Age of Patients Cared ForNewborn/Neonate (Birth to 30 days)* 1 2 3 4 Infant (1 month to 1 year)* 1 2 3 4 Preschooler (3 year to 5 years)* 1 2 3 4 Toddler (1 year to 3 years)* 1 2 3 4 Preschooler (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 to 79 years)* 1 2 3 4 Elderly Adults (over 79+ years)* 1 2 3 4 General SkillsStandard Precautions* 1 2 3 4 Isolation Precautions* 1 2 3 4 Patient Head to Toe Assessment* 1 2 3 4 Medication Titration* 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 Automated Med Dispensing Systems* 1 2 3 4 Care Planning & Discharge Planning* 1 2 3 4 Patient/Family Education* 1 2 3 4 Document Interventions, Outcomes, Lab Studies, MD Notifications & Follow-Up Care* 1 2 3 4 Admission to PACU Initial Assessment/Vital Signs* 1 2 3 4 Airway Management* 1 2 3 4 Proper Positioning* 1 2 3 4 Skin Color, Temp, Turgor* 1 2 3 4 Neurological Status* 1 2 3 4 Monitor Recovery of Patient FromGeneral Anesthesia* 1 2 3 4 Regional Anesthesia* 1 2 3 4 Local Anesthesia* 1 2 3 4 Neuro Skills and Care of Patient Post OperativeNeuro Assessment* 1 2 3 4 Glasgow Coma Scale* 1 2 3 4 Spinal Fusion* 1 2 3 4 Spinal Cord Injury* 1 2 3 4 Ventriculostomy* 1 2 3 4 Craniotomy* 1 2 3 4 ICP Monitor* 1 2 3 4 Cardiac SkillsUse of Doppler* 1 2 3 4 Cardiac Assessment* 1 2 3 4 Knowledge of Labs and Normal Values* 1 2 3 4 12 Lead Interpretation* 1 2 3 4 Arrhythmia Analysis* 1 2 3 4 Cardioversions & Defibrillation* 1 2 3 4 Assist with Insertion of Temporary Pacemaker* 1 2 3 4 Use of Non-Invasive Temporary Pacing Equipment* 1 2 3 4 Intravascular Hemodynamic MonitoringPulmonary Artery Catheters* 1 2 3 4 Arterial Catheters* 1 2 3 4 Swan-Ganz Catheters* 1 2 3 4 Equipment Maintenance* 1 2 3 4 Dressing Changes* 1 2 3 4 Prevention of Complications* 1 2 3 4 Leveling Waveform Analysis* 1 2 3 4 Obtain and InterpretCardiac Output* 1 2 3 4 PA Pressure* 1 2 3 4 PCWP/PAWP* 1 2 3 4 CVP* 1 2 3 4 LAP* 1 2 3 4 Cardiac Care of Post Operative PatientMalignant Hyperthermia* 1 2 3 4 AAA Repair* 1 2 3 4 Open Heart Surgery (CABG)* 1 2 3 4 Off Pump Heart Surgery* 1 2 3 4 Valve Repair* 1 2 3 4 Permanent/Temporary Pacemaker* 1 2 3 4 Congestive Heart Failure* 1 2 3 4 Heart Transplant* 1 2 3 4 Medication knowledge of antiarrhythmics* 1 2 3 4 Medication Knowledge and Use of Calcium Channel Blockers* 1 2 3 4 Medication Knowledge and Use of Heparin* 1 2 3 4 Medication Knowledge and Use of Dopamine* 1 2 3 4 Medication Knowledge and Use of Dobutamine* 1 2 3 4 Respiratory General SkillsAirway Insertion/Management* 1 2 3 4 Assess Respiratory Rate, Rhythm, Depth & Symmetry* 1 2 3 4 Auscultate Breath Sounds* 1 2 3 4 Recognize Abnormal Breath sounds & Implement Interventions* 1 2 3 4 Laryngospasm* 1 2 3 4 Obtain ABG’s* 1 2 3 4 Knowledge of ABG’s and Normal Values* 1 2 3 4 Set-Up Chest Tube Drainage System* 1 2 3 4 Recognize Air Leak, Assess for SQ emphysema* 1 2 3 4 Measure Drainage* 1 2 3 4 Suctioning and O2 AdministrationOral* 1 2 3 4 Nasal* 1 2 3 4 Endotracheal* 1 2 3 4 