| Name |
|
| Date |
|
| Please choose your level of experience in each of the following. |
| |
| GENERAL SKILLS |
| Advanced directives |
|
| End of life care |
|
| Emergency codes |
|
| Disaster protocols |
|
| Universal precautions |
|
| Infection control |
|
| Blood Glucose Monitoring (BGM) |
|
| Insulin administration |
|
| Diabetes mellitus |
|
| Isolation |
|
| Prevention of pressure ulcers |
|
| Wound care |
|
| Minimize risk for falls |
|
| Patient family teaching |
|
| Restraints |
|
| Organ donor protocols |
|
| Specialty beds |
|
| Lift/transfer devices |
|
| Consent for treatment of a minor |
|
| O2 therapy and delivery |
|
| Use of rapid response teams |
|
| Treatments of dysrythmias |
|
| Cardiac arrest/CPR |
|
| Pulse oximetry |
|
| Use of Doppler |
|
| Cobra criteria |
|
| Suture tray set up |
|
| Triage |
|
| |
| IV THERAPY |
| Use of PCA (IV, intrathecal, epidural) |
|
| Starting & maintaining peripheral IV’s |
|
| Blood draw: venous |
|
| Blood draw: central line |
|
| Central line care |
|
| Care & management of ports |
|
| Care & management of PICC/Groshong/Hickman |
|
| TPN & Lipids |
|
| Monitoring chemotherapy (does not initiate) |
|
| Administration of blood/blood products |
|
| |
| 2024 NATIONAL PATIENT SAFETY GOALS |
NPSG.01.01.01
• Identify patients correctly |
|
| • Use patients name and date of birth |
|
| • Make sure correct patient gets the correct medicine and treatment |
|
Improve staff communication
|
|
NPSG.02.03.01
Get important test results to the right staff person on time. |
|
Use medicines safely
|
|
NPSG.03.04.01
Before a proceedure, label medicines that are not labeled. For example, medicines in syringes, cups and basins. Do this in the area where medicines and supplies are set up. |
|
NPSG.03.05.01
Take extra care with patients who take medicines to thin their blood. |
|
NPSG.03.06.01
Record and pass along correct information about a patient’s medicines. Find out what medicines the patient is taking. Compare those medicines to new medicines given to the patient. Give the patient written information about the medicines they need to take. Tell the patient it is important to bring their up-to-date list of medicines every time they visit their doctor. |
|
| Use Alarms Safely |
|
NPSG.06.01.01
Make improvements to ensure that alarms on medical equipment are heard and responded to on time. |
|
| Prevent infection
|
|
NPSG.07.01.01
Use the hand cleaning guidelines from the Centers of Disease Control and Prevention or the World Health Organization. Set goals for improving hand cleaning |
|
| Identify patient safety risks |
|
NPSG.15.01.01
Reduce the risk for suicide. |
|
| Improve health care equity |
|
NPSG.16.01.01
Improving health care equity is a quality and patient safety priority. For example, health care disparities in the patient population are identified and a written plan describes ways to improve health care equity. |
|
| Prevent mistakes in surgery |
|
UP.01.01.01
Make sure that the correct surgery is done on the correct patient and at the correct place on the patient’s body. |
|
UP.01.02.01
Mark the correct place on the patients body where the surgery is to be done. |
|
UP.01.03.01
Pause before the surgery to make sure that a mistake is not being made. |
|
| |
| COMPUTERIZED CHARTING |
| Health Connect |
|
| Meditech |
|
| Cerner |
|
| McKesson |
|
| EPIC |
|
| Camis |
|
| Affinity |
|
| Wellsoft – ER |
|
| T-System – ER |
|
| Automated medication dispensing |
|
| Bar coding for medication administration |
|
| |
CARDIOVASCULAR |
