HIS 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

Medication Administration Rating Stars (Click) 1 2 3 4  
Documentation on M.A.R. 
Dose calculation 
Generic equivalents 
Usage of PDR 
Knowledge of drug actions/interactions 
Verification of narcotic wastage 
Oral medications 
Sublingual medications 
Intradermal medications 
Parenteral medications 
Subcutaneous medications 
Intramuscular medications 
Topical medications 
Eye drops 
Ear drops 
Swallowing precautions 
Inventory and storage control 
Infectious Control Rating Stars (Click) 1 2 3 4  
AIDS/HIV interaction 
Hepatitis interaction 
Fever management 
Interpretation of labs 
Decubitus/Wound care (Contaminated) 
Linen -Transporting, storing, & Handling 
Personal clothing 
Proper disposal of sharpes and waste 
Standard precautions 
Pain Management Rating Stars (Click) 1 2 3 4  
Documentation and assessment of site, character, & frequency of pain 
Assessment of pain levels 
Documentation of response to pain medications 
Intraveneous Therapy Rating Stars (Click) 1 2 3 4  
I.V. certified (Check '4') 
Administration of I.V. antibiotics 
Administration of I.V. fluids 
Administration of I.V. pain medications 
Administration of I.V. cardiac meds 
Blood draws - peripheral 
Blood draws - central line 
Blood draws - implanted catheter 
Care of I.V. site - peripheral 
Care of I.V. site - central line 
Care of I.V. site - implanted catheter 
I.V. dose calculations 
I.V. insertion - peripheral 
Use of infusion pumps 
Diabetic Care Rating Stars (Click) 1 2 3 4  
Diabetic monitoring 
S/S hyper/hypoglycemia 
Diabetic patient teaching 
Performing fingersticks 
Use of glucometers 
Insulin infusions 
Regular, long-acting insulin 
Mixed insulin 
Psychosocial Problems Rating Stars (Click) 1 2 3 4  
Assessment and documentation of behavioral problems (target behaviors) 
Assessment and documentation of s/s of depression 
Assessment and documentation of patient response to psychotropic medications 
Parameters for use of restraints in long-term care settings 
Assessment and documentation of effectiveness of preventive medicine medications 
Orthopedics Rating Stars (Click) 1 2 3 4  
Assessment of circulation 
Assessment of gait 
Assessment of range of motion 
Amputation care 
Post-arthroscopy care 
Casts and related care 
Pinned fractures 
Total hip replacement 
Total knee replacement 
Rheumatic/Arthritic disease 
Continuous passive motion 
Cervical collars 
Gait belts 
Transfer board 
Cardiovascular Problems Rating Stars (Click) 1 2 3 4  
Auscultation of rate/rythym 
Blood pressure 
Circulation checks 
Post-abdominal aortic bypass 
Post carotic endarterectomy 
Fem-pop bypass 
Permanent pacemaker 
Post acute M.I. 
Post cardiac surgery 
Congestive heart failure 
Administration of post-op cardiac meds 
Gastrointestinal Problems Rating Stars (Click) 1 2 3 4  
Administration of tube feedings 
Administration of medications via tube 
Inflammatory bowel disease 
Bowel prep 
G.I. bleeding 
Nutritional status 
Colostomy care 
Post abdominal surgery 
NG tube placement and care 
Nasointestinal tube care 
Assessment of bowel tones 
Assessment of abdomen 
Enema administration 
Assessment of bowel incontinence 
Signs and symptoms of fecal impaction 
Neurological Problems Rating Stars (Click) 1 2 3 4  
Post-Op anticonvulsant medications 
Assessing levels of consciousness 
Dementias (Re-direction/Validation) 
Neuromuscular disease 
Pupil check 
Seizure precautions 
Administration of anticonvulsant 
Aneurysm precautions 
Spinal cord injuries - long term 
Urinary Problems Rating Stars (Click) 1 2 3 4  
Assessment and care of AV shunt 
Post renal surgery 
Renal failure 
Assessment of urinary incontinence 
Assessment of I and O data 
Use of bladder scanne 
Signs and symptoms of UTI 
Indwelling catheter insertion 
Indwelling catheter care 
Straight catheter insertion 
Suprapubic catheter care 
Screening for UTI via urine dipstick 
Wounds, Pressure Sores, and Skin Impairments Rating Stars (Click) 1 2 3 4  
Assessment and care of post-surgical wounds 
Assessment, prevention, and care of pressure ulcers 
Assessment and documentation of skin conditions/wounds 
Dressing changes - asceptic 
Dressing changes - sterile 
Wound irrigation 
Application of wound care products 
Use of air fluidized, low air-loss beds 
Use of pressure-relieving seat cushions 
Staple and suture removal 
Other Skills Rating Stars (Click) 1 2 3 4  
Alert charting system 
Use of 24-hour written and verbal reporting systems 
Use of '911' in LTC setting 
Regulatory guidelines related to the prevention of abuse and neglect of residents 
Regulatory guidelines related to resident rights in LTC setting 
Discerning code status 
Incident and accident reporting 
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)