Age of Patients Cared ForNeonate < 23 Weeks* 1 2 3 4 Neonate 23-28 Weeks* 1 2 3 4 Neonate 29-32 Weeks* 1 2 3 4 Neonate > 32 Weeks* 1 2 3 4 Full Term Newborn* 1 2 3 4 NEUROLOGICALAssessment Of Neurological Status* 1 2 3 4 Intracranial Pressure Monitoring* 1 2 3 4 NEUROLOGICAL- CARE OF NEONATE WITH:Spina Bifida* 1 2 3 4 Myelomeningocele* 1 2 3 4 Brain Death/Organ Procurement* 1 2 3 4 Externalized VP Shunt/Reservoirs* 1 2 3 4 Intraventricular Hemorrhage* 1 2 3 4 Increased Intracranial Pressure* 1 2 3 4 Meningitis* 1 2 3 4 Seizures* 1 2 3 4 Anticonvulsant Medications* 1 2 3 4 CARDIOVASCULARAssessment/Auscultation (rate, rhythm, volume)* 1 2 3 4 Blood Pressure/Invasive (arterial line)* 1 2 3 4 Blood Pressure/Non-invasive* 1 2 3 4 Heart Sounds/Murmurs* 1 2 3 4 Perfusion* 1 2 3 4 Pulses* 1 2 3 4 EKG Interpretation/Rhythm Recognition* 1 2 3 4 Defibrillation/Cardioversion* 1 2 3 4 Invasion Hemodynamic Monitoring* 1 2 3 4 Central Venous Pressure* 1 2 3 4 CARDIOVASCULAR- CARE OF NEONATE WITH:Cardiac Arrest* 1 2 3 4 Cardiac Transplant* 1 2 3 4 Cardiomyopathy* 1 2 3 4 Congenital Heart Disease/Defects* 1 2 3 4 Hemodynamic Instability* 1 2 3 4 Cardiogenic/Hypovolemic Shock* 1 2 3 4 Post Cardiac Surgery* 1 2 3 4 Post Cardiac Cath* 1 2 3 4 Hyper/Hypotension* 1 2 3 4 Knowledge and Use ofVasopressin* 1 2 3 4 Digoxin* 1 2 3 4 Dobutamine* 1 2 3 4 Dopamine* 1 2 3 4 Epinephrine* 1 2 3 4 Nipride* 1 2 3 4 Sodium Bicarbonate* 1 2 3 4 RESPIRATORYAssessment of Breath Sounds* 1 2 3 4 Rate and Work of Breathing* 1 2 3 4 Interpretation of ABGs* 1 2 3 4 Assist with Chest Tube Insertion* 1 2 3 4 Assist With Chest Tube Removal* 1 2 3 4 ECMO (Extracorporeal Membrane Oxygenation)* 1 2 3 4 Thoracentesis* 1 2 3 4 Use of Artificial Surfactant* 1 2 3 4 AIRWAY MANAGEMENT:Assist with Intubation* 1 2 3 4 Bulb Syringe* 1 2 3 4 Endotracheal Tube Suctioning* 1 2 3 4 In-Line Suction* 1 2 3 4 Open ET Catheter Suction* 1 2 3 4 Extubation* 1 2 3 4 Nasal/Oral Airway/Suctioning* 1 2 3 4 Tracheostomy/Suctioning* 1 2 3 4 Apnea Monitor* 1 2 3 4 Respiratory Insufficiency* 1 2 3 4 Respiratory Arrest* 1 2 3 4 O2 THERAPY DELIVERY SYSTEMS:Bag and Mask* 1 2 3 4 Nasal Cannula* 1 2 3 4 Nebulizer* 1 2 3 4 Oxyhood/Ten* 1 2 3 4 Trach Collar* 1 2 3 4 OBTAINING LABS:Arterial* 1 2 3 4 Heelstick* 1 2 3 4 Peripheral* 1 2 3 4 Umbilical Line* 1 2 3 4 USE OF VENTILATORS:CPAP/PEEP* 1 2 3 4 High Frequency Jet Ventilator* 1 2 3 4 Home Ventilator* 1 2 3 4 IMV* 1 2 3 4 Oscillating* 1 2 3 4 Pressure Ventilator* 1 2 3 4 Volume Ventilator* 1 2 3 4 CO2 Monitoring* 1 2 3 4 