PACU Skills Checklist

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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.

POST OP CARE OF PATIENTS WITH


	Never Performed	Limited Experience	Comfortable Performing	Proficient
CABG
Aneurysm with graft replacement

Cardiac Transplantation

Cardiac Valve Replacement (MVR, AVR)

Chest Tubes

Embolectomy/Thrombectomy

Endarterectomy

Laryngectomy

Open Heart Procedures

Penetrating/Open Chest Trauma

Peripheral Vascular Bypasses

Pneumonectomy/Lobectomy

Post Op Myocardial Infarction

Radical Neck Resection

Stent Placements

Thorocotomy

Tracheostomy

Vena Cava Filter

Craniotomy

a. Epidural

b. Subdural

Aneurysm Clipping

Burr Holes

Evacuation of Hematoma

Intracranial Tumor Excision

Laminectomy

Spinal Fusions

Spinal Tumor Excision

Subarachnoid Screw/Bolt

POST OP CARE OF PATIENTS WITH


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Ventricular Peritoneal Shunt
Ventriculostomy

Neuromuscular Disease

Abdominal Trauma

Cholecystectomy

Colon Resection

Colostomy/Ileostomy

Esophagectomy

Exploratory Laparotomy

Gastrectomy

Gastric Stapling

Hepatic Resection

Biliary Atresia

Hernia Repair

Pyloric Stenosis

Pyloroplasty

Vagotomy

Whipple

Hemorrhoidectomy

AV Fistulas, Shunts & Dialysis Catheters

Cystectomy

Ileal Conduit

Nephrectomy

Prostatectomy

Renal Transplant

TURP/TURBP

Ureteral Stent Insertion

Amputations

Open Reduction/Internal Fixation

Total Joint Replacements/Arthroplasty

Adenotonsillectomy (T&A)

Adrenalectomy

Cleft Lip/Palate Repair

Facial Fractures

Sinus Surgery

Thyroidectomy

Transphenoidal Hypophysectomy

Dilation & Curettage (D&C

Hysterectomy

POST OP CARE OF PATIENTS WITH


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Whipple
Hemorrhoidectomy

AV Fistulas, Shunts & Dialysis Catheters

Cystectomy

Ileal Conduit

Nephrectomy

Prostatectomy

Renal Transplant

TURP/TURBP

Ureteral Stent Insertion

Amputations

Open Reduction/Internal Fixation

Total Joint Replacements/Arthroplasty

Adenotonsillectomy (T&A)

Adrenalectomy

Cleft Lip/Palate Repair

Facial Fractures

Sinus Surgery

Thyroidectomy

Transphenoidal Hypophysectomy

Dilation & Curettage (D&C)

Mastectomy

Oophorectomy

Orchiectomy

POST OP CARE OF PATIENTS WITH


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Salpingectomy
TAH-BSO

Cataract Extraction

Cochlear Implant

Keratoplasty (Corneal Transplant)

Laser Eye Surgery

Myringotomy

Orbital Fracture

Orbital Implant

Scleral Bucking (for Retinal Detachment)

Dacryocystectomy

Gun Shot/Stab Wound-Abdomen

Gun Shot/Stab Wound-Chest

Gun Shot/Stab Wound-Head

Plastic Surgery

Skin Flaps

Skin Grafts

Wound Debridement

Anaphylaxis

Latex Allergies

MEDICATION ADMINISTRATION


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Pain Management
a. Fentanyl

b. Demerol

c. Dilaudid

d. Morphine

Sedatives

a. Ativan

b. Valium

c. Versed

H2 Receptor Antagonists

a. Zantac

b. Pepcid

c. Carafate

Antiemetics

a. Droperidol

b. Phenergan

c. Zofran

Anticonvulsants (Dilantin, Phenobarbital)

Inotropes/Vasoactive Drips

Ca++ Channel Blockers (Cardizem)

Nitroglycerine

Nipride

MEDICATION ADMINISTRATION


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Amiodarone
Lidocaine

Procainamide (Pronestyl)

Heparin/Coumadin

Diuretics

Steriods (Decadron, Solumedrol)

Glycoprotein IIb/IIIa Receptor Inhibitors

Narcan

Romazicon

Nebulizer Tx (Atrovent, Ventolin)

Epinephrine

Atropine

IM Injections

SQ Injections

Continuous IV Pump Infusions

Eye/Ear Instillations

Medication Administration/Monitoring

a. Epidural

b. Intrathecal

c. Spinal Anesthesia

d. IV Push

PROCEDURES/SKILLS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Interpretation of Arrhythmias
Performing 12 lead EKGs

Hemodynamic Monitoring

a. Arterial Line

b. PA Catheter/Swan Ganz Catheter

c. CVP Line

Interpretation of Lab Values

a. ABGs

b. CBC

c. Blood Chemistry

d. Electrolytes

Assessment/Management Fluid Balance

Management Electrolyte Disturbances

Cardiac Arrest/CPR

Cardioversion

Defibrillation

External/Temporary Pacing

Airway Management

a. Head Position

b. Oral/NT Airway

c. Laryngeal Mask Airway (LMA)

d. Endotracheal Tube

e. Tracheostomy

PROCEDURES/SKILLS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Oxygen Therapy
a. Nasal Cannula

b. Face Mask

c. Non-Rebreather Mask

d. Ambu Bag

e. Trach Collar

CO2 Monitoring

Intubation - assist with

Extubation - assist with

Mechanical Ventilation

Obtaining ABG's

a. via A-Line

b. via arterial stick

Suctioning

a. Oral/NT

b. ETT/Tracheostomy

Chest Tubes - Care/Maintenance

Seizure Precautions

Cervical Spine Precautions

Intracranial Pressure Monitoring (ICP)

Cerebral Perfusion Pressure (CPP)

Nasogastric Tube - Insertion/Care

Gastric Tube - Care/Maintenance

Jejunostomy Tube - Care/Maintenance

Stoma Care/Maintenance

Wound Drains

a. Self Suction (J-P, Hemovac)

b. Irrigation Drains (Axiom)

c. Tube

d. Biliary Tube

Care Maintenance Of:

a. Foley Catheter

b. Suprapubic Catheter

c. Nephrostomy Tube

d. Bladder Irrigation

Orthopedic Traction

CPM Machine

Peripheral IV Insertion/Care

PICC Care

PROCEDURES/SKILLS


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Blood/Blood Products
a. Admininstration

b. Autotransfusion

c. Volume Expander Administration

Aldrette Scoring

Malignant Hyperthermia Management

Blood Glucose Monitoring

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

ASSESSMENT/OTHER


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Ambulatory Infusion Pumps
Assess Breath Sounds

Assess Heart Sounds

Admission of patients to unit

Care Planning

Circulation Checks

Computerized Charting

Patient Teaching

Neurological Assessment

Vital Signs

EQUIPMENT


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

Defibrillator

Glucometer

Hypo/Hyperthermia Blanket

Pulse Oximeter

Computer Charting Systems

if you any Other Equipment, Please Specify below

Infusion Pumps (Specific Brands)

PAIN MANAGEMENT


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Pain assessment using pain scales
Epidural analgesia

IV conscious sedation

Patient controlled analgesia (PCA)

Narcotic Agents

Non-narcotic agents

Non-pharmacological measures

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.