

2

3

4

1

2

3

4

Assess adequate perfusion of affected
extremity with invasive lines

1

2

3

4

1

2

3

4

Management of IABP:ProficiencyFrequency

Waveform interpretation

1

2

3

4

1

2

3

4

Determination of appropriate timing

1

2

3

4

1

2

3

4

Perfusion assessment of affected extremity

1

2

3

4

1

2

3

4

Recognize IABP complications

1

2

3

4

1

2

3

4

Pacemaker:ProficiencyFrequency

PPM

1

2

3

4

1

2

3

4

Transvenous

1

2

3

4

1

2

3

4

Transcutaneous

1

2

3

4

1

2

3

4

Management of Temporary Pacemaker:ProficiencyFrequency

Recognition of failure to sense, capture

1

2

3

4

1

2

3

4

Manipulation of TPM settings

1

2

3

4

1

2

3

4

Troubleshoot TPM settings

1

2

3

4

1

2

3

4

Management of epicardial wires

1

2

3

4

1

2

3

4

Identification and interpretation of:ProficiencyFrequency

Arterial waveform

1

2

3

4

1

2

3

4

PA/Swan-Ganz waveform

1

2

3

4

1

2

3

4

PCWP waveform

1

2

3

4

1

2

3

4

CVP waveform

1

2

3

4

1

2

3

4

SVO2 Data

1

2

3

4

1

2

3

4

Perform calculations for:ProficiencyFrequency

PVR

1

2

3

4

1

2

3

4

SVR

1

2

3

4

1

2

3

4

MAP

1

2

3

4

1

2

3

4

Assist with:ProficiencyFrequency

Set-Up for Cardioversion

1

2

3

4

1

2

3

4

Cardioversion

1

2

3

4

1

2

3

4

Central Line insertion

1

2

3

4

1

2

3

4

CAVH-D

1

2

3

4

1

2

3

4

Emergency Open Chest

1

2

3

4

1

2

3

4

Arterial line insertion

1

2

3

4

1

2

3

4

PA/Swan-Ganz insertion

1

2

3

4

1

2

3

4

Chest Tube insertion

1

2

3

4

1

2

3

4

Chest Tube Removal

1

2

3

4

1

2

3

4

Emergency Tracheostomy

1

2

3

4

1

2

3

4

Pericardiocentesis

1

2

3

4

1

2

3

4

Transesophageal Echocardiogram

1

2

3

4

1

2

3

4

Thoracentesis

1

2

3

4

1

2

3

4

Emergency Intubation

1

2

3

4

1

2

3

4

Pulmonary
Assessment :ProficiencyFrequency

Auscultation of breath sounds

1

2

3

4

1

2

3

4

Identify adventitious lung sounds

1

2

3

4

1

2

3

4

Auscultate for confirmation of ET Tube placement

1

2

3

4

1

2

3

4

Implement Ventilator Acquired Pneumonia protocols

1

2

3

4

1

2

3

4

Assess and confirm proper vent settings

1

2

3

4

1

2

3

4

Manage Patient on machanical ventilation

1

2

3

4

1

2

3

4

Assist with post-extubation care

1

2

3

4

1

2

3

4

Application of BiPAP

1

2

3

4

1

2

3

4

Application of CPAP

1

2

3

4

1

2

3

4

Maintenance of pulmonary stability post-extubation

1

2

3

4

1

2

3

4

Application of Pulse Oximetry

1

2

3

4

1

2

3

4

Interpretation of Pulse Oximetry Values

1

2

3

4

1

2

3

4

Procedures:ProficiencyFrequency

Perform ET Tube suctioning

1

2

3

4

1

2

3

4

Perform NT(Nasotracheal) suctioning

1

2

3

4

1

2

3

4

Perform suctioning of Tracheostomy

1

2

3

4

1

2

3

4

Collection of Sputum via NT Suction

1

2

3

4

1

2

3

4

Collection of Sputum Specimen via ET w/specimen
Trap

1

2

3

4

1

2

3

4

Assist with extubation of patient

1

2

3

4

1

2

3

4

Chest Tubes:ProficiencyFrequency

Perform Chest Tube Set-up

1

2

3

4

1

2

3

4

Monitor & record output

1

