Age of Patients Cared ForNewborn (birth-30 days)* 1 2 3 4 Infant (30 days - 1 year)* 1 2 3 4 Toddler (1 - 3 years)* 1 2 3 4 Preschooler (3 - 5 years)* 1 2 3 4 School Age (5 - 12 years)* 1 2 3 4 Adolescents (12 - 18 years)* 1 2 3 4 Young Adults (18 - 39 years)* 1 2 3 4 Middle Adults (39 - 64 years)* 1 2 3 4 Older Adults (64+ years)* 1 2 3 4 General SkillsStandard Precautions* 1 2 3 4 Isolation Precautions* 1 2 3 4 Discontinue PIV* 1 2 3 4 Initiate Peripheral IV* 1 2 3 4 Lift/ Transfer Devices* 1 2 3 4 Pediatric Respiratory/Cardiac Arrest* 1 2 3 4 Adult Respiratory/Cardiac Arrest* 1 2 3 4 Crash Carts* 1 2 3 4 Defibrillators* 1 2 3 4 Use of Rapid Response Teams* 1 2 3 4 Care of Patients in Restraints* 1 2 3 4 Pain Management* 1 2 3 4 Automated Med Dispensing* 1 2 3 4 List TypesCare Planning and Discharge Planning* 1 2 3 4 Organ/ Tissue Donation* 1 2 3 4 Patient/Family Education* 1 2 3 4 Electronic Documentation* 1 2 3 4 List TypesPatient Head to Toe Assessment* 1 2 3 4 Knowledge of Normal Serum Lab Values* 1 2 3 4 Obtaining Cultures (Blood, Sputum, Swab, Urine)* 1 2 3 4 Calculate mcg/min and mcg/kg/min* 1 2 3 4 Titrating Medications* 1 2 3 4 IV Conscious Sedation* 1 2 3 4 Interpretation of Dysrhythmia* 1 2 3 4 Management of Dysrhythmia* 1 2 3 4 PsychologicalOverdose/Withdrawal* 1 2 3 4 Suicidal Precautions* 1 2 3 4 Manic Disorder/Behavior* 1 2 3 4 De-Escalation Techniques* 1 2 3 4 Depression* 1 2 3 4 Knowledge and Use ofAnti-Depressents* 1 2 3 4 Anti-Anxiety Medications* 1 2 3 4 Psych Medications* 1 2 3 4 MedicationsAnticoagulants* 1 2 3 4 Narcotics* 1 2 3 4 PCA for Pain Control* 1 2 3 4 Epidural for Pain Control* 1 2 3 4 Non-Narcotic Analgesics* 1 2 3 4 Topical Medications* 1 2 3 4 IM Medications* 1 2 3 4 SQ Medications* 1 2 3 4 Oral Medications* 1 2 3 4 IV Push Medications* 1 2 3 4 IV Drip Medications* 1 2 3 4 Antibiotics* 1 2 3 4 Chemotherapy* 1 2 3 4 Neuro General SkillsAssessing Levels of Consciousness* 1 2 3 4 Glasgow Coma Scale* 1 2 3 4 Dysphagia Screen* 1 2 3 4 Pupil Checks* 1 2 3 4 Seizure Precautions* 1 2 3 4 Aneurysm Precautions* 1 2 3 4 Assisting with Lumbar Puncture* 1 2 3 4 Use of Hyper/Hypothermia Blanket* 1 2 3 4 Neuro- Care of Patients WithStroke* 1 2 3 4 Seizure Activity* 1 2 3 4 Seizuer Disorder* 1 2 3 4 Acute Head Injury* 1 2 3 4 Spinal Cord Injury - Acute* 1 2 3 4 Spinal Cord Injury – Long Term* 1 2 3 4 Aneurysm* 1 2 3 4 Alzheimer’s Disease* 1 2 3 4 Neuromuscular Disease* 1 2 3 4 Multiple Sclerosis* 1 2 3 4 Encephalitis* 1 2 3 4 Meningitis* 1 2 3 4 Intracranial Hemorrhage* 1 2 3 4 Metastic Tumor* 1 2 3 4 Hydrocephalus* 1 2 3 4 Knowledge and Use OfAnticonvulsants* 1 2 3 4 IV Drip Steroids* 1 2 3 4 Cardiac General SkillsCardiac Monitors* 1 2 3 4 