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NICU 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
Level IV NICU
1
2
3
4
Level III NICU
1
2
3
4
Level II NICU
1
2
3
4
Level I NICU/Nursery
1
2
3
4
Mother/Baby
1
2
3
4
Attended High Risk Deliveries
1
2
3
4
PATIENT TYPES
1
2
3
4
Neonates < 28 Weeks
1
2
3
4
Neonates 29 - 34 Weeks
1
2
3
4
Neonates > 34 Weeks
1
2
3
4
CARDIOVASCULAR
1
2
3
4
Cardiac Surgery - Pre-op
1
2
3
4
Cardiac Surgery - Immediate Post-op
1
2
3
4
Congenital Heart Disease/Defects
1
2
3
4
CHF/Pulmonary Edema
1
2
3
4
Hemodynamic Instability
1
2
3
4
PULMONARY
1
2
3
4
Bronchopulmonary Dysplasia
1
2
3
4
Diaphragmatic Hernia
1
2
3
4
Fresh Tracheostomy
1
2
3
4
Meconium Aspiration
1
2
3
4
Persistent Pulmonary Hypertension
1
2
3
4
Pneumonia
1
2
3
4
Respiratory Distress Syndrome/Failure
1
2
3
4
Interpretation of ABGs
1
2
3
4
Assist with Intubation/Extubation
1
2
3
4
Endotracheal Suctioning
1
2
3
4
Chest Tube Placement and Management
1
2
3
4
Modes of Ventilation (AC/PC/SIMV/CPAP/BiPAP)
1
2
3
4
High Frequency Ventilation
1
2
3
4
Inhaled NO
1
2
3
4
ECMO
1
2
3
4
NEUROLOGIC
1
2
3
4
Ballard/Dubowitz
1
2
3
4
Reflexes Based on Gestational Age
1
2
3
4
Hydrocephalus
1
2
3
4
Intraventricular Hemorrhage
1
2
3
4
Meningocele/Myelomeningocele
1
2
3
4
Neonatal Abstinence Score/Syndrome
1
2
3
4
Seizures
1
2
3
4
GASTROINTESTINAL
1
2
3
4
Colostomy/Ileostomy
1
2
3
4
Gastroschisis/Omphalocele
1
2
3
4
GI Bleeding
1
2
3
4
Necrotizing Enterocolitis
1
2
3
4
Post Abdominal Procedure
1
2
3
4
FEEDINGS
1
2
3
4
Breast Milk Handling/Storage
1
2
3
4
Breast Pump
1
2
3
4
Gavage Feedings
1
2
3
4
NG/OG/NJ Tube Placement and Management
1
2
3
4
RENAL/ENDOCRINE/GENETIC
1
2
3
4
Circumcision Care
1
2
3
4
Genetic Disorders
1
2
3
4
Hypo/Hyperglycemia
1
2
3
4
Infant of Diabetic Mother
1
2
3
4
Malformations of the GU Tract/Kidney
1
2
3
4
Phototherapy
1
2
3
4
Renal Failure
1
2
3
4
INFECTIOUS DISEASES
1
2
3
4
Neonatal Sepsis
1
2
3
4
Septic Work Up
1
2
3
4
Assist with Lumbar Puncture
1
2
3
4
MEDICATIONS
1
2
3
4
Calculation of Neonatal Dosages
1
2
3
4
Antibiotics/Antivirals
1
2
3
4
Anticonvulsants
1
2
3
4
Immunizations
1
2
3
4
Digoxin
1
2
3
4
IV Vasopressors
1
2
3
4
Prostaglandin
1
2
3
4
Bronchodilators
1
2
3
4
Steroids
1
2
3
4
Caffeine
1
2
3
4
Surfactant
1
2
3
4
Automated Medication Dispensing (i.e. Pyxis, Omnicell)
1
2
3
4
IV THERAPY
1
2
3
4
Administration of Blood/Blood Products
1
2
3
4
Central Line Catheter/Dressings
1
2
3
4
Management of UAC/UVC Lines
1
2
3
4
Radial Arterial Lines
1
2
3
4
Start IVs
1
2
3
4
CARDIAC MONITORING & EMERG. RESPONSE
1
2
3
4
Attend High Risk Deliveries
1
2
3
4
Preparation for Transport
1
2
3
4
Transport Neonate
1
2
3
4
Rhythm Interpretation
1
2
3
4
Dysrhythmia Management
1
2
3
4
PROFESSIONAL KNOWLEDGE AND SKILLS
1
2
3
4
National Patient Safety Goals/Core Measures
1
2
3
4
Bereavement/Postmortem Care
1
2
3
4
Neonatal Skin Care
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
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