Home Health Skill 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.

GENERAL SKILLS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Standard Precautions
Isolation Precautions

Pediatric Respiratory/Cardiac Arrest

Adult Respiratory/Cardiac Arrest

Defibrillators

Care Planning & Discharge Planning

Patient/Family Education

Pain Management

Electronic Documentation

Patient Head to Toe Assessment

CARDIOVASCULAR


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Assessment:
Angina

Apical Pulse Rate/Rhythm

Cardiac Auscultation (Rate, Rhythm)

Clinical Identification of Arrhythmias

Fluid Overload

Peripheral Pulses/Circulation Checks

Interpretation of Lab Results:

PT/PTT/INR

Serum Electrolytes

Equipment & Procedures:

Holter Monitor

Pacemaker/AID

Care of Patient With:

CAD/Post Myocardial Infarction (MI)

Congestive Heart Failure (CHF)

Fluid Retention

Hypertension

Pre/Post Cardiac Surgery

Pre/Post Vascular Surgery

Medication Administration:

ACE Inhibitors

Anti-arrhythmic

Antibiotics

Anticoagulants

Antihypertensives

Antiplatelet Medications

Beta Blockers

Calcium Channel Blockers

Diuretics

Digoxin (Lanoxin)

Oral and Topical Nitrates

Narcotics

Potassium Supplements

Statin Medications

PULMONARY


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Assessment:
Auscultation of Lung Sounds/Rate & Work of Breathing

Pulse Oximetry

ABGs

Equipment & Procedures:

Administration of O2 via Nasal Cannula

Apnea Monitor

Chest Percussion

Establishing an Airway

Incentive Spirometry

Orotracheal and Nasotracheal Suctioning

Sputum Specimen Collection

Nebulizer

CPAP

BiPAP

Ventilator Management

Care of Patient With:

Asthma

Chronic Obstructive Pulmonary Disease (COPD)

Lung Cancer

Primary Pulmonary Hypertension

Pulmonary Fibrosis

Pulmonary Emboli

Medication Administration:

Bronchodilators

Steroids

Expectorants

Inhalers

NEUROLOGICAL


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Assessment:
Neurological Signs/Level of Consciousness (LOC)

Neuro-Motor/Sensory Functions

Equipment & Procedures:

Seizure Precautions

Traction

Care of Patient With:

Alzheimer’s Disease

Dementia

Degenerative Neurological Disorders (ALS, MS, etc.)

Cerebral Tumors

Post-Cerebrovascular Accident

Guillain-Barre Syndrome

Hemiparesis

Meningitis

Parkinson’s Disease

Seizure Disorders

Paraplegia/Quadriplegia

Traumatic Brain Injury (TBI)

Transient Ischemic Attacks (TIAs)

Medication Administration:

Alzheimer’s Medications

Anti-Parkinson’s Medications

Anti-Seizure Medications

Corticosteroids

Sedative/Hypnotics

ORTHOPEDICS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Assessment:
Circulation/Skin Checks

Gait

Range of Motion

Equipment & Procedures:

Range of Motion (Active & Passive)

Cast/Brace

Crutch/Walking

Assistive Devices

TENS Units

Wheelchairs/Lift Equipment

Total Hip/Knee/Joint Replacement

Medication Administration:

Enoxaparin (Lovenox)

GASTROINTESTINAL


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Assessment:
Bowel Sounds

Bowel Habits

Fluid Balance

Nutritional Status

Equipment & Procedures:

Colostomy/Ileostomy Care

Long-Term Feeding Tube

Nasogastric (NG) Tube

PEG/Gastronomy Tube

Drainage Devices/Tubes

Tube Feeding

Feeding Pumps

Care of Patient With:

Bowel Obstruction

Fecal Incontinence

Gastrointestinal Bleeding (G.I. Bleed)

Post-Gastrointestinal Surgery

Hepatitis

Inflammatory Bowel Disease

Liver Failure/Transplant

RENAL/GENITOURINARY


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Assessment:
Arterio-Venous Fistula/Shunt

Fluid Balance

Interpretation of Lab Results:

Blood Urea Nitrogen (BUN)

Serum Creatinine

Serum Electrolytes

Equipment & Procedures:

3-Way Bladder Catheter

Foley Catheter Insertion/Maintenance

Straight Catheterization

Self-Catheterization

Ileostomy

Irrigations

Nephrostomy Tube

Suprapubic Catheter

Care of Patient With:

Hemodialysis (Receiving in an Out Pt. Clinic Setting)