| Acute MI |
|
| Unstable angina |
|
| Aneurysm (Thoracic or Abdominal) |
|
| Cardioversion |
|
| Cardiogenic shock |
|
| CHF |
|
| Defibrillation |
|
| Assist with insertion of a temporary pacemaker |
|
| Application of an external pacemaker |
|
| Aortic aneurysm |
|
| Acute myocardial infarction |
|
| Obtain 12 lead EKG |
|
| Dysrhythmias/conduction disturbances |
|
| Interpretation of rhythm strips |
|
| Cardiogenic shock |
|
| Hypertensive crisis |
|
| Post open heart (CABG/valve) |
|
| Pericarditis/endocarditis |
|
| Pulse oximetry |
|
| Cardiac tamponade |
|
| Cardiac contusion/trauma |
|
| Blood draw – central line |
|
| Cardiac valvular disease |
|
| Pacemaker-permanent, automatic internal cardioverter defibrillator (AICD) |
|
| |
|
TRAUMA |
|
| Trauma score |
|
| Critical transports |
|
| Air transport (Helicopter or Jet) |
|
| Other transport experience |
|
| Open chest massage |
|
| Hypovolemic shock |
|
| Level 1 trauma |
|
| Level 2 trauma |
|
| Level 1 infuser |
|
| Peritoneal lavage |
|
| Auto transfuser |
|
| H+H stat lab test machine |
|
| |
|
VASCULAR ACCESS |
|
| Assist with arterial line insertion |
|
| Assist with central line insertion |
|
| Assist with intraosseous needle insertion |
|
| Assisting with a cut-down |
|
| Antiplalelets |
|
| |
|
| PULMONARY |
|
| Nebulizer |
|
| Pneumonia |
|
| C.O.P.D. |
|
| Near drowning |
|
| Asthma |
|
| ABG interpretation |
|
| Assessment of breath sounds |
|
| Airway management |
|
| Acute pulmonary embolus |
|
| Assisting with intubation/extubation |
|
Airway management care & maintenance of |
|
| Oral/NT airway/suctioning |
|
| Endotracheal tube/suctioning |
|
| Tracheostomy/suctioning |
|
| Obtaining ABG blood sample analysis & interpretation |
|
| Pulse oximetry |
|
| Ventilator management |
|
| BiPap |
|
| SIMV/IMV (Synchronized/intermittent mandatory ventilation) |
|
| External CPAP |
|
| PCV (pressure control ventilation) |
|
| PEEP (positive and expiration pressure) |
|
| Inverse ration ventilation |
|
| High-frequency jet ventilation |
|
| Weaning modes & T-piece weaning |
|
Caring of patient with |
|
| Acute pneumonia |
|
| Pulmonary edema (hypertension) |
|
| Acute respiratory failure |
|
| Adult respiratory distress syndrome (ARDS) |
|
| Chronic obstructive pulmonary disease (COPD) |
|
| Near drowning |
|
| Lung transplant |
|
| Pre/post thoracic surgery |
|
| Chest trauma |
|
| Status asthmaticus |
|
Pharmacology – use & administration of |
|
| Rapid sequence intubation drugs/protocols |
|
| Aminophylline |
|
| Nebulizer treatments |
|
| |
|
GASTROINTESTINAL |
|
| Assessment of abdominal/bowel sounds |
|
| Interpretation of lab results |
|
| Nasogastric tube insertion/feedings |
|
| Gastric Lavage |
|
| Maintenance of gastric/jejunostomy tube |
|
| Use of activated charcoal |
|
| Stoma care |
|
| Maintenance & management of eternal tube feedings |
|
| TPN & lipids administration |
|
| Insertion of post-pyloric feeding tubes |
|
Care of patient with |
|
| Abdominal trauma |
|
| GI bleeding |
|
| Peritonitis |
|
| Esophageal varices/bleeding |
|
| Balloon tamponade devices |
|
| Bowel obstruction |
|
| Hepatitis/hepatic failure |
|
| Acute pancreatitis |
|
| Liver/pancreas transplant |
|
Pharmacology – use & administration of |
|
| Antiemetics: raglan, zofran |
|
| H2 receptor antagonists |
|
| |
|
ENDOCRINE/METABOLIC |
|
| Interperation of lab results |
|
| Administration/monitoring of insulin infusion |
|
| Diabetic ketoacidosis (DKA) |
|
| Disorders of pituatory gland |
|
| Drug overdose |