Weaning* 1 2 3 4 RESPIRATORY- CARE OF NEONATE WITH:Apnea* 1 2 3 4 Meconium Aspiration* 1 2 3 4 Persistent Pulmonary Hypertension (PPHN)* 1 2 3 4 Bronchopulmonary Dysplasia (BPD)* 1 2 3 4 Diaphragmatic Hernia* 1 2 3 4 Fresh Tracheostomy* 1 2 3 4 Pneumothorax* 1 2 3 4 Respiratory Distress Syndrome (RDS)* 1 2 3 4 Respiratory Failure* 1 2 3 4 Knowledge and Use ofAldactazide* 1 2 3 4 Lasix* 1 2 3 4 Caffeine* 1 2 3 4 Prostaglandin* 1 2 3 4 Bronchodilators* 1 2 3 4 Steroids* 1 2 3 4 GASTROINTESTINALAbdominal Girth* 1 2 3 4 Bowel Sounds* 1 2 3 4 Palate* 1 2 3 4 Suck/Swallow* 1 2 3 4 Care of Gastrostomy Tube* 1 2 3 4 Test for Occult Blood* 1 2 3 4 FEEDINGS:Assist with Breast Feeding* 1 2 3 4 Bottle* 1 2 3 4 Breast Milk Handling/Storage* 1 2 3 4 Gavage* 1 2 3 4 Hospital Grade Electronic Breast Pump* 1 2 3 4 PLACEMENT OF INTESTINAL TUBES:Jejunal/Gastro* 1 2 3 4 Nasogastric/Orogastric* 1 2 3 4 GASTROINTESTINAL- CARE OF NEONATE WITH:Cleft lip/Palate* 1 2 3 4 GI Bleed* 1 2 3 4 Ostomy* 1 2 3 4 Post Abdominal Surgery* 1 2 3 4 Inguinal hernia* 1 2 3 4 Necrotizing Enterocolitis* 1 2 3 4 Gastroschesis/Omphalocele* 1 2 3 4 Reflux* 1 2 3 4 Tracheoesophageal Fistula (TEF)* 1 2 3 4 Fluid & Electrolyte Balance* 1 2 3 4 Calculating Output* 1 2 3 4 Knowledge/Interpretation of Lab results/Chemistry* 1 2 3 4 Bilirubin* 1 2 3 4 Glucose* 1 2 3 4 Labstix* 1 2 3 4 Occult Blood* 1 2 3 4 pH* 1 2 3 4 Specific Gravity* 1 2 3 4 COLLECTION OF URINE SPECIMENS:Assist with Suprapubic Tab* 1 2 3 4 CATHETER:Diaper/Bag* 1 2 3 4 Phototherapy for Jaundice* 1 2 3 4 Post Circumcision Care* 1 2 3 4 RENAL/GU/METABOLIC/ENDOCRINE- CARE OF NEONATE WITH:Acute Renal Failure* 1 2 3 4 DIC (disseminated Intravascular Coagulation)* 1 2 3 4 Disorders of Internal/External Organs* 1 2 3 4 Drug Addiction/Withdrawal* 1 2 3 4 Hyper/Hypokalemia* 1 2 3 4 Hyper/Hyponatremia* 1 2 3 4 Infant of Diabetic Mother- Monitor for Hyper/Hypoglycemia* 1 2 3 4 Malformations of the GU Tract, Kidney* 1 2 3 4 Peritoneal Dialysis* 1 2 3 4 INFECTIOUS DISEASESAssist with Lumbar Puncture* 1 2 3 4 Collect Culture Specimens* 1 2 3 4 Isolation Techniques* 1 2 3 4 Standard Precautions* 1 2 3 4 KNOWLEDGE OF LAB RESULTS:CBC/Differential* 1 2 3 4 Culture Reports* 1 2 3 4 Maternal Lab Results* 1 2 3 4 INFECTIOUS DISEASE- CARE OF NEONATE WITH:Hepatitis Surface Antigen + Mother* 1 2 3 4 HIV Positive Mother* 1 2 3 4 Neonatal Sepsis* 1 2 3 4 Knowledge and Use ofAntibiotics* 1 2 3 4 HBIG* 1 2 3 4 HBV* 1 2 3 4 HIB* 1 2 3 4 RespiGam/Synagis Prophylaxis* 1 2 3 4 MEDICATION SKILLS/KNOWLEDGE