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Dialysis Skills Checklist
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
WORK SETTINGS
1
2
3
4
Acute/Inpatient Dialysis
1
2
3
4
Chronic/Outpatient Dialysis
1
2
3
4
Dialysis Home Care
1
2
3
4
Pediatric Dialysis
1
2
3
4
Apheresis
1
2
3
4
Plasmapheresis
1
2
3
4
Predialysis Nursing Assessment
1
2
3
4
Charge Experience
1
2
3
4
SET UP/INITIATE DIALYSIS TREATMENT
1
2
3
4
Bicarbonate Dialysate
1
2
3
4
Conductivity Testing
1
2
3
4
Priming Dialyzer
1
2
3
4
Prep Vascular Access
1
2
3
4
Fistula Gortex/Bovine Graft
1
2
3
4
Anticoagulation Management
1
2
3
4
Apheresis
1
2
3
4
Plasmapheresis
1
2
3
4
Cannulating Buttonholes
1
2
3
4
Continuous Renal Replacement Therapy
1
2
3
4
Peritoneal Dialysis
1
2
3
4
ASSESSMENT DURING DIALYSIS
1
2
3
4
Vascular Access Function
1
2
3
4
Arterial and Venous Pressures
1
2
3
4
Blood Flow Rate
1
2
3
4
Management of Anticoagulation
1
2
3
4
Conductivity
1
2
3
4
Ultra Filtration Calculation
1
2
3
4
Operation of Myron L. Meter
1
2
3
4
Administration of Blood and Blood Products
1
2
3
4
Administration of Mannitol
1
2
3
4
Sequential Ultrafiltration/PUF
1
2
3
4
PATIENT MANAGEMENT
1
2
3
4
Fluid Overload
1
2
3
4
Hypertension
1
2
3
4
Hypotension
1
2
3
4
Disequilibrium Syndrome
1
2
3
4
Hyperkalemia
1
2
3
4
Seizures
1
2
3
4
Muscle Cramps
1
2
3
4
Clotted Access/Poor Blood Flow Rate from Catheter
1
2
3
4
Pyrogenic Reaction
1
2
3
4
Hemolysis
1
2
3
4
Air Embolus
1
2
3
4
Chest Pain
1
2
3
4
Anemia
1
2
3
4
Neuropathy
1
2
3
4
Pericarditis
1
2
3
4
Filter Blood Leak
1
2
3
4
Cardiopulmonary Arrest
1
2
3
4
Anticoagulation Emergencies
1
2
3
4
DIALYSIS EQUIPMENT
1
2
3
4
Baxter
1
2
3
4
Cobe
1
2
3
4
Fresenius H/K
1
2
3
4
Gambro
1
2
3
4
Phoenix
1
2
3
4
T Machine
1
2
3
4
PROFESSIONAL KNOWLEDGE AND SKILLS
1
2
3
4
National Patient Safety Goals
1
2
3
4
Patient Isolation/Infection Prevention
1
2
3
4
Management of Dialysis Equipment Alarms
1
2
3
4
Bedside Blood Glucose Monitoring
1
2
3
4
Pyxis Medication Admin. System
1
2
3
4
Computerized Charting
1
2
3
4
Proton Charting Experience
1
2
3
4
AMI Charting Experience
1
2
3
4
Ecube Charting Experience
1
2
3
4
COMPUTERIZED CHARTING
1
2
3
4
Epic
1
2
3
4
Cerner
1
2
3
4
Eclipsys
1
2
3
4
McKesson
1
2
3
4
Meditech
1
2
3
4
Other Computerized System
1
2
3
4
Computerized Physician Order Entry
1
2
3
4
Bar Coding for Medication Administration
1
2
3
4
Yes
No
EMR Conversion
Yes
No
First Name
*
Last Name
*
Phone Number
*
Last 4 of Social Security Number
*
Email Address
*
Date Completed:
*
+
By checking the "Agree" box and clicking “Submit” below you certify and acknowledge the information provided on this checklist is accurate to the best of your knowledge and an accurate representation of your abilities.
*
Agree