| 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 (restricted devices) |
|
| Specialty beds |
|
| Lift/transfer devices |
|
| O2 therapy and delivery |
|
| Use of rapid response teams |
|
| Treatments of dysrythmias |
|
| Cardiac arrest/CPR |
|
| Pulse oximetry |
|
| Use of Doppler |
|
| |
| 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 |
|
| Conscious sedation |
|
| |
| 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 |
|
| Automated medication dispensing |
|
| Bar coding for medication administration |
|
| |
| PULMONARY |
| Breath sounds, rate & work of |
|
| Breathing |
|
| ABG interpretation |
|
| Airway management |
|
| Endotracheal tub suctioning |
|
| Face mask/nasal cannula |
|
| Intubation |
|
| Extubation |
|
| Nasal/oral airway |
|
Ventilator management |
|
| Modes of Ventilation: AC, PC, SIMV, CPAP |
|
| PEEP |
|
| Weaning |
|
Identification & intervention of respiratory complications |
| Aspiration |
|
| Laryngospams |
|
| Pneumothorax/hemothroax |
|
| Tension pneumothorax |
|
Care of post surgical patient with |
|
| Chest/pulmonary trauma |
|
| COPD |
|
| Fresh tracheostomy |
|
| Lung transplant |
|
| Pulmonary edema |
|
| Status asthmaticus |
|
| Thoracotomy/lobectomy/pneumonectomy |
|
Medications |
|
| Atrovent |
|
| Corticosteroids |
|
| Ventolin (Albuterol) |
|
| |
| NEUROLOGICAL |
| Glasgow coma scale |
|
| Neuro assessment |
|
| Pathologic reflexes |
|
Equipment & procedures |
|
| Assist with lumbar puncture |
|
| Hypo/hyperthermia blanket |
|
| Seizure precautions |
|
| |
| GASTROINTESTINAL |
Interpretation of lab results |
|
| Serum ammonia/amylase/LFTs |
|
Equipment & procedures |
|
| Tube feedings |
|
| Balloon tamponade |
|
| Lavage |
|
Management of |
|
| G tube/J tube |
|
| T tube |
|
| TPN/lipid administration |
|
Care of patient with |
|
| Major trauma |
|
| Bowel obstruction |
|
| Colostomy/ileostomy |
|
| ERCP |
|
| Esophageal/GI bleeding |
|
| GI surgery |
|
| Liver transplant |
|
Medications |
| Aquamephyton (vitamin K) |
|
| Inderal (propanolol) |
|
| Kayexalate |
|
| Lactulose (cephulac) |
|
| Pitressin (vasopressin) |
|
Care of patient with |
|
| A lines/dressings |
|
| CVP lines/dressings |
|
| PA lines/dressings |
|
| PICC lines/dressings |
|
| Tunneled lines/dressings |
|
| |
|
| RENAL/GENITOURINARY |
|
| AV fistula/shunt |
|
| Fluid status |
|
Interpretation of lab results |
|
| BUN/creatinine/electrolytes |
|
Equipment & procedures |
|
| Bladder irrigation |
|
| Insertion/care of bladder catheter |
|
| 3 way catheter |
|
| Suprapubic catheter |
|
Care of patient with |
|
| Acute renal failure |
|
| Hemodialysis |
|
| Nephrectomy |
|
| |
|
| ENDOCRINE/METABOLIC |
|
Interpretation of lab results |
|
| Blood/urine glucose |
|
Equipment & procedures |
|
| Bedside blood glucose monitoring/equipment |
|
Care of the post-op patient with |
|
| Adrenal gland disorders |
|
| Diabetes insipidus |
|
| Diabetes mellitus |
|
| Hyper/hypoglycemia |
|
| Pituitary gland disorders |
|
Medications |
|
| Insulin/insulin drip |
|
| |
|
| WOUND MANAGEMENT |
|
| Skin for impeding breakdown |
|
Equipment & procedures |
|
| Specialty beds |
|
| Sterile dressings changes |
|
Care of patient with |
|
| Burns |
|
| Decubitus ulcers |
|
| Staged decubitus ulcers |
|
| Surgical wounds/drains |
|
| |
|
| PAIN MANAGEMENT |
|
| Assessment of pain level |
|
| Assessment of response to pain management |
|
| Interventions |
|
Care of patient with |
|
| Epidural anesthesia/analgesia |
|
| |
|
| ANESTHESIA |
|
Knowledge about use and side effects of |
|
| Conscious sedation |
|
| Benzodiazepines (valium, versed, ativan) |
|
| Inapsine |
|
| Systemic barbiturates (nabutol, seconal) |
|
| Anticholinergics (robinol, transderm scoop) |
|
| H2 blockers (tagament, zantac) |
|
| Surgical wound healing |
|
| Citrates (bicitra) |
|
| Neuromuscular blocking agents (pavulon, norcuron) |
|
| Barbiturate IV anesthetics (pentothal, brevitol, suritol) |
|
| Non-barbiturate IV anesthetics (diprivan, ketamine, versed) |
|
| Reversal agents (romazicon, naloxone) |
|
| |
|
PHLEBOTOMY/IV THERAPY |
|
Equipment & procedures |
|
| Administration of blood/blood products |
|
| Start IV’s |
|
| Draw ABGs |
|
| |
|
| MISCELLANEOUS |
|
Equipment & procedures |
|
| Charge experience |
|
| Experience with level I trauma patients |
|
| Preceptor experience |
|
| Pyxis medication administration system |
|
| Other medication administration system |
|
Care of patient with |
|
| Anaphylactic shock |
|
| Disseminated intravascular coagulation |
|
| Hypovolemic shock |
|
| Immunosuppression |
|
| Latex allergy |
|
| Malignant hyperthermia |
|
| Multisystem organ failure |
|
| Organ/tissue donation |
|
| |
|
OTHER PROCEDURES |
|
| Post orthopedic/musculoskeletal procedures |
|
| Post ENT procedures |
|
| Post breast procedures (mastectomy/lumpectomy) |
|
| Post GYN procedures |
|
| Post prostate procedures |
|
| Post wound care (I&D/debridement) |
|
| |
|
| 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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