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 | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Admit patient to pre-procedure holding |
|
||||||
Complete assessments, obtain family history & risk factors |
|
||||||
Start peripheral IV |
|
||||||
Complete pre-procedure checklist |
|
||||||
Transport pre-procedure patient to the Lab. |
|
||||||
Transport post-procedure patient to in-hospital units |
|
||||||
PROCEDURES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Cerebral Angiogram – Prepare |
|
||||||
Cerebral Angiogram – Assist |
|
||||||
Lower Extremity Angiogram – Prepare |
|
||||||
Lower Extremity Angiogram – Assist |
|
||||||
Upper Extremity Angiogram – Prepare |
|
||||||
Upper Extremity Angiogram – Assist |
|
||||||
Ultrasound Guided Biopsy – Prepare |
|
||||||
Ultrasound Guided Biopsy – Assist |
|
||||||
CT Scan Guided Biopsy – Prepare |
|
||||||
CT Scan Guided Biopsy – Assist |
|
||||||
Liver Biopsy and Embolization – Prepare |
|
||||||
Liver Biopsy and Embolization – Assist |
|
||||||
Prepare and Assist with Line Placement – Broviac |
|
||||||
Prepare and Assist with Line Placement – Groshong |
|
||||||
Prepare and Assist with Line Placement – Hickman |
|
||||||
Prepare and Assist with Line Placement – PICC |
|
||||||
Prepare and Assist with Line Placement – PortaCath |
|
||||||
Uterine Fibroid Embolization – Prepare |
|
||||||
Uterine Fibroid Embolization – Assist |
|
||||||
Temporary Hemodialysis Shunt Placement– Prepare |
|
||||||
Temporary Hemodialysis Shunt Placement– Assist |
|
||||||
Permanent Hemodialysis Shunt Placement– Prepare |
|
||||||
Permanent Hemodialysis Shunt Placement– Assist |
|
||||||
AV Fistula/Shunt Declotting – Prepare |
|
||||||
AV Fistula/Shunt Declotting – Assist |
|
||||||
Vertebroplasty – Prepare |
|
||||||
Vertebroplasty – Assist |
|
||||||
Lumbar Puncture – Prepare |
|
||||||
Lumbar Puncture – Assist |
|
||||||
Myelogram – Prepare |
|
||||||
Myelogram – Assist |
|
||||||
Other Procedures (please list): |
|
||||||
Provide care for the post-procedure patient |
|
||||||
CARDIOVASCULAR | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Assess heart sounds and peripheral pulses |
|
||||||
Interpret arrhythmias |
|
||||||
Perform CPR |
|
||||||
Perform defibrillation |
|
||||||
Participate as a team member in resuscitation |
|
||||||
PULMONARY | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Assess lung sounds |
|
||||||
Set up oxygen devices |
|
||||||
Obtain pulse oximetry reading |
|
||||||
Interpret ABG |
|
||||||
Use Ambu bag |
|
||||||
Assist with intubation |
|
||||||
Assist with chest tube insertion |
|
||||||
Provide care for the patient with mechanical ventilation |
|
||||||
MEDICATIONS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Titrate vasoactive drugs |
|
||||||
Calculate mcg/min and mcg/kg/min |
|
||||||
Use IV infusion pump to calculate drug doses |
|
||||||
Administer IV dopamine |
|
||||||
Administer IV nitroglycerine |
|
||||||
Administer IV dobutamine (Dobutrex) |
|
||||||
Administer IV lidocaine |
|
||||||
Administer IV diltiazem (Cardizem) |
|
||||||
Administer IV epinephrine |
|
||||||
Administer IV atropine |
|
||||||
Administer IV heparin |
|
||||||
Administer IV benzodiazepines (Valium, Versed, Ativan) |
|
||||||
Administer IV propofol (Diprivan) |
|
||||||
Administer IV neuromuscular blocking agents (Pavulon, Norcuron) |
|
||||||
Administer IV narcotics (morphine, fentanyl) |
|
||||||
PAIN/WOUND MANAGEMENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Assess pain level/tolerance |
|
||||||
Care of patient with anesthesia/analgesia |
|
||||||
Care of patient with IV conscious sedation |
|
||||||
Care of patient with narcotic analgesia |
|
||||||
Care of patient with patient controlled analgesia (PCA pump) |
|
||||||
Assess surgical wound status with/without drain(s) |
|
||||||
Care of patient with sterile dressing changes |
|
||||||
Care of patient with FemoStop device |
|
||||||
Assessment of VasoSeal, AngioSeal, PerClose success |
|
||||||
AGE SPECIFIC PRACTICE CRITERIA | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Pediatric (1-18years) |
|
||||||
Adolescents (12 - 18 years) |
|
||||||
Adult (19 - 65 years) |
|
||||||
Older adults (Older than 65years) |
|
||||||
EXPERIENCE WITH AGE GROUPS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
Calculate body weight to verify correct dosing of medication |
|
||||||
Assess immunization status for pediatric, and adolescent |
|
||||||
Set age-appropriate short-term and long-term goals in care planning |
|
||||||
Provide age-appropriate education, considering possible vision and hearing impairment for Older than 65years |
|