GI Lab / Endoscopy Skills Checklist

Name*

Telephone*

Who is your recruiter?*

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.

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PROCEDURES


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Assist with EGD's
Assist with Endoscopic Ultrasound

Assist with Active GI Bleed

Cautery Devices

Assist with Manometry Studies

Assist with Variceal Banding

Asist with Esophageal Dilatations:

a. Balloon

b. Other types

Assist with Sclerotherapy

Assist with TEE

Assist with Bronchoscopy

Assist with Colonscopy

Assist with Polypectomy

Assist with ERCP's

Assist with PEG placements

Assist with Collection of Hot & Cold Bx's

Specimen Collection & Labeling

Apply External Abdominal Pressure to assist with Scope Movement

Monitoring of Conscious Sedation

PRE / POST PROCEDURES


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Knowledge of Sedation Reversal Agents
O2 Administration

Pulse Oximetry

Scope Cleaning

Set-up of Scopes & Video Equipment

Obtain IV Access

Pre-procedure Checklist

Pre-procedure Teaching

Monitor EKG

Monitor O2 sats

Monitor VS

Use of Sedation Recovery Scale

Airway Management

Assess GI Statue Post-procedure

Assess for Gag Reflex Post EGD

Perform Post Procedure Teaching

MEDICATIONS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Antibiotics
Insulin

Conscious Sedations Medications

Sedation Reversal Agents

EQUIPMENT


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Computer Charting Systems

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.