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Skills Checklist

Dialysis

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 year to 5 years)*
- 1
- 2
- 3
- 4
School Age (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
Care of Patient in Restraints*
- 1
- 2
- 3
- 4
Pain Management*
- 1
- 2
- 3
- 4
Automated Med Dispensing Systems*
- 1
- 2
- 3
- 4
Care Planning and Discharge Planning*
- 1
- 2
- 3
- 4
Patient/Family Education*
- 1
- 2
- 3
- 4
Peripheral IV Insertion, Care and Maintenance*
- 1
- 2
- 3
- 4
Renal/Genitourinary
Assessment of Renal/GU System*
- 1
- 2
- 3
- 4
Insertion of Urinary Catheter*
- 1
- 2
- 3
- 4
Patient with Nephrostomy Tube*
- 1
- 2
- 3
- 4
Patient with AV Fistula/A V Graft*
- 1
- 2
- 3
- 4
Patient with Tunneled/Non-Tunneled Catheter*
- 1
- 2
- 3
- 4
Patient with Ileal Conduit*
- 1
- 2
- 3
- 4
Patient with Supra-Pubic Catheter*
- 1
- 2
- 3
- 4
Patient with Renal Failure*
- 1
- 2
- 3
- 4
Patient with Nephrectomy*
- 1
- 2
- 3
- 4
Patient with TURP*
- 1
- 2
- 3
- 4
Patient on Peritoneal Dialysis*
- 1
- 2
- 3
- 4
Patient on Hemodialysis*
- 1
- 2
- 3
- 4
Hemodialysis Skills/Procedures Experience
Acute/Inpatient Dialysis*
- 1
- 2
- 3
- 4
Chronic/Outpatient Dialysis*
- 1
- 2
- 3
- 4
Dialysis Home Care*
- 1
- 2
- 3
- 4
Pediatric Dialysis*
- 1
- 2
- 3
- 4
Pre-dialysis Nursing Assessment*
- 1
- 2
- 3
- 4
Set Up / Initiate Dialysis Treatment
Bicarbonate Dialysate*
- 1
- 2
- 3
- 4
Conductivity Testing*
- 1
- 2
- 3
- 4
Priming Dialyzer*
- 1
- 2
- 3
- 4
Checks for Machine/Alarm Settings*
- 1
- 2
- 3
- 4
Prep Vascular Access*
- 1
- 2
- 3
- 4
Fistula Gortex/Bovine Graft*
- 1
- 2
- 3
- 4
Dialysis*
- 1
- 2
- 3
- 4
Collect Blood Specimens*
- 1
- 2
- 3
- 4
Volume Status*
- 1
- 2
- 3
- 4
Vascular Access Function*
- 1
- 2
- 3
- 4
Arterial and Venous Pressures*
- 1
- 2
- 3
- 4
Blood Flow Rate*
- 1
- 2
- 3
- 4
Subjective Response to Treatment*
- 1
- 2
- 3
- 4
Management of Anticoagulation*
- 1
- 2
- 3
- 4
Conductivity*
- 1
- 2
- 3
- 4
Ultrafiltration Calculation*
- 1
- 2
- 3
- 4
Myron L Water Meter*
- 1
- 2
- 3
- 4
Administration of Mannitol*
- 1
- 2
- 3
- 4
Sequential Ultrafiltration/PUF*
- 1
- 2
- 3
- 4
Documentation of Dialysis Treatment*
- 1
- 2
- 3
- 4
Fluid Overload*
- 1
- 2
- 3
- 4
Hypertension*
- 1
- 2
- 3
- 4
Hypotension*
- 1
- 2
- 3
- 4
Disequilibrium Syndrome*
- 1
- 2
- 3
- 4
Hyperkalemia*
- 1
- 2
- 3
- 4
Seizures*
- 1
- 2
- 3
- 4
Muscle Cramps*
- 1
- 2
- 3
- 4
Clotted Access/Poor Blood Flow Rate from Catheter*
- 1
- 2
- 3
- 4
Pyrogenic Reaction*
- 1
- 2
- 3
- 4
Hemolysis*
- 1
- 2
- 3
- 4
Air Embolus*
- 1
- 2
- 3
- 4
Chest Pain*
- 1
- 2
- 3
- 4
Anemia*
- 1
- 2
- 3
- 4
Neuropathy*
- 1
- 2
- 3
- 4
Pericarditis*
- 1
- 2
- 3
- 4
Filter Blood Leak*
- 1
- 2
- 3
- 4
Alarm
Blood Leak Alarm*
- 1
- 2
- 3
- 4
Arterial Pressure Alarm*
- 1
- 2
- 3
- 4
Venous Pressure Alarm*
- 1
- 2
- 3
- 4
Conductivity Alarm*
- 1
- 2
- 3
- 4
Ultrafiltration Alarm*
- 1
- 2
- 3
- 4
High Temperature Alarm*
- 1
- 2
- 3
- 4
Air/Foam Detector Alarm*
- 1
- 2
- 3
- 4
Power Failure Alarm*
- 1
- 2
- 3
- 4
Blood Pump Alarm*
- 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*
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