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.
| General Patient Care | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Admission |
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| Advanced Directives |
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| Charge Nurse Experience |
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| Collect Appropriate Data |
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| Discharge Teaching |
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| Organ/Tissue Donation |
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| Patient and Family Teaching |
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| Preoperative Teaching |
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| Computerized Documentation |
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| Cardiac | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Abnormal Heart Sounds/Murmurs |
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| Apical Pulse |
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| Auscultation (Rate/Rhythm) |
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| Capillary Refill |
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| Color |
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| Pulses/Circulation Checks |
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| Abdominal Aortic |
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| Aneurysm |
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| Acute MI |
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| Angina |
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| Cardiac Tamponade |
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| Cardiac Teaching |
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| Cardiomyopathy |
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| Cardiopulmonary Arrest |
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| Carotid Endarterectomy |
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| Congestive Heart Failure |
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| Endocarditis |
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| EP Study & Ablation |
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| Femoral Popliteal Bypass |
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| Heart Transplant |
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| Hypertension |
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| Hypovolemic Shock |
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| Multi-System Organ Failure |
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| Myocardial Contusion |
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| Pacemaker-External |
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| Pacemaker-Permanent |
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| Pacemaker-Temporary |
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| Pacemaker-Transthoracic (Epicardial) |
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| Pericarditis |
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| Post AICD Insertion |
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| Pre/Post Cardiac Cath |
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| Pre/Post Cardiac Surgery |
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| Pre/Post PTCA/Stents |
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| Valve Replacement |
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| Ventricular Assist Device (RVAD or LVAD) |
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| Monitoring |
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| 1. 12 Lead EKG |
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| 2. Interpretation |
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| 3. Arrhythmia Interpretation |
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| 4. Arterial Line |
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| 5. CVP Monitoring |
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| 6. EKG Monitoring |
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| Labs |
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| 1. BNP |
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| 2. Cardiac Enzymes & Isoenzymes |
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| 3. Coagulation Studies |
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| 4. Troponin |
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| Pulmonary | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Adventitious Breath Sounds |
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| Assess Lung Sounds |
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| Oxygenation Status |
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| Rate and Work of Breathing |
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| Acute Pneumonia |
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| ARDS |
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| Asthma |
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| Chest Trauma |
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| Chest Tube |
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| COPD |
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| Inhalation Injuries |
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| Lobectomy |
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| Lung Transplant |
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| Near Drowning |
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| Pre/Post Thoracic Surgery |
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| Pulmonary Edema |
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| Pulmonary Embolism |
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| Status Asthmaticus |
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| Tension Pneumothorax |
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| TracheostomyTuberculosis |
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| Pulse Oximetry Monitoring |
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| ABGS Lab |
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| Neurological | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Glasgow Coma Scale |
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| Level of Consciousness |
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| Reflex/Motor Deficits |
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| Visual/Communication Deficits |
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| Acute Head Injury |
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| Alzheimer’s Disease |
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| CNS Infection |
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| Coma |
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| CVA |
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| DTS |
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| Encephalitis |
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| Halo Traction/Cervical Tongs |
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| Increased ICP |
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| Intracranial Hemorrhage |
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| Laminectomy |
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| Meningitis |
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| Metastatic Tumor |
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| Multiple Sclerosis |
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| Neuromuscular Disease |
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| Pre/Post Neuro Surgery |
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| Seizure Disorder |
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| Spinal Cord Injury |
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| TIAs |
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| Tumor Resection |
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| Ventriculostomy |
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| Gastrointestinal | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Bowel Sounds |
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| Colostomy Care |
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| G.I. Assessment |
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| Abdominal Wounds and Surgeries |
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| Blunt Trauma |
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| Bowel Obstruction |
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| Colostomy |
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| Esophageal Bleeding |
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| GI Bleeding |
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| Hepatitis |
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| Ileostomy |
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| Inflammatory Bowel Diseases |
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| Jejunostomy Tube |
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| Liver Cancer |
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| Liver Failure |
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| Treatment Side Effects Chemo/Radiation |
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| Pancreatic Cancer |
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| Pancreatitis |
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| Paralytic Ileus |
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| LFTs Lab |
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| Serum Ammonia Lab |
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| Serum Amylase Lab |
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| Nutritional Status Monitoring |
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| Renal/Genitourinary | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Skin Tugor |
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| Acute Renal Failure |
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| End Stage Renal Disease |
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| Hemodialysis |
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| Nephrectomy |
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| Nephrostomy Tube |
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| Peritoneal Dialysis |
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| Renal Transplant |
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| Suprapubic Cath |
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| V Fistula/Shunt |
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| Fluid Balance Monitoring |
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| Measurement I & O Monitoring |
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| Bun & Creatinine Lab |
