Endoscopy 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

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