Wound Care / Ostomy Skills Checklist

Work Settings

Acute Care – Adult*

1
2
3
4

Clinic – Adult*

1
2
3
4

SNF/LTAC/Subacute*

1
2
3
4

Hospice / Palliative Care*

1
2
3
4

Acute/Long Term Care – Pediatrics*

1
2
3
4

Clinic – Pediatrics*

1
2
3
4

PRESSURE ULCERS

Assessment*

1
2
3
4

Staging*

1
2
3
4

Prevention/ Risk Assessment Tools – Adult*

1
2
3
4

Prevention/ Risk Assessment Tools -Pediatrics*

1
2
3
4

Support Surface Selection*

1
2
3
4

NEUROPATHIC ULCERS

Assessment*

1
2
3
4

Management*

1
2
3
4

VENOUS STASIS ULCERS

Assessment*

1
2
3
4

Management*

1
2
3
4

PERIPHERAL ARTERIAL ULCERS

Assessment*

1
2
3
4

Ankle Brachial Index*

1
2
3
4

Management*

1
2
3
4

OTHER WOUNDS

Fistulae – Pouching / Skin Care*

1
2
3
4

Skin Care/ Management of Drains*

1
2
3
4

WOUND DEBRIDEMENT

Autolytic*

1
2
3
4

Enzymatic*

1
2
3
4

Mechanical*

1
2
3
4

Sharp*

1
2
3
4

DRESSINGS/ TREATMENTS

Hydrogels*

1
2
3
4

Hydrocolloids*

1
2
3
4

Silver Products*

1
2
3
4

Foams*

1
2
3
4

Alginates*

1
2
3
4

Vacuum Assisted Closure*

1
2
3
4

Growth Factors*

1
2
3
4

Skin Substitutes*

1
2
3
4

Hyperbaric Oxygen Therapy*

1
2
3
4

Wound Cultures*

1
2
3
4

Electrical Stimulation*

1
2
3
4

Enzymatic Debriding Agents*

1
2
3
4

Mist Therapy*

1
2
3
4

COLOSTOMY / ILEOSTOMY

Ostomy Equipment Selection*

1
2
3
4

Continence Skin Care Management*

1
2
3
4

Loop with Rod Stoma*

1
2
3
4

End Stoma*

1
2
3
4

Mucous Fistula*

1
2
3
4

Double Barrel Stoma*

1
2
3
4

Irrigation*

1
2
3
4

Ileal Lavage*

1
2
3
4

CONTINENT ILEOSTOMY

Knock pouch*

1
2
3
4

Pelvic Pouch*

1
2
3
4

UROSTOMY / CONTINENT

Catherization for C&S*

1
2
3
4

Knock Pouch*

1
2
3
4

Neobladder*

1
2
3
4

CONTINENCE THERAPEUTIC DEVICES

Vaginal Cones*

1
2
3
4

Penile Clamps*

1
2
3
4

Male External Catheters*

1
2
3
4

Internal Urethral Inserts*

1
2
3
4

Catheters –Mgmt & Self Care Teaching*

1
2
3
4

Magnetic Therapy*

1
2
3
4

Urinary Incontinence Program*

1
2
3
4

Fecal Incontinence Program*

1
2
3
4

BURNS

Burn Management*

1
2
3
4

PROFESSIONAL KNOWLEDGE AND SKILLS

National Patient Safety Goals/ Core Measures*

1
2
3
4

Patient Family Teaching*

1
2
3
4

Age Specific/Population Based Care*

1
2
3
4

Isolation Precautions*

1
2
3
4

Infection Precautions*

1
2
3
4

Pain assessment & Management*

1
2
3
4

Interpretation & Communication of Lab Values*

1
2
3
4

EMR*

1
2
3
4

EPIC*

1
2
3
4

Cerner*

1
2
3
4

Eclipsys*

1
2
3
4

McKesson*

1
2
3
4

Other Computerized System*

1
2
3
4

Computerized Physician Order Entry*

1
2
3
4

Bar coding for Medication*

1
2
3
4

Culture*

1
2
3
4

OTHER / MISC.

Pain Management Assessment of Pain Levels without intervention*

1
2
3
4

Pain Management Response Assessment with Intervention*

1
2
3
4

Experience: Charge Duty*

1
2
3
4

Experience: Preceptor*

1
2
3
4

Age Specific Skills

Newborn 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

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*

Wound Care / Ostomy Skills Checklist