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Skills Checklist

Let’s assess your clinical skills and experience. Fill out this checklist to get one step closer to your next opportunity.

1 = No theory and/or experience 2 = Limited Experience 3 = Experienced/minimal support needed to perform 4 = Proficient

AGE OF PATIENTS CARED FOR
Newborn/Neonate (birth to 30 days)*
- 1
- 2
- 3
- 4
Infant (1 month to 1 year)*
- 1
- 2
- 3
- 4
Toddler (1 year to 3 years)*
- 1
- 2
- 3
- 4
Preschooler (3 years to 5 years)*
- 1
- 2
- 3
- 4
School Age Child (5 years to 12 years)*
- 1
- 2
- 3
- 4
Adolescents (12 years to 18 years)*
- 1
- 2
- 3
- 4
Young Adults (18 years to 39 years)*
- 1
- 2
- 3
- 4
Middle Adults (39 years to 64 years)*
- 1
- 2
- 3
- 4
Older Adults (64 years to 79 years)*
- 1
- 2
- 3
- 4
Elderly Adults (over 79+ years)*
- 1
- 2
- 3
- 4
GENERAL SKILLS
Standard Precautions*
- 1
- 2
- 3
- 4
Isolation Precautions*
- 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
Participation on Code Teams*
- 1
- 2
- 3
- 4
Patient/Family Education*
- 1
- 2
- 3
- 4
Care of Patient in Restraints*
- 1
- 2
- 3
- 4
Automated Med Dispensing Systems*
- 1
- 2
- 3
- 4
List Types:
Access/Management of Implanted Ports*
- 1
- 2
- 3
- 4
Access/Management of Central Lines*
- 1
- 2
- 3
- 4
Titration of Drips*
- 1
- 2
- 3
- 4
Administration of Blood/Blood Products*
- 1
- 2
- 3
- 4
Knowledge of Current IV Therapy Guidelines*
- 1
- 2
- 3
- 4
Knowledge of Anatomy*
- 1
- 2
- 3
- 4
Moderate Conscious Sedation*
- 1
- 2
- 3
- 4
Sedation Reversal Agents*
- 1
- 2
- 3
- 4
KNOWLEDGE OF CURRENT IV THERAPY GUIDELINES
INS*
- 1
- 2
- 3
- 4
ISMP*
- 1
- 2
- 3
- 4
CDC*
- 1
- 2
- 3
- 4
State*
- 1
- 2
- 3
- 4
INSERTION OF
Peripheral IV – Adult*
- 1
- 2
- 3
- 4
Peripheral IV – Child*
- 1
- 2
- 3
- 4
Peripheral IV – Neonate*
- 1
- 2
- 3
- 4
Vein Selection – Peripheral IVs*
- 1
- 2
- 3
- 4
Interosseous Needles*
- 1
- 2
- 3
- 4
MIDLINE/PICC LINES
Midline Catheter Insertion – Adult*
- 1
- 2
- 3
- 4
Midline Catheter Insertion – Child*
- 1
- 2
- 3
- 4
Indications for Midline/PICC Placement*
- 1
- 2
- 3
- 4
Contraindications for Midline/PICC Placement*
- 1
- 2
- 3
- 4
Vein Selection*
- 1
- 2
- 3
- 4
Measuring Technique*
- 1
- 2
- 3
- 4
Catheter and Introducer Device Selection*
- 1
- 2
- 3
- 4
Correct Tip Placement*
- 1
- 2
- 3
- 4
Insertion Technique – Basic (Vein)*
- 1
- 2
- 3
- 4
Insertion Technique – Seldinger*
- 1
- 2
- 3
- 4
Insertion Technique – Ultrasound*
- 1
- 2
- 3
- 4
Assist with Insertion in Interventional Radiology*
- 1
- 2
- 3
- 4
Insertion Site Preparation*
- 1
- 2
- 3
- 4
Maintaining Sterile Field*
- 1
- 2