|
| Disorders of thyroid gland |
|
| Diabetes mellitus |
|
| Hyperosmolar |
|
| Hyperglycemic |
|
| Non ketotic coma (HHNK) |
|
| |
|
| NEUROLOGY |
|
| Cranial nerve assessment |
|
| Glasgow coma scale |
|
| Intracranial/cerebal perfusion pressure monitoring (ICP/CPP) via |
|
| Ventriculostomy |
|
| Subarachnoid screw/bolt |
|
| Intrathecal catheters |
|
| Seizure precautions |
|
| Cervical spine precautions/logroll positioning |
|
| Halo vest/halo traction |
|
| Use of kinetic bed |
|
| Skeletal traction |
|
| Assist with lumbar puncture |
|
Care of patient with |
|
| Cerebal aneurysm |
|
| Head injury |
|
| Spinal cord injury |
|
| Pre/post cranial surgery |
|
| Meningitis |
|
| Status Epilepticus |
|
| Laminectomy |
|
| Externalized V.P. shunts |
|
| Pituitary tumor |
|
Pharmacoloty-use & administration of |
|
| Steriods |
|
| Anticonvulsants |
|
| Paralytic agents: norcuron, pavulon |
|
| Nimbex, tracrium |
|
| Mannitol |
|
| Antipsychotics: haldol |
|
| |
|
GENITOURINARY/RENAL |
|
| Interpretation of lab results |
|
| Foley catheter insertion/care 3 way foley/female/male |
|
| Testicular torsion |
|
| Maintenance & management of fluid & electrolyte balance |
|
| Suprapubic tube |
|
| Nephrostomy tube |
|
| Continuous arteriovenous |
|
| Hemofiltration (CAVHD, CVVHD, SCUF) |
|
Care of patient with |
|
| Acute renal failure |
|
| AV fistulas, shunts, & dialysis catheters |
|
| Hemodialysis |
|
| Neprectomy |
|
| Renal transplant |
|
| Renal/urinary tract trauma |
|
| |
|
OBSTETRICS/GYNECOLOGY |
|
| Spontaneous abortion hemorrhage |
|
| Ectopic pregnancy |
|
| Placenta previa |
|
| Assist with pelvic exams |
|
| Rape kits |
|
| Cultures |
|
| Preeclampsia |
|
| Fetal heart tones |
|
| |
|
ORTHOPEDICS |
|
| Assist with cast application |
|
| Application of orthopedic appliances |
|
| Splinting |
|
| Assist with closed fracture reductions |
|
| Assess vascular circulation |
|
| |
|
PEDIATRIC |
|
| Pediatric resuscitation |
|
| Overdose |
|
| Poison ingestion |
|
| Pediatric assessment/vital signs |
|
| Sickle cell anemia |
|
| Child abuse |
|
| |
|
PSYCHIATRIC |
|
| Care of alcohol/drug withdrawal |
|
| Gastric lavage |
|
| Care of suicidal patient |
|
| Management of assaultive behavior |
|
Reporting procedures for: |
|
| Acts of violence |
|
| Transferring patient |
|
| Elder abuse |
|
| |
|
OTHER |
|
| Electrocution |
|
| Amputation |
|
| Gangrene |
|
| Multiple fractions |
|
| Thermoregulation |
|
| Fluid resuscitation |
|
| Wound care |
|
| Hypothermia |
|
| Heat stroke/exhaustion |
|
| Human/animal bite |
|
| Snake bite |
|
| Anaphylaxis |
|
| Multi-system organ failure |
|
| Mass casualty |
|
| Septic shock |
|
| Anaphylactic shock |
|
| Hypovolemic shock |
|
| |
|
| AGE SPECIFIC COMPETENCIES |
| Newborn (birth – 30 days) |
|
| Infant (30 days – 1 year) |
|
| Toddler (ages 1 – 3 years) |
|
| Preschooler (ages 3 – 5 years) |
|
| Childhood (ages 6 – 12 years) |
|
| Adolescents (ages 12 – 21 years) |
|
| Young Adults (ages 21 – 39 years) |
|
| Adults (ages 40 – 64 years) |
|
| Older Adults (ages 65 – 79 years) |
|
| Elderly (ages 80+ years) |
|
YEARS EXPERIENCE |
Please indicate number of years of experience in the following disciplines. |
| Medical |
years |
| Surgical |
years |
| Neurology |
years |
| CCU/ICU |
years |
| Telemetry |
years |
| ER–Trauma |
years |
| PACU |
years |
| Cardiothoracic |
years |
| Case Management |
years |
| Other |
years |
| |
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| |
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