| 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) |
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| Insulin administration |
|
| Diabetes mellitus |
|
| Isolation |
|
| Wound care |
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| Minimize risk for falls |
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| Patient family teaching |
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| Restraints |
|
| Specialty beds |
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| Lift/transfer devices |
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| O2 therapy and delivery |
|
| Use of rapid response teams |
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| Cardiac arrest/CPR |
|
| Use of Doppler |
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| Coaching needs: physical, computer & emotional |
|
| Assist with sterile speculum exam (effacement, dilation, station and presentation |
|
| Perform sterile speculum exam independently |
|
| |
| 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 |
|
| |
| LABOR ASSESSMENT & PROCEDURES |
| Assess & document progression of labor |
|
| Assist with AROM procedure |
|
| Use of EFM (external fetal monitor) |
|
| Use of IFM (internal fetal monitor) |
|
| Abdominal/perineal prep |
|
| Assess & document fetal status |
|
| Assist with vaginal delivery |
|
| Amnioinfusion |
|
| Forceps/vacuum extraction |
|
| Assist with IUPC placement & calibration |
|
| Emergency delivery |
|
| Shoulder dystocia |
|
| Assist with high risk delivery |
|
| Hemorrhage/shock |
|
| Scrub for c-section |
|
| Circulate for c-section |
|
| Fundal assessment/height |
|
| Assist with fetal scalp blood sampling |
|
| Prolapsed card |
|
| Collect vaginal cultures |
|
| Collect blood/urine specimens |
|
| |
|
PATIENT MONITORING |
|
| Regional/spinal/epidural |
|
| General anesthesia |
|
| Assist/monitor anesthesia |
|
| Medical history for any pre-existing problems |
|
| Seizure disorder |
|
| Neurological disease |
|
| Cardiac disease |
|
| Prior c-section |
|
| RH incompatibilities |
|
| Diabetic monitoring |
|
| Infectious diseases |
|
| HIV/drug addiction |
|
| |
|
CARE OF NEWBORN IN LABOR & DELIVERY |
| Assessment/apgar scores |
|
| Routine neonatal medications |
|
| Eye prophylaxis |
|
| Collect cord sample |
|
| Meconium |
|
| Radiant warmer/thermoregulation |
|
| Heelsticks |
|
| ID/security banding |
|
| |
|
EMERGENCY CARE |
|
| Adult cardiac arrest/ACLS |
|
| Infant/neonatal arrest/NRP |
|
| Preparation & administration of emergency drugs |
|
| Interpretation of rhythm strips |
|
| Obtains 12 lead EKG |
|
| Pulse oximetry |
|
| Interpretation of ABG’s |
|
| Assist with intubation |
|
| O2 (NC/mask/oxyhood) |
|
| Suctioning |
|
| |
|
IV THERAPY |
|
| Start & maintain peripheral IV |
|
| Start & maintain scalp veins |
|
| Maintain central lines (CVC/PICC) |
|
| Administration of blood & blood products |
|
| TPN/lipids |
|
| Use of PCA (IV, intrathecal, epidural) |
|
| Start maintaining peripheral IV’s |
|
| Blood draws – venous |
|
| Care & management of ports |
|
| |
ANTEPARTUM CARE & PROCEDURES |
| Triage of obstetrical patients |
|
| OCT (oxytocin challenge tests) |
|
| Reflex checks/edema assessment/clonus |
|
| NST (non stress tests) |
|
| Assist with amniocentesis |
|
Care of patient with: |
|
| Placenta previa |
|
| Abruptio placenta |
|
| Uterine rupture |
|
| Pregnancy induced hypertension |
|
| Pre-eclampsia/eclampsia |
|
| Preterm labor |
|
| VBAC management/trial of labor |
|
| Multiple gestation |
|
| Malpresentations (breech/face/brow) |
|
Administration of: |
|
| Insulin drips |
|
| Magnesium sulfate therapy |
|
| Pitocin (oxytocin) |
|
| Prostaglandins |
|
| Ritodrine |
|
| Turbutaline |
|
| |
|
POSTPARTUM CARE |
|
| Episiotomy/incision care |
|
| Post-op c-section |
|
| Fundus/lochia/perineum care |
|
| Bladder assessment |
|
| Foley catheter insertion |
|
| Breast feeding instructions |
|
| Couplet care |
|
| |
|
GENERAL SKILLS FOR NEWBORN |
|
| Newborn nursery |
|
| Full body assessment |
|
| Neonatal level II/III (complete NNICU checklist) |
|
| Cord & circumsion care |
|
| UAC/UVC |
|
| Swanz Ganz |
|
| Obtain specimens from UAC/UVC |
|
| High Frequency Jet Ventilation (HFJV) |
|
| Apnea monitoring |
|
| Radiant warmers |
|
| Extra Corporeal Membrane Oxygenation (ECMO) |
|
| Glascow coma scale |
|
| Calculation of pedi dosage |
|
| Phototherapy |
|
Care of baby with: |
|
| Drug addiction/withdrawal |
|
| HIV |
|
| Low birth weight infants |
|
| Intracranial hemorrhage |
|
| Diabetes mellitus |
|
| CHF |
|
| Neuromusclar disease |
|
| Pneumonia |
|
| Pulmonary edema |
|
| Seizure activity |
|
| RDS |
|
| Sickle cell disease |
|
| Bowel obstruction |
|
| Broncho-pulmonary dysplasia |
|
| PDA ligation |
|
| Systemic infection |
|
| Tetralogy of fallot |
|
| Transposition of great vessels |
|
| Tracheoesophogeal fistula |
|
| |
|
| AGE SPECIFIC COMPETENCIES |
| Newborn (birth – 30 days) |
|
| Adolescents (ages 12 – 21 years) |
|
| Young Adults (ages 21 – 39 years) |
|
| Adults (ages 40 – 64 years) |
|
| |
YEARS EXPERIENCE |
Please indicate number of years of experience in the following disciplines. |
| Labor & Delivery |
years |
| Post Partum |
years |
| Newborn Nursery |
years |
| |
All the information on this page is true and accurate to the best of my knowledge. By completing this form, I am authorizing
Professional Staffing to release this information to the appropriate client facilities in consideration of employment as a registry, local traveler of full traveler. |
| |
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|