- 3
- 4
Securing Insertion Site Post Placement*
- 1
- 2
- 3
- 4
X-Ray Assessment for Tip Location*
- 1
- 2
- 3
- 4
Repositioning After X-Ray*
- 1
- 2
- 3
- 4
CARE AND MAINTENANCE
Peripheral IV*
- 1
- 2
- 3
- 4
Scalp IV*
- 1
- 2
- 3
- 4
Heparin/Saline Lock*
- 1
- 2
- 3
- 4
Groshong PICC*
- 1
- 2
- 3
- 4
Groshong CVL*
- 1
- 2
- 3
- 4
Hickman/Broviac*
- 1
- 2
- 3
- 4
Port-a-Cath*
- 1
- 2
- 3
- 4
Vascath*
- 1
- 2
- 3
- 4
Multilumen Catheters*
- 1
- 2
- 3
- 4
Subclavian Line*
- 1
- 2
- 3
- 4
IJ Line*
- 1
- 2
- 3
- 4
Femoral Line*
- 1
- 2
- 3
- 4
Power PICC*
- 1
- 2
- 3
- 4
Power Port*
- 1
- 2
- 3
- 4
Dressing Changes*
- 1
- 2
- 3
- 4
Cap Changes*
- 1
- 2
- 3
- 4
Flushing Lines (Frequency/Solution)*
- 1
- 2
- 3
- 4
MEDICATION ADMINISTRATION
Chemotherapy*
- 1
- 2
- 3
- 4
Heparin*
- 1
- 2
- 3
- 4
Streptokinase*
- 1
- 2
- 3
- 4
TPA (Alteplase)*
- 1
- 2
- 3
- 4
Lidocaine*
- 1
- 2
- 3
- 4
TPN/Lipids*
- 1
- 2
- 3
- 4
Ativan*
- 1
- 2
- 3
- 4
Valium*
- 1
- 2
- 3
- 4
Versed*
- 1
- 2
- 3
- 4
Fentanyl*
- 1
- 2
- 3
- 4
EQUIPMENT
Curlin Pump*
- 1
- 2
- 3
- 4
CADD Pump*
- 1
- 2
- 3
- 4
Vista Pump*
- 1
- 2
- 3
- 4
Syringe Pump*
- 1
- 2
- 3
- 4
Rate Flow Regulator*
- 1
- 2
- 3
- 4
Needleless Systems*
- 1
- 2
- 3
- 4
Blood Warmer*
- 1
- 2
- 3
- 4
PCA Pumps*
- 1
- 2
- 3
- 4
Pressure Lines*
- 1
- 2
- 3
- 4
TROUBLESHOOTING/ COMPLICATIONS
Repair PICC*
- 1
- 2
- 3
- 4
Repair Midline*
- 1
- 2
- 3
- 4
Air Embolism*
- 1
- 2
- 3
- 4
Bleeding*
- 1
- 2
- 3
- 4
Brachial Plexus Injury*
- 1
- 2
- 3
- 4
Cardiac Arrhythmia*
- 1
- 2
- 3
- 4
Cardiac Tamponade*
- 1
- 2
- 3
- 4
Catheter Erosion*
- 1
- 2
- 3
- 4
Catheter Embolism*
- 1
- 2
- 3
- 4
Catheter Occlusion*
- 1
- 2
- 3
- 4
Catheter-Related Sepsis*
- 1
- 2
- 3
- 4
Endocarditis*
- 1
- 2
- 3
- 4
Exit Site Infection*
- 1
- 2
- 3
- 4
Exit Site Necrosis*
- 1
- 2
- 3
- 4
Extravasation*
- 1
- 2
- 3
- 4
Hematoma*
- 1
- 2
- 3
- 4
Laceration of Vessels or Viscus*
- 1
- 2
- 3
- 4
Myocardial Erosion*
- 1
- 2
- 3
- 4
Perforation of Vessels or Viscus*
- 1
- 2
- 3
- 4
Phlebitis*
- 1
- 2
- 3
- 4
Catheter Tip Malposition or Retraction*
- 1
- 2
- 3
- 4
Thromboembolism*
- 1
- 2
- 3
- 4
Venous Thrombosis*
- 1
- 2
- 3
- 4
Ventricular Thrombosis*
- 1
- 2
- 3
- 4
Vessel Erosion*
- 1
- 2
- 3
- 4
Declotting Peripheral Site*
- 1
- 2
- 3
- 4
Complications from Sedation*
- 1
- 2
- 3
- 4
DISCONTINUING IV THERAPY
Peripheral IVs*
- 1
- 2
- 3
- 4
PICC/Midline*
- 1
- 2
- 3
- 4
Central Lines*
- 1
- 2
- 3
- 4
Please list the EMR systems you have used*
*
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.*
Your Recruiter*
Name*
First Last
Email*
Phone*
TODAY'S DATE*
MM slash DD slash YYYY