Home Hemodialysis

Peritoneal Dialysis

Post-Bladder Surgery

Post-Prostate Surgery

Shunts and Fistulas

Urinary Incontinence

ENDOCRINE/METABOLIC


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Assessment:
Diabetic Skin Assessment

Hyper- and Hypoglycemia

Interpretation of Lab Results:

Hemoglobin A1C

Serum Glucose

Equipment & Procedures:

Glucometers

Insulin Pumps

Care of Patient With:

Diabetes

Post-Transplantation Surgery

Medication Administration:

Insulin

Oral Hypoglycemics

WOUND/SKIN CARE MANAGEMENT


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Assessment:
Wound Assessment Scale

Skin Assessment

Surgical Wound Healing

Skin Grafts

Equipment & Procedures:

Burns

Care of Pressure Ulcers

Dry and Wet to Dry Dressing Changes

Positioning of Patients

Specialty Beds

Special Mattresses and Positioning Devices

Wound Care (Sterile)

Wound Cultures

Wound Irrigations

Wound Vac

Care of Patient With:

Burns

Pressure Ulcers

Surgical Wounds

Skin Grafts

ONCOLOGY


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Assessment:
Immune Status

Symptoms Management

Signs/Symptoms of Infection

Interpretation of Lab Results:

CBC with Differential

CMP

Equipment & Procedures:

Reverse Isolation

Care of Patient With:

Radiation Therapy

Leukemia/Lymphoma

Post-Oncology Surgery

Medication Administration:

Oral Chemotherapy

Intravenous Chemotherapy Administration

Intravenous Chemotherapy Monitoring

Bone Marrow Stimulating Agents

INFECTIOUS DISEASE


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Assessment:
Signs/Symptoms of Infection

Interpretation of Lab Results:

Blood Counts

Culture and Sensitivity

Equipment & Procedures:

Isolation Precautions

Care of Patient With:

HIV Infection

Tuberculosis

MRSA/VRE

Medication Administration:

Antibiotics

Antivirals

Anti-HIV

Immunizations

PSYCHIATRY


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Assessment:
Monitoring Symptoms

Compliance with Medications

Care of Patient With:

Cognitive Disorders

Schizophrenia/Psychotic Disorders

Substance-Related Disorders

Mood Disorders (Anxiety/Depression, etc)

WOMEN’S HEALTH/MATERNAL-INFANT CARE


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Assessment:
Fetal Heart Tones

Contractions

Care of Patient With:

Breast Feeding

Pregnancy-Related Complications

Post-Mastectomy

Post-Partum Mother/Baby Visit

Newborn Care

Bulb Suctioning

Cord and Circumcision Care

Phototherapy

PEDIATRICS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Assessment:
Growth

Development Stages

Nutrition

Family/Caregiver Interaction

Equipment & Procedures:

Calculations of Pediatric Dosages

Croup Tent

Ventilator

Trach

Pediatric Ambu

Near Drowning

Per- and Post-Cardiac Surgery

Care of Patient With:

Broncho Pulmonary Dysplasia

Cystic Fibrosis

Respiratory Distress Syndrome (RDS)

Reye’s Syndrome

Pre- and Post-Spinal Surgery

Sickle Cell Disease

Spina Bifida

PAIN MANAGEMENT


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Assessment:
Pain Scale

Response to Pain Management Interventions

Equipment & Procedures:

Pharmacologic Pain Relief

Non-pharmacologic Pain Relief Measures

PCA Pump

Care of Patient With:

Epidural Catheter/Site Monitoring/Pump

Patient Controlled Analgesia

PALLIATIVE AND END-OF-LIFE CARE


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Family Support and Teaching:
Medication Protocols

Symptom Management

After Death Protocol and Management

PATIENT AND FAMILY TEACHING


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Diabetic
Pre- and Post-Procedure

Post-partum/Infant Care

Medications

Monitoring

Nutrition

Safety

Self-care

Equipment

Resources

MISCELLANEOUS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
National Patient Safety Goals
Safety Assessment

Recognizing Failure to Thrive Across the Lifespan

Wheelchairs/Lift Equipment

Glucometer

CASE MANAGEMENT


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Experience as a Case Manager
Case Load

Supervision of Home Health Aides

EXPERIENCE WITH


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Long-term/Short-term Disability
Management of Complaints

Medicare/Medicaid

Pre-certifications

Private Insurance

Telephone Assessments

Utilization Review

Workman’s Compensation

DOCUMENTATION


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Diagnosis Coding (ICD Coding)
Document Plan of Care (Form 485)

OASIS Documentation

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.