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| Serum Electrolytes Lab |
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| Endocrine/Metabolic | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Diabetic |
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| Diabetic Ketoacidosis |
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| Drug Overdoes |
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| Insulin Shock |
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| Blood Glucose Lab |
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| Thyroid Studies Lab |
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| Musculoskeletal | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Cast Care |
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| Circulation/Pulse Checks |
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| Amputation |
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| External Fixation |
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| Joint Replacements |
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| Multiple Trauma |
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| Paraplegia |
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| Rheumatoid Arthritic Disease |
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| Immunology/Hematology/Oncology | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Blood Transfusions |
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| Acute Leukemia |
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| Cancer |
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| Disseminated Intravascular Coagulation |
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| HIV/Aids |
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| Treatment Side Effects Chemo/Radiation |
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| Sepsis |
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| Hematology Lab |
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| Wounds/Integument | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| S/S Infection Assessment |
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| Skin Assessment |
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| Burns |
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| Staged Decubitus Ulcers |
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| Stasis Ulcers |
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| Surgical Wounds with Drains |
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| Skin Breakdown Monitoring |
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| Medications Administration | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Administer IM and SQ Meds |
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| Administer PO Medications |
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| Bladder Irrigation and Instillation |
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| Needleless Systems |
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| IV Therapy | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Assess/Maintain IV Insertion Site |
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| PICCS |
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| Inserting IVs |
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| Multi-Lumen Central Venous Catheters |
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| Blood | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Administer Blood/Blood Products |
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| Albumin |
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| Nutritional Therapy | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Dobhoff Insertion |
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| Enteral Administration |
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| Gravity/Bolus Tube Feedings |
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| J-Tube |
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| NGT Insertion |
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| PEG |
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| TPN and Hyperalimentation |
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| Oxygen Administration | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Ambu-Bag |
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| Nasal Cannula |
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| Nebulizer Treatments |
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| Non-Rebreather Mask |
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| Portable Oxygen |
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| Tracheostomy Tube |
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| Venti Mask |
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| Pain Management | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Assess Pain Level/Tolerance |
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| Epidural Anesthesia/Analgesia |
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| Moderate Sedation |
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| Patient Controlled Analgesia |
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| Ramsey Scale |
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| Procedures/Equipment | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Chest Tube Drainage Systems |
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| Doppler |
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| Drains (JP-Hemovac-Penrose) |
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| Dressing Changes |
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| Establish/Protect Airway |
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| Femoral Artery Sheath Removal |
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| Foley |
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| Hyper/hypothermia Blanket |
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| Incentive Spirometry |
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| Isolation |
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| Specialty Beds |
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| Sterile Dressing Changes |
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| Suction (ET-Oral-Trach-Nasal) |
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| Universal Precautions |
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| Wound Care/Irrigations |
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| Wound Vac |
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| Specimen Collection |
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| 1. Arterial Line Draw |
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| 2. Butterfly Stick |
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| 3. Central Line Draw |
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| 4. Clean Catch Urine |
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| 5. Cultures-Blood |
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| 6. Dip Stick |
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| 7. Finger Stick |
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| 8. Stool |
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| 9. Sputum |
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| 10. Sterile Urine |
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| 11. Throat Swabs |
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| 12. Venipuncture |
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| Assisting with |
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| 1. Bedside Invasive Procedures |
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| 2. Bronchoscopy |
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| 3. Cardioversion/Defibrillation |
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| 4. Central Line Insertion |
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| 5. Chest Tube Insertion |
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| 6. Chest Tube Removal |
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| 7. Emergency Tracheostomy |
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| 8. ET Intubation and Extubation |
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| 9. Lumbar Puncture |
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| 10. Open Chest Emergency |
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| 11. Pericardiocentesis |
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| 12. Paracentesis |
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| 13. Temporary Pacemaker Insertion |
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| 14. Thoracentesis |
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| 15. Transesophogeal Echocardiogram |
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| Age Specific Practice Criteria | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Newborn/Neonate (birth - 30 days) |
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| Infant (30 days - 1 year) |
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| Toddler (1 - 3 years) |
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| Preschooler (3 - 5 years) |
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| School age children (5 - 12 years) |
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| Adolescents (12 - 18 years) |
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| Young adults (18 - 39 years) |
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| Middle adults (39 - 64 years) |
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| Older adults (64+ years) |
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| Critical Care Settings | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Interventional Unit |
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| PCU |
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| Stepdown |
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| Tele |
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| EMR | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| AllScripts |
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| ARIA |
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| Canopy |
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| Epic |
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| Cerner |
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| Eclipsys |
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| McKesson |
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| Meditech |
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| Other Computerized System |
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| Computerized Physician Order Entry |
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| EMR Conversion | |||||||
| Bar Coding for Medication Administration |
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