Telemetry/Stepdown 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.

Proficiency Scale:

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

CARDIOVASCULAR Care of Patient with Rating Stars (Click) 1 2 3 4  
Acute MI 
Angina Hypertension 
Cardiomyopathy Cardiopulmonary Arrest 
Abdominal Aortic Aneurysm 
Carotid Endarterectomy 
Femoral Popliteal Bypass 
Pre & Post Cardiac Surgery 
Pre & Post Cardiac Cath 
Pre & Post PTCA 
Permanent Pacemaker Temporary PacemakerExternal Pacemaker 
Cardiac Lab Interpretation 
Cardiac Patient/Family Teaching 
RESPIRATORY Rating Stars (Click) 1 2 3 4  
Respiratory assessment 
Assess Lung sounds 
Chest percussion 
Establish/Protect Airway 
Chest tubes/Pleurevac 
Oxygen therapy 
Drawing ABGs 
Interpretation of ABGs 
Incentive Spirometry 
Suctioning: oral nasotracheal endotracheal tube tracheostomy tube 
Oxygen Equipment Set Up and Maintenance: nasal canula non-rebreather mask venti-mask ET 
Inturbation/extubationambu bag pulse oximetry 
Care of patient with: COPD tracheostomy pulmonary edema ARDS ventilator (A/C, IMV, PEEP) pre/post-op thoracis surgery pneumonia chest tubes asthma emphysema 
NEUROLOGY Rating Stars (Click) 1 2 3 4  
Neurological assessment 
Seizure precautions 
Assessment and Management of Seizure Activity 
Assisting with lumbar puncture 
Signs/Symptoms of increasing ICP 
Glascow Coma Scale 
Crutchfield tongs 
Circo-electric bed Halo traction 
Stryker frame 
Care of patient with: seizures CNS infection overdose DTs spinal cord injury acute head injury CVA/TIA neuromuscular disease pre/post neuro surgery 
GASTROINTESTINAL Rating Stars (Click) 1 2 3 4  
G.I. assessment 
Bowel sounds 
Inserting N-G tubes 
Colostomy care 
Measurement of I & O 
Administration of tube feedings 
Care of patients with: GI bleed NG tube G-tube J-tube abdominal wounds/surgeries inflammatory bowel disease bowel obstruction 
RENAL/GENITOURINARY Rating Stars (Click) 1 2 3 4  
Insertion and care of: straight cath Indwelling urinary cath: male female 3-way 
Care of Patient with: Bladder Irrigation Suprapubic Tube Nephrostomy Tube Renal Transplant Nephrectomy Renal Transplant BPH Pre/post Turp 
ORTHOPEDIC Rating Stars (Click) 1 2 3 4  
Total Knee Replacement 
Bucks Extension 
Cast Care 
Crutch Walking 
Spica Casts 
Balanced Suspension Traction 
Circulation Checks 
Care of Patient with: Amputation Rheumatic/Arthritic Disease Multiple Trauma Paraplegia External Fixation Post Arthroplasty 
GENERAL Rating Stars (Click) 1 2 3 4  
Blood Glucose Monitoring 
Dressing Changes 
Universal Precautions 
Discharge Planning 
Care of Patient with: Diabetes Pressure Sores Sickle Cell Anemia Cancer Alzheimer's Disease HIV/AIDS 
MEDICATIONS Rating Stars (Click) 1 2 3 4  
Unit Dose 
Dosage Calculation 
Pouring from stock medication 
Administration of Code Cart Emergency Drugs 
Chemotherapy Agents 
Heparin Inhalers 
Magenesium Sulfate 
Nipride Nitroglycerin 
Thrombolytic Agents 
IV THERAPY Rating Stars (Click) 1 2 3 4  
Inserting IVs Mixing IV solutions 
Heparin locks 
IV push IV drip Infusion pumps Syringe pumps 
Continuous Subcutaneous Infusion Pumps 
PCA Pumps 
Ultrasonic Doppler 
CVP lines/measurement of CVP 
Central line dressing change 
Blood/Blood products administration ordering/obtaining from blood bank identification/intercession for adverse reaction 
Multi-lumen central venous catheters Implanted CVC (port-a-cath) 
Assessment of IV insertion site 
Assist with insertion of central line 
X-ray/assessment after insertion 
Care of patient with Central Line 
Charge Nurse Experience? 
CPR certified? 
BCLS certified? 
ACLS certified? 
Knowledge of normal values? 
Have you had a dysrhythmia course? 
Age Specific Competencies Rating Stars (Click) 1 2 3 4  
Infant (Birth - 1 year) 
Preschooler (ages 2-5 years) 
Childhood (ages 6-12 years) 
Adolescents (ages 13-21 years) 
Young Adults (ages 22-39 years) 
Adults (ages 40-64 years) 
Older Adults (ages 65-79 years) 
Elderly (ages 80+ years)