AND USE OFCalculation of Dosage* 1 2 3 4 Prep and Administration of Emergency Meds* 1 2 3 4 Emergency Drug Action & Reaction* 1 2 3 4 Eye Prophylaxis – Vitamin K* 1 2 3 4 Neonatal Drug Action & Reactions* 1 2 3 4 Computerized/Automated Medication Administration System* 1 2 3 4 List TypesComputerized/Automated Medication Administration System* 1 2 3 4 List TypesPAIN MANAGEMENTAssessment Of Pain Level Using Age Appropriate Scales* 1 2 3 4 Care of Neonate with Sedation* 1 2 3 4 Use of Sedation Reversal Agents* 1 2 3 4 ADMINISTRATION OF BLOOD/BLOOD PRODUCTSCryoprecipitate* 1 2 3 4 Packed Red Blood Cells* 1 2 3 4 Plasma/Albumin* 1 2 3 4 Whole Blood* 1 2 3 4 Drawing Blood from Central Line* 1 2 3 4 Drawing Venous Blood* 1 2 3 4 DELIVERY SYSTEMS:IV Pump* 1 2 3 4 Syringe Pump* 1 2 3 4 Hyperalimentation/TPN/PPN* 1 2 3 4 Intralipid* 1 2 3 4 MANAGING IV THERAPY:Insertion* 1 2 3 4 Discontinuation* 1 2 3 4 Dressing & Tubing Change* 1 2 3 4 Rate Calculation* 1 2 3 4 Site & Patency Assessment* 1 2 3 4 IV THERAPY/PHLEBOTOMY- CARE OF THE NEONATE WITH:Central Line/Catheter/Dressing* 1 2 3 4 Broviac* 1 2 3 4 Groshong* 1 2 3 4 Hickman* 1 2 3 4 Port-A-Cath* 1 2 3 4 Quinton* 1 2 3 4 Percutaneous Arterial Line* 1 2 3 4 PICC (peripherally inserted central catheter)* 1 2 3 4 Umbilical Artery Line* 1 2 3 4 Umbilical Venous Line* 1 2 3 4 OTHER/MISC:Crash Carts* 1 2 3 4 Defibrillators* 1 2 3 4 Computerized Charting System* 1 2 3 4 List TypesApgar Scoring* 1 2 3 4 Eye Exam (r/o retinopathy)* 1 2 3 4 Cord Care* 1 2 3 4 Neonatal Skin Care* 1 2 3 4 Positioning Devices* 1 2 3 4 Preparation for Transport/Transfer* 1 2 3 4 GESTATIONAL AGE:Car Seat Safety* 1 2 3 4 Ballard* 1 2 3 4 Dubowitz* 1 2 3 4 Other (Specify):Maternal History* 1 2 3 4 Screen for Hearing Loss* 1 2 3 4 Equipment & Procedures* 1 2 3 4 Bereavement/Postmortem Care* 1 2 3 4 Consents* 1 2 3 4 Immunization* 1 2 3 4 Procedural* 1 2 3 4 Treatment* 1 2 3 4 Family Teaching/Education* 1 2 3 4 Care Planning* 1 2 3 4 THERMOREGULATION:Isolette with Humidity* 1 2 3 4 Radiant Warmer* 1 2 3 4 Temperature (auxillary, rectal, skin)* 1 2 3 4 Weaning To Open Crib/Bassinet* 1 2 3 4 WEIGHTS:Bed Scale* 1 2 3 4 Scale* 1 2 3 4 List Any Additional Training:List Any Additional Equipment:List Any Additional Skills:Experience with ventilators? Yes No If so, what type?Experience with cardiac monitors? Yes No If so, what type?NRP current? Yes No STABLE current? Yes No 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.*Name* First Last Email* Phone*TODAY'S DATE* MM slash DD slash YYYY