Auscultation of Cardiac Sounds* 1 2 3 4 EKG – 12 Lead* 1 2 3 4 Recognizing Basic and Life Threatening Dysrthymias* 1 2 3 4 Cardioversion/Defibrillation* 1 2 3 4 Pulse Checks* 1 2 3 4 Interpretation of Cardiac Enzymes* 1 2 3 4 Capillary Refill* 1 2 3 4 Permanent Pacemaker* 1 2 3 4 Temporary Pacemaker* 1 2 3 4 Use of Doppler* 1 2 3 4 Use of Automatic BP Cuff (ie Dinamap)* 1 2 3 4 Cardiac- Care Of Patients WithAngina* 1 2 3 4 CHF* 1 2 3 4 Chest Pain* 1 2 3 4 Abdominal Aortic Aneursym* 1 2 3 4 Acute MI* 1 2 3 4 Pericarditis* 1 2 3 4 Post MI* 1 2 3 4 Knowledge and Use OfNitrates (Oral, Topical)* 1 2 3 4 Antiarrhythmics (Oral)* 1 2 3 4 Antihypertensives (Oral)* 1 2 3 4 Heparin Drip* 1 2 3 4 Respiratory General SkillsO2 Cannulas/Masks* 1 2 3 4 Nebulizer Set-Up/Use* 1 2 3 4 Incentive Spirometry* 1 2 3 4 Chest PT* 1 2 3 4 Pulse Oximetry* 1 2 3 4 Trach Management* 1 2 3 4 Assessment of Lung Sounds* 1 2 3 4 Suctioning – Oral* 1 2 3 4 Suctioning – Tracheostomy Tube* 1 2 3 4 Respiratory- Care Of Patient WithSOB* 1 2 3 4 Pulmonary Embolism* 1 2 3 4 Pulmonary Edema* 1 2 3 4 Tracheostomy Tube* 1 2 3 4 COPD* 1 2 3 4 Emphysema* 1 2 3 4 ARDS* 1 2 3 4 Asthma Exacerbation* 1 2 3 4 Pneumothorax* 1 2 3 4 Pneumonia* 1 2 3 4 Pre/Post Thoracic Surgery* 1 2 3 4 Chest Tubes* 1 2 3 4 Tuberculosis* 1 2 3 4 Tuberculosis* 1 2 3 4 Inhalation Injuries* 1 2 3 4 Knowledge and Use ofO2 Therapy* 1 2 3 4 Bronchodilators* 1 2 3 4 Oral Steroids* 1 2 3 4 IV Steroids* 1 2 3 4 Inhaler* 1 2 3 4 Gastrointestinal General SkillsInsertion Care and Maintenance of Nasogastric Tubes (ie Salem Pump, Levine)* 1 2 3 4 Nasointestinal Tubes (ie Cantor, Miller-Abbot)* 1 2 3 4 Jejunostomy,Gastrostomy, Cecostomy Tubes* 1 2 3 4 Auscultation of Bowel Sounds* 1 2 3 4 Tube Feedings via Flexible Tubesby Gravity Infusion* 1 2 3 4 by Feeding Pump* 1 2 3 4 Collection of Stool Specimens* 1 2 3 4 Bowel Preparation & Cleansing Procedures* 1 2 3 4 Gastrointesinal - Care of Patients WithStoma* 1 2 3 4 Bowel Obstruction* 1 2 3 4 Pancreatitis* 1 2 3 4 Post Abdominal Surgery* 1 2 3 4 Ileostomy* 1 2 3 4 Colostomy* 1 2 3 4 Inflammatory Bowel Disease* 1 2 3 4 Hepatitis* 1 2 3 4 Liver Failure* 1 2 3 4 Esophageal Bleeding* 1 2 3 4 G.I Bleed* 1 2 3 4 Paralytic Ileus* 1 2 3 4 Knowledge and Use OfTotal Parenteral Nutrition (TPN)* 1 2 3 4 Peripheral Parenteral Nutrition (PPN)* 1 2 3 4 Antiemetics* 1 2 3 4 Proton Pump Inhibitors* 1 2 3 4 Renal/GU General SkillsInsertion of Catheter Straight* 1 2 3 4 Insertion of Catheter Foley* 1 2 3 4 Bladder Irrigation Continuous* 1 2 3 4 Bladder Irrigation Intermittent* 1 2 3 4 Peritoneal Dialysis* 1 2 3 4 Automatic Cycler Machine* 1 2 3 4 Collection of Urine Specimens* 1 2 3 4 Hemodialysis* 1 2 3 4 A-V Fistula/Shunt