Wound Care Skill Checklist

SKILLS CHECKLIST

Wound Care

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.


	Never Performed	Limited Experience	Comfortable Performing	Proficient
WORK SETTINGS
Acute Care - Adult

Clinic - Adult

SNF/LTAC/Subacute

Hospice / Palliative Care

Acute/Long Term Care - Pediatrics

Clinic - Pediatrics

PRESSURE ULCERS

Assessment

Staging

Prevention/ Risk Assessment Tools - Adult

Prevention / Risk Assessment Tools - Pediatrics

Support Surface Selection

NEUROPATHIC ULCERS

Assessment

Management

VENOUS STASIS ULCERS

Assessment

Management

PERIPHERAL ARTERIAL ULCERS

Assessment

Ankle Brachial Index

Management

OTHER WOUNDS

Fistulae – Pouching / Skin Care

Skin Care/ Management of Drains

WOUND DEBRIDEMENT

Autolytic

Enzymatic


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Mechanical
Sharp

DRESSINGS/ TREATMENTS

Hydrogels

Hydrocolloids

Silver Products

Foams

Alginates

Vacuum Assisted Closure

Growth Factors

Skin Substitutes

Hyperbaric Oxygen Therapy

Wound Cultures

Electrical Stimulation

Enzymatic Debriding Agents

Mist Therapy

COLOSTOMY / ILEOSTOMY

Ostomy Equipment Selection

Continence Skin Care Management

Loop with Rod Stoma

End Stoma

Mucous Fistula

Double Barrel Stoma

Irrigation

Ileal Lavage

CONTINENT ILEOSTOMY

Knock pouch


	Never Performed	Limited Experience	Comfortable Performing	Proficient
Pelvic Pouch
UROSTOMY / CONTINENT

Catherization for C&S

Knock Pouch

Neobladder

CONTINENCE THERAPEUTIC DEVICES

Vaginal Cones

Penile Clamps

Male External Catheters

Internal Urethral Inserts

Catheters –Mgmt & Self Care Teaching

Magnetic Therapy

Urinary Incontinence Program

Fecal Incontinence Program

BURNS

Burn Management

PROFESSIONAL KNOWLEDGE AND SKILLS

National Patient Safety Goals/ Core Measures

Patient Family Teaching

Age Specific/Population Based Care

Isolation Precautions

Infection Precautions

Pain assessment & Management

Interpretation & Communication of Lab Values

EMR


	Never Performed	Limited Experience	Comfortable Performing	Proficient
EPIC
Cerner

Eclipsys

McKesson

Other Computerized System

Computerized Physician Order Entry

Bar Coding for Medication

Culture

OTHER / MISC.

Pain Management Assessment of Pain Levels without intervention

Pain Management Response Assessment with Intervention

Experience: Charge Duty

Experience: Preceptor

AGE SPECIFIC CARE

Infant (Birth to 1 year)

Toddler (1-3 years)

Pre-school (3-6 years)

School Age (6-12 years)

Adolescent (12-18 years)

Young Adult (18-30 years)

Mature Adult (30-60 years)

Elderly (>60 years)

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.