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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