Care* 1 2 3 4 Pre/Post Dialysis Care* 1 2 3 4 Suprapubic Catheter* 1 2 3 4 Nephrostomy Tube* 1 2 3 4 Renal/GU- Care Of Patient WithUrinary Tract Infection* 1 2 3 4 Renal Calculi* 1 2 3 4 Pyelonephritis* 1 2 3 4 Urinary Retention/Incontinence* 1 2 3 4 Chronic/ Acute Renal Failure* 1 2 3 4 Shunts and Fistulas* 1 2 3 4 Endocrine General SkillsPerforming Fingersticks* 1 2 3 4 Use of Blood Glucose Meter Device* 1 2 3 4 Use of Visual Blood Glucose Strips* 1 2 3 4 Endocrine Care of Patient WithHyper/Hypoglycemia* 1 2 3 4 DKA* 1 2 3 4 Diabetes* 1 2 3 4 Thyroid Disorders* 1 2 3 4 Knowledge and Use of InsulinSingle Type* 1 2 3 4 Dextrose* 1 2 3 4 Mixed Insulins* 1 2 3 4 Insulin Infusion* 1 2 3 4 Orthopedic General SkillsCast Care* 1 2 3 4 C.M.S. Checks* 1 2 3 4 Traction – Skin* 1 2 3 4 Traction – Skeletal* 1 2 3 4 Range of Motion* 1 2 3 4 Use of Assistive Devices* 1 2 3 4 Applications of Splints Extremities* 1 2 3 4 Continuous Passive Motion Machine (CPM)* 1 2 3 4 Orthopedic- Care Of Patients WithTotal Joint Replacements* 1 2 3 4 Rheumatic/Arthritic Disease* 1 2 3 4 Amputation* 1 2 3 4 Paraplegia/ Quadriplegia* 1 2 3 4 Spice Cast/ Body Cast* 1 2 3 4 External Fixation* 1 2 3 4 ORIF* 1 2 3 4 Multiple Trauma* 1 2 3 4 Compartment Syndrome* 1 2 3 4 Wound/Skin CareDressing Change* 1 2 3 4 Air Fluidized, Low Airloss Beds* 1 2 3 4 Pressure Relief Mattress/ Seat Cushion* 1 2 3 4 Pressure Sores* 1 2 3 4 Leg Ulcers* 1 2 3 4 Burns* 1 2 3 4 Braden Scale* 1 2 3 4 Wound VacsHemovacs* 1 2 3 4 Jackson-Pratt Tubes* 1 2 3 4 Penrose Drains* 1 2 3 4 T-Tubes* 1 2 3 4 Surgical Wound Irrigations & Dressings* 1 2 3 4 VascularDiscontinue PICC* 1 2 3 4 Care of Patient with DVT* 1 2 3 4 Draw Blood from Arterial Line* 1 2 3 4 Draw Blood from Central Line* 1 2 3 4 Peripheral IV Insertion, Care and Maintenance* 1 2 3 4 Discontinue Peripheral IV* 1 2 3 4 IV Infusion Pumps* 1 2 3 4 CVP Lines – Measurement of CVP* 1 2 3 4 Central Line Care & Maintenance (including dressing changes)* 1 2 3 4 Blood/Blood Product Administration* 1 2 3 4 Multi-Lumen Central Catheters* 1 2 3 4 Port-A-Caths (Infusa-Ports)* 1 2 3 4 Continuous Subcutaneous Infusion Pumps* 1 2 3 4 OtherCare of Oncology Patient* 1 2 3 4 Chemotherapy Administration* 1 2 3 4 Care of Patient with Burns* 1 2 3 4 Care of Patient with HIV/AIDS* 1 2 3 4 Care of Patient with Sepsis* 1 2 3 4 Hyperbaric Oxygenation* 1 2 3 4 Suicide Precautions* 1 2 3 4 Post Mortem Cares** 1 2 3 4 Application Agreement* I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form.** I hereby consent to allow CrossMed Healthcare Staffing Solutions to release these skills checklist to the client facilities.*Name* First Last Email* Phone*TODAY'S DATE* MM slash DD slash YYYY
