Wound Care/Ostomy Skills Checklist

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 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
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
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*
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Skills Checklist

Age of Patients Cared For

Work Settings

PRESSURE ULCERS

NEUROPATHIC ULCERS

VENOUS STASIS ULCERS

PERIPHERAL ARTERIAL ULCERS

OTHER WOUNDS

WOUND DEBRIDEMENT

DRESSINGS/ TREATMENTS

COLOSTOMY / ILEOSTOMY

CONTINENT ILEOSTOMY

UROSTOMY / CONTINENT

CONTINENCE THERAPEUTIC DEVICES

BURNS

PROFESSIONAL KNOWLEDGE AND SKILLS

OTHER / MISC.