2

3

4

1

2

3

4

Identify and troubleshoot clotted chest tube

1

2

3

4

1

2

3

4

Identify and troubleshoot patient bleeding

1

2

3

4

1

2

3

4

Identify presence of air leak

1

2

3

4

1

2

3

4

Gastroenterology
Assessment:ProficiencyFrequency

Bowel Sounds

1

2

3

4

1

2

3

4

Proper N/G Tube placement

1

2

3

4

1

2

3

4

Provision of care for GI Bleed

1

2

3

4

1

2

3

4

Procedures:ProficiencyFrequency

Insertion of N/G Tube

1

2

3

4

1

2

3

4

Removal of N/G Tube

1

2

3

4

1

2

3

4

LIS (low intermittent suction)

1

2

3

4

1

2

3

4

Continuous Suction

1

2

3

4

1

2

3

4

Endocrine
Provision of Care for:ProficiencyFrequency

Diabetes mellitus

1

2

3

4

1

2

3

4

Diabetic ketoacidosis

1

2

3

4

1

2

3

4

Diabetes Insipidus

1

2

3

4

1

2

3

4

Addison’s Disease

1

2

3

4

1

2

3

4

Hyperthyroidism

1

2

3

4

1

2

3

4

Hypothyroidism

1

2

3

4

1

2

3

4

Insulin Shock

1

2

3

4

1

2

3

4

Procedures:ProficiencyFrequency

Fingerstick blood glucose

1

2

3

4

1

2

3

4

Implementation of Sliding Scale

1

2

3

4

1

2

3

4

Equipment:ProficiencyFrequency

Blood glucose monitoring

1

2

3

4

1

2

3

4

Use of Insulin Pen

1

2

3

4

1

2

3

4

Use of Lancet

1

2

3

4

1

2

3

4

Neurology
Assessment:ProficiencyFrequency

Cranial Nerves

1

2

3

4

1

2

3

4

Glasgow Coma Scale

1

2

3

4

1

2

3

4

Pathologic Reflexes

1

2

3

4

1

2

3

4

Reflex/Motor Deficits

1

2

3

4

1

2

3

4

Visual/Communication Deficits

1

2

3

4

1

2

3

4

Provision of care for:ProficiencyFrequency

CVA

1

2

3

4

1

2

3

4

TIA

1

2

3

4

1

2

3

4

Encephalopathy

1

2

3

4

1

2

3

4

Procedures:ProficiencyFrequency

CRRT

1

2

3

4

1

2

3

4

CAVH dialysis

1

2

3

4

1

2

3

4

Hemodialysis

1

2

3

4

1

2

3

4

Provision of care for:ProficiencyFrequency

Hypovolemic Shock

1

2

3

4

1

2

3

4

Cardiogenic Shock

1

2

3

4

1

2

3

4

Septic Shock

1

2

3

4

1

2

3

4

Disseminated intravascular coagulation (DIC )

1

2

3

4

1

2

3

4

Organ/tissue donation

1

2

3

4

1

2

3

4

Implementation of Core Measures

1

2

3

4

1

2

3

4

Labs
Interpretation of:ProficiencyFrequency

ABG's

1

2

3

4

1

2

3

4

BUN/Creatinine

1

2

3

4

1

2

3

4

Electrolytes

1

2

3

4

1

2

3

4

Coagulation Studies

1

2

3

4

1

2

3

4

Cardiac Enzymes

1

2

3

4

1

2

3

4

Blood glucose

1

2

3

4

1

2

3

4

Thyroid Panel

1

2

3

4

1

2

3

4

CBC

1

2

3

4

1

2

3

4

Patient EducationProficiencyFrequency

Turn, cough, and deep breathing technique

1

2

3

4

1

2

3

4

Splinting technique post cardiac surgery

1

2

3

4

1

2

3

4

Use of incentive spirometer

1

2

3

4

1

2

3

4

Importance of increasing mobility post-cardiac
surgery when applicable

1

2

3

4

1

2

3

4

Cardiovascular Pharmacology
Provision of Care:ProficiencyFrequency

Titrate vasopressors to effect/parameters

1

2

3

4

1

2

3

4

Assess for therapeutic response

1

2

3

4

1

2

3

4

Perform manage dosage drip calculations

1

2

3

4

1

2

3

4

Medications:ProficiencyFrequency

Alupent (Metaproterenol)

