GENERAL INFORMATION

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This profile is for use by healthcare professionals in the Medical / Surgical discipline and specialty. It will not be a determining factor for the program.

CHECKLIST INSTRUCTIONS

Please mark your level of experience      1. No theory and/or experience      2. Limited experience/need supervision and/or support      3. Experienced/minimal support needed to perform      4. Proficient/can perform independently

Cardiac

1

2

3

4

Angina

Post Acute MI

Congestive Heart Failure

Post Cardiac Cath

Post Cardiac Surgery

Aneurysm

Carotid Endarterectomy

Post Vascular Surgery

Post Cardiac Transplant

PULMONARY

1

2

3

4

Pneumonia

COPD

Tuberculosis

Pulmonary Embolism

Tracheostomy Management

CPAP/BiPAP

Interpretation of Arterial Blood Gases

Post Lung Transplant

Neurological & Psychiatric

1

2

3

4

Stroke Scale Assessment

Traumatic Brain Injury

CVA

Post Craniotomy

Seizure Disorders

Spinal Cord Injuries

Mood Disorders

Substance Withdrawal

ORTHOPEDICS

1

2

3

4

Circulation/Skin Checks

Continuous Passive Motion Devices

Ambulation Assistive Devices

Prosthetics

Cast Care

Pin Care

Traction

Total Joint Replacement

Amputation

GASTROINTESTINAL

1

2

3

4

Bariatrics

Feeding Tubes

GI Bleeding

Bowel Obstruction

GI Surgery

Liver Disease

Pancreatitis

Post Liver Transplant

Post Pancreas Transplant

RENAL/GENITOURINARY

1

2

3

4

Arteriovenous Fistula/Shunt

3 Way Catheter & Bladder Irrigation

Suprapubic Catheter

Renal Failure

Peritoneal Dialysis

GU Surgery

Nephrostomy Tubes

Renal Transplant

Management Pre/Post Hemodialysis

Gyn Surgery

Endocrine Metabolic

1

2

3

4

Diabetes Type I

Diabetes Type II

Blood Glucose Monitoring

IV Insulin Protocols

Management of Hypoglycemia

Indwelling Insulin Pumps

Pituitary Disorders

ONCOLOGY

1

2

3

4

Chemotherapy Administration

Radiation Therapy

Medical Oncology

Surgical Oncology

Radiation Implants

Bone Marrow Transplant

MEDICATIONS

1

2

3

4

Antiarrhythmics

Anticoagulants (IV, oral, & injection)

Anti-Depressants

Anti-Hypertensives

Anti-Psychotics

Benzodiazepines

Emergency Medications

Epidural Analgesia

Inhaled Medications

Insulin

Narcotics/Opioid Analgesics (IV, oral, & injection)

Nitrates (Oral & Topical)

Non-Opioid Analgesics (IV, Oral, & Injection)

Oral Hypoglycemics

Patient Controlled Analgesia

Procedural Sedation Administration

Reversal Agents

Steroids (IV, Oral, Inhaled)

Automated Medication Dispensing (i.e. Pyxis, Omnicell)

IV THERAPY

1

2

3

4

Starting IVs

Central Line Blood Draws

Central Line/Implanted Line Care

TPN & Lipids

Blood Product Administration

Monitoring of Chemotherapy

CARDIAC MONITORING & EMERG. RESPONSE

1

2

3

4

Placement of Telemetry Leads

Rhythm Interpretation

Dysrhythmia Management

Obtain 12 Lead EKG

Use of Rapid Response Teams

PROFESSIONAL KNOWLEDGE AND SKILLS

1

2

3

4

National Patient Safety Goals/Core Measures

Fall Risk Assessment/Prevention

Pressure Ulcer Risk Assessment/Prevention

Restraints/Use of Least Restrictive Device

Patient/Family Teaching

Age Specific/Population-Based Care

Isolation Precautions

Infection Prevention

Pain Assessment & Management

Charge Experience

Interpretation and Communication of Lab Values

Wound Care /Wound Vac

Specialty Beds

EMR

1

2

3

4

Epic

Cerner

Eclipsys

McKesson

Meditech

Other Computerized System

Computerized Physician Order Entry

Bar Coding for Medication Administration

EMR Conversion

Yes

No

CERTIFICATIONS

BLS

ACLS

Telemetry Certificate

ONS Chemo/Biotherapy Certification

Other Chemo Certification

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