Mask* 1 2 3 4 Nasal Cannula* 1 2 3 4 T-Piece* 1 2 3 4 ETT Mechanical Ventilator* 1 2 3 4 Respiratory – Care of Post Operative PatientPneumothorax* 1 2 3 4 Chest Tube* 1 2 3 4 Lung Transplant* 1 2 3 4 Thoracotomy* 1 2 3 4 Lobectomy* 1 2 3 4 Medication Knowledge & Use of Bronchodilators* 1 2 3 4 Medication Knowledge & Use of Diuretics* 1 2 3 4 Medication Knowledge & Use of Corticosteroids* 1 2 3 4 Medication Knowledge & Use of Racemic Epinephrine* 1 2 3 4 Gastrointestinal – Care of Post Operative PatientBowel Sounds/Abnormal Assessment* 1 2 3 4 G or J Tube* 1 2 3 4 NG Tube* 1 2 3 4 Ostomy Care and Assessment* 1 2 3 4 Gastric Bypass* 1 2 3 4 Appendectomy* 1 2 3 4 Colostomy/Ileostomy* 1 2 3 4 GI Surgery* 1 2 3 4 Small Bowel Transplant* 1 2 3 4 Pancreatic Transplant* 1 2 3 4 Liver Transplant* 1 2 3 4 GU/Renal - Care of Post Operative PatientAssessment of Output* 1 2 3 4 Catheters* 1 2 3 4 Urethral* 1 2 3 4 Suprapubic* 1 2 3 4 Bladder Irrigation* 1 2 3 4 Knowledge of Normal Lab Chemistry Values* 1 2 3 4 Shunts/Fistulas* 1 2 3 4 TURB* 1 2 3 4 Nephrectomy* 1 2 3 4 Kidney Transplant* 1 2 3 4 Bladder Repair* 1 2 3 4 Testicular Procedures* 1 2 3 4 Lithotripsy* 1 2 3 4 Orthopedic – Care of Post Operative PatientAmputation* 1 2 3 4 Total Joint* 1 2 3 4 Fractures* 1 2 3 4 Arthroscopic Procedures* 1 2 3 4 Eye/Ear - Care of Post Operative PatientCataract Extraction* 1 2 3 4 Keratoplasty* 1 2 3 4 Laser Eye Surgery* 1 2 3 4 Orbital Fracture* 1 2 3 4 Orbital Implant* 1 2 3 4 Scleral Bucking* 1 2 3 4 Dacryocystectomy* 1 2 3 4 Cochlear Implant* 1 2 3 4 Myringotomy* 1 2 3 4 Pain ManagementAssessment and Documentation of paint and follow up after intervention* 1 2 3 4 PCA Systems* 1 2 3 4 Epidural Pain Systems* 1 2 3 4 IV Sedation* 1 2 3 4 Titration of Medication Per Orders* 1 2 3 4 Narcotic Analgesic* 1 2 3 4 Non-Narcotic Analgesics* 1 2 3 4 Muscle Relaxants* 1 2 3 4 IV Therapy/PhlebotomyPeripheral IV Insertion, Care and Maintenance* 1 2 3 4 PICC Line Care & Maintenance* 1 2 3 4 Central Line Care & Maintenance* 1 2 3 4 Port-A-Cath Access, Care & Maintenance* 1 2 3 4 Drawing Lab work from Central line/Port* 1 2 3 4 Administration of Blood/Blood Products* 1 2 3 4 Tubes/Drains – Care of Patient with:Penrose Drain* 1 2 3 4 Jackson Pratt* 1 2 3 4 T Tube* 1 2 3 4 Hemovac* 1 2 3 4 Operate & Monitor Unit EquipmentPortable Suction Machine* 1 2 3 4 Transport Monitor* 1 2 3 4 Automatic BP Monitor* 1 2 3 4 Blanket Warmer/Bear Hugger* 1 2 3 4 Sequential Compression Device* 1 2 3 4 Pulse Oximeter* 1 2 3 4 Hyper/Hypothermia Blanket* 1 2 3 4 Blood Warmer* 1 2 3 4 IV Pumps* 1 2 3 4 PACU Stretcher* 1 2 3 4 Anesthesia Equipment & DischargeNitrogen Controls* 1 2 3 4 Tanks* 1 2 3 4 Wall Units* 1 2 3 4 Perform A Discharge Physical* 1 2 3 4 Level of Consciousness* 1 2 3 4 Pupillary Reactions* 1 2 3 4 Motor & Sensory Function* 1 2 3 4 Muscular Strength* 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.*Name* First Last Email* Phone*TODAY'S DATE* MM slash DD slash YYYY