1

2

3

4

1

2

3

4

Amicar

1

2

3

4

1

2

3

4

Aminophylline (Theophylline)

1

2

3

4

1

2

3

4

Amiodarone (Cordarone)

1

2

3

4

1

2

3

4

Atropine

1

2

3

4

1

2

3

4

Apresoline

1

2

3

4

1

2

3

4

Bretylium (Bretylol)

1

2

3

4

1

2

3

4

Corticosteroids

1

2

3

4

1

2

3

4

Digoxin (Lanoxin)

1

2

3

4

1

2

3

4

Diltiazem (Cardizem)

1

2

3

4

1

2

3

4

Dobutamine (Dobutrex)

1

2

3

4

1

2

3

4

Dopamine (Intropin)

1

2

3

4

1

2

3

4

Epinephrine (Adrenalin)

1

2

3

4

1

2

3

4

Esmolol (Brevibloc)

1

2

3

4

1

2

3

4

Heparin Drip

1

2

3

4

1

2

3

4

Inocor (Amrinone)

1

2

3

4

1

2

3

4

Levophed

1

2

3

4

1

2

3

4

Lidocaine

1

2

3

4

1

2

3

4

Metoprolol (Lopressor)

1

2

3

4

1

2

3

4

Neosynephrine

1

2

3

4

1

2

3

4

Nipride (Nitroprusside)

1

2

3

4

1

2

3

4

Nitroglycerin (Tridil)

1

2

3

4

1

2

3

4

Procainamide (Pronestyl)

1

2

3

4

1

2

3

4

Propofol (Diprivan)

1

2

3

4

1

2

3

4

Sodium Bicarbonate

1

2

3

4

1

2

3

4

Succinylcholine

1

2

3

4

1

2

3

4

Vasopressin

1

2

3

4

1

2

3

4

Verapamil (Calan, Isoptin, Verelan)

1

2

3

4

1

2

3

4

Vecuronium

1

2

3

4

1

2

3

4

Electrolyte Replacement Therapy

1

2

3

4

1

2

3

4

Patient AdvocacyProficiencyFrequency

Provide care for end-of-life decisions that families face in ICU such as withdrawal of life support

1

2

3

4

1

2

3

4

Adhere to legal procedures regarding notification
of organ donation provider

1

2

3

4

1

2

3

4

Demonstrate Spiritual and Cultural Considerations
for the Critical Care patient

1

2

3

4

1

2

3

4

Provide for the integration of comfort care and
death with dignity

1

2

3

4

1

2

3

4

Demonstrate effective coping skills in caring for
the critica l care patient

1

2

3

4

1

2

3

4

Age SpecificProficiencyFrequency

Please indicate the frequence with which you provide care for each age group:

Infant (Birth to 1 year)

1

2

3

4

1

2

3

4

Toddler (1-3 years)

1

2

3

4

1

2

3

4

Pre-school (3-6 years)

1

2

3

4

1

2

3

4

School Age (6-12 years)

1

2

3

4

1

2

3

4

Adolescent (12-18 years)

1

2

3

4

1

2

3

4

Young Adult (18-30 years)

1

2

3

4

1

2

3

4

Mature Adult (30-60 years)

1

2

3

4

1

2

3

4

Elderly (>60 years)

1

2

3

4

1

2

3

4

Years Experience in Clinical Speciality :

Most recent facility worked at :

* 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.

Proficiency : -	1 = Never Performed	2 = Limited Experience	3 = Comfortable Performing	4 = Proficient
Frequency : -	1 = Never	2 = Sometimes	3 = Often	4 = Always