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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 
 
Hospice 
 
MRSA 
 
VRE 
 
Fever management 
 
Interpretation of labs 
 
Decubitus/Wound care (Contaminated) 
 
Linen -Transporting, storing, & Handling 
 
Cleaned 
 
Soiled 
 
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 
 
Osteoporosis 
 
Pinned fractures 
 
Total hip replacement 
 
Total knee replacement 
 
Rheumatic/Arthritic disease 
 
Continuous passive motion 
 
Canes 
 
Cervical collars 
 
Gait belts 
 
Prostheses 
 
Slings 
 
Transfer board 
 
Walker 
 
Wheelchair 
 
Cardiovascular Problems Rating Stars (Click) 1 2 3 4  
Auscultation of rate/rythym 
 
Blood pressure 
 
Doppler 
 
Pulses 
 
Circulation checks 
 
CPR 
 
Post-abdominal aortic bypass 
 
Aneurysm 
 
Angina 
 
Post carotic endarterectomy 
 
Fem-pop bypass 
 
Permanent pacemaker 
 
Post acute M.I. 
 
Post cardiac surgery 
 
Thrombophlebitis 
 
DVT 
 
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 
 
Gualac 
 
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 
 
CVA 
 
Pupil check 
 
A.I.M.S. 
 
Seizure precautions 
 
Administration of anticonvulsant 
 
Medications 
 
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)