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.
| Practice Settings/Experience | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Academia |
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| Ambulatory Care |
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| Clinic |
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| Compounding |
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| Consulting |
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| Correctional Facility (Jail) |
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| Diabetes |
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| Drug Information |
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| Formulary Management |
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| Geriatrics |
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| Home Health |
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| Home Infusion |
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| Hospital– Inpatient |
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| Hospital– Outpatient |
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| Infectious Disease |
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| Long Term Care (LTC) |
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| Mail Order |
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| Military/Government/VA |
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| Nuclear |
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| Oncology |
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| Pain Management |
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| Pediatrics |
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| Pharmaceutical Research |
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| Pharmaceutical Sales |
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| Pharmacy Benefits Management (PBM ) |
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| Poison Control |
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| Psychiatric Patient Management |
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| Public Health |
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| Renal Patient Management |
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| Retail– Chain |
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| Retail– Independent |
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| Sub-Acute Care |
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| Veterinary |
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| Other: |
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| Other: |
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| Other: |
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| Pharmacy Software Systems | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Etreby |
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| HBS |
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| JASRx |
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| McKesson– 3PM |
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| McKesson– Pharmserv |
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| Meditech |
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| NDC |
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| OPUS– ISM |
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| OSCOR |
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| PDX |
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| PharmNet |
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| Pharmtrak |
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| PROScript 2000 |
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| QS1 |
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| Renlar |
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| Rescot– Omni-DX |
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| Rx-Link |
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| Speed Script |
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| TechRx |
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| WinPharm |
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| Other: |
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| Automation | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Accumed/Baker Cells |
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| BAXA– Rapid-Fill (ASF) |
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| BAXA– Repeater Pump |
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| Baxter |
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| Baxter– AUTOMIX Compounder |
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| Baxter– MICROMIX Compounder |
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| Kirby Lester |
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| McKesson– AcuDose-Rx |
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| McKesson– Baker Scale |
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| McKesson– IntelliShelf-Rx |
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| McKesson– MedCarousel |
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| McKesson– ROBOT– Rx |
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| McKesson– PACMED |
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| MTS– Automated Sealers |
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| MTS– Prepackaging |
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| Parata– PACMED |
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| Parata– RDS |
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| Parata– APM |
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| PharmASSIST– RDS ROBOTx |
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| PharmASSIST– ROBOTx |
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| PharmASSIST– SmartCabinet |
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| PharmASSIST– SmartScale |
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| Pyxis |
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| Other: |
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| Other: |
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| Disease State Management | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| AIDS/HIV |
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| Anticoagulation |
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| Asthma |
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| Cardiovascular Disease |
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| Chemotherapy |
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| Cystic Fibrosis |
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| Depression |
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| Diabetes |
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| Dyslipidemia |
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| Hormone Replacement Therapy |
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| Hypertension |
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| Osteoporosis |
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| Pain Management |
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| Smoking Cessation |
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| Transplant |
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| Other: |
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| Other: |
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| Other: |
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| Clinical and Job related Experience | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Admixture |
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| Adolescent Care |
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| Aseptic Techniques |
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| Blister Packs |
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| Cart Check |
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| Cart Fill |
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| Chemotherapy |
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| Computerized Physician Order Entry |
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| Consulting |
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| Discharge Counseling |
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| DME Equipment |
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| Drug Information |
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| Drug Information Rounds |
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| Drug Rehabilitation Programs |
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| Emergency Room |
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| Enteral Nutrition Products |
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| Formulary Management |
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| Geriatric Care |
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| Hazardous Drug Handling |
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| Homeopathic Treatments |
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| Hyperalimentation Calculation |
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| Immunizations |
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| Immunoglobulin Therapy |
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| Incontinence Supplies |
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| Infectious Disease |
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| Infusion Pumps and Systems |
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| Intensive Care (ICU) |
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| IV Preparation |
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| Neonatal Intensive Care (NICU) |
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| Oncology |
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| Ostomy Supplies |
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| OTC selection and recommendations |
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| P&T committee participant |
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| Pain Management |
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| PCA Pumps |
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| Pediatric Care |
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| Poison Control |
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| Psychiatric Care |
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| Retail Compounding |
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| Surgical Supplies |
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| Tocolytic Therapy |
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| TPN Preparation |
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| Transplant Therapy |
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| Urological Supplies |
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| Other: |
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| Other: |
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| Other: |
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| Age Specific Competencies | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Infant (Birth - 1 year) |
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| Preschooler (ages 2-5 years) |
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| Childhood (ages 6-12 years) |
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| Adolescents (ages 13-21 years) |
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| Young Adults (ages 22-39 years) |
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| Adults (ages 40-64 years) |
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| Older Adults (ages 65-79 years) |
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| Elderly (ages 80+ years) |
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| Pharmacokinetic Dosing of | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Aminoglycosides |
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| Anticoagulation |
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| Digoxin |
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| Lithium |
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| Theophylline |
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| Vancomycin |
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| Other: |
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| Other: |
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| Other: |
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