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Medical Surgical 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
LTAC
1
2
3
4
MS/Tele
1
2
3
4
Med/Surg
1
2
3
4
Rehab
1
2
3
4
Short Stay- 23 hour Stay Unit
1
2
3
4
Telemetry
1
2
3
4
CARDIAC
1
2
3
4
Angina
1
2
3
4
Post Acute MI
1
2
3
4
Congestive Heart Failure
1
2
3
4
Post Cardiac Cath
1
2
3
4
Post Cardiac Surgery
1
2
3
4
Aneurysm
1
2
3
4
Carotid Endarterectomy
1
2
3
4
Post Vascular Surgery
1
2
3
4
Post Cardiac Transplant
1
2
3
4
PULMONARY
1
2
3
4
Pneumonia
1
2
3
4
COPD
1
2
3
4
Tuberculosis
1
2
3
4
Pulmonary Embolism
1
2
3
4
Tracheostomy Management
1
2
3
4
CPAP/BiPAP
1
2
3
4
Interpretation of Arterial Blood Gases
1
2
3
4
Post Lung Transplant
1
2
3
4
NEUROLOGICAL & PSYCHIATRIC
1
2
3
4
Stroke Scale Assessment
1
2
3
4
Traumatic Brain Injury
1
2
3
4
CVA
1
2
3
4
Post Craniotomy
1
2
3
4
Seizure Disorders
1
2
3
4
Spinal Cord Injuries
1
2
3
4
Mood Disorders
1
2
3
4
Substance Withdrawal
1
2
3
4
ORTHOPEDICS
1
2
3
4
Circulation/Skin Checks
1
2
3
4
Continuous Passive Motion Devices
1
2
3
4
Ambulation Assistive Devices
1
2
3
4
Prosthetics
1
2
3
4
Cast Care
1
2
3
4
Pin Care
1
2
3
4
Traction
1
2
3
4
Total Joint Replacement
1
2
3
4
Amputation
1
2
3
4
GASTROINTESTINAL
1
2
3
4
Bariatrics
1
2
3
4
Feeding Tubes
1
2
3
4
GI Bleeding
1
2
3
4
Bowel Obstruction
1
2
3
4
GI Surgery
1
2
3
4
Liver Disease
1
2
3
4
Pancreatitis
1
2
3
4
Post Liver Transplant
1
2
3
4
Post Pancreas Transplant
1
2
3
4
RENAL/GENITOURINARY
1
2
3
4
Arteriovenous Fistula/Shunt
1
2
3
4
3 Way Catheter & Bladder Irrigation
1
2
3
4
Suprapubic Catheter
1
2
3
4
Renal Failure
1
2
3
4
Peritoneal Dialysis
1
2
3
4
GU Surgery
1
2
3
4
Nephrostomy Tubes
1
2
3
4
Renal Transplant
1
2
3
4
Management Pre/Post Hemodialysis
1
2
3
4
Gyn Surgery
1
2
3
4
ENDOCRINE METABOLIC
1
2
3
4
Diabetes Type I
1
2
3
4
Diabetes Type II
1
2
3
4
Blood Glucose Monitoring
1
2
3
4
IV Insulin Protocols
1
2
3
4
Management of Hypoglycemia
1
2
3
4
Indwelling Insulin Pumps
1
2
3
4
Pituitary Disorders
1
2
3
4
ONCOLOGY
1
2
3
4
Chemotherapy Administration
1
2
3
4
Radiation Therapy
1
2
3
4
Medical Oncology
1
2
3
4
Surgical Oncology
1
2
3
4
Radiation Implants
1
2
3
4
Bone Marrow Transplant
1
2
3
4
MEDICATIONS
1
2
3
4
Antiarrhythmics
1
2
3
4
Anticoagulants (IV, oral, & injection)
1
2
3
4
Anti-Depressants
1
2
3
4
Anti-Hypertensives
1
2
3
4
Anti-Psychotics
1
2
3
4
Benzodiazepines
1
2
3
4
Emergency Medications
1
2
3
4
Epidural Analgesia
1
2
3
4
Inhaled Medications
1
2
3
4
Insulin
1
2
3
4
Narcotics/Opioid Analgesics (IV, oral, & injection)
1
2
3
4
Nitrates (Oral & Topical)
1
2
3
4
Non-Opioid Analgesics (IV, Oral, & Injection)
1
2
3
4
Oral Hypoglycemics
1
2
3
4
Patient Controlled Analgesia
1
2
3
4
Procedural Sedation Administration
1
2
3
4
Reversal Agents
1
2
3
4
Steroids (IV, Oral, Inhaled)
1
2
3
4
Automated Medication Dispensing (i.e. Pyxis, Omnicell)
1
2
3
4
IV THERAPY
1
2
3
4
Starting IVs
1
2
3
4
Central Line Blood Draws
1
2
3
4
Central Line/Implanted Line Care
1
2
3
4
TPN & Lipids
1
2
3
4
Blood Product Administration
1
2
3
4
Monitoring of Chemotherapy
1
2
3
4
CARDIAC MONITORING & EMERG. RESPONSE
1
2
3
4
Placement of Telemetry Leads
1
2
3
4
Rhythm Interpretation
1
2
3
4
Dysrhythmia Management
1
2
3
4
Obtain 12 Lead EKG
1
2
3
4
Use of Rapid Response Teams
1
2
3
4
PROFESSIONAL KNOWLEDGE AND SKILLS
1
2
3
4
National Patient Safety Goals/Core Measures
1
2
3
4
Fall Risk Assessment/Prevention
1
2
3
4
Pressure Ulcer Risk Assessment/Prevention
1
2
3
4
Restraints/Use of Least Restrictive Device
1
2
3
4
Patient/Family Teaching
1
2
3
4
Age Specific/Population-Based Care
1
2
3
4
Isolation Precautions
1
2
3
4
Infection Prevention
1
2
3
4
Pain Assessment & Management
1
2
3
4
Charge Experience
1
2
3
4
Interpretation and Communication of Lab Values
1
2
3
4
Wound Care /Wound Vac
1
2
3
4
Specialty Beds
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