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.
| Procedures | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Assist with EGD’s |
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| Assist with endoscopic ultrasound |
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| Assist with active GI bleed |
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| Cautery devices |
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| Assist with manometry studies |
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| Assist with variceal banding |
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| Assist with esophageal dilatations |
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| Assist with esophageal ballooning |
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| Assist with scelrotherapy |
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| Assist with TEE |
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| Assist with bronchoscopy |
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| Assist with colonoscopy |
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| Assist with polypectomy |
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| Assist with ERCP’s |
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| Assist with PEG placements |
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| Assist with liver BX |
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| Assist with collection of hot & cold BX’s |
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| Specimen collection & labeling |
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| Set up of scopes & video equipment |
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| Apply external abdominal pressure to assist with scope movement |
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| Scope cleaning |
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| Assist with mobile cases, ICU, ER, etc. |
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| Radiation safety |
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| Automated Medication Dispensing System, Pyxis, Omnicell, or other |
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| Takes call for emergency cases |
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| National Patient Safety Goals |
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| Awareness of HCAHPS |
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| Accurate patient identification |
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| Effective communication |
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| Interpretation & communication of lab values |
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| Medication administration |
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| Labeling (medications & specimens) |
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| Anticoagulation therapy |
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| Monitoring conscious sedation |
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| Pain assessment & management |
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| Infection control |
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| Universal precautions |
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| Isolation |
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| Minimize risk for falls |
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| Prevention of pressure ulcers |
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| Use of rapid response teams |
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| Administer Conscious Sedation | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Fentanyl |
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| Propofol |
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| Demerol |
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| Presedex |
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| Versed |
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| Reversal agents |
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| Pre Procedure | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Pre procedure phone calls |
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| Electronic documentation |
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| Patient assessment |
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| Colon prep or re-prep |
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| Pre procedure checklist/consent |
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| IV start, med admin |
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| Post Procedure | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Assess for air movement post colonoscopy |
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| Assess for pain |
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| Assess for bowel sounds |
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| Assess for gag reflex post EGD |
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| Assess for gag reflex post bronchoscopy |
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| Recover from MAC |
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| Recover from (moderate) conscious sedation |
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| Discharge outpatients to home |
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| Post procedure phone calls |
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| Age Specific | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Newborn/neonate (birth-30 days) |
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| Infant (31 days-1 year) |
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| Toddler (ages 2-3 years) |
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| Preschool (ages 4-5 years) |
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| School age (ages 6-12 years) |
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| Adolescent (ages 13-21 years) |
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| Young adult (ages 22-39 years) |
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| Adult (ages 40-64 years) |
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| Older adult (ages 65-79 years) |
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| Elderly (ages 80+ years) |
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