subject_line
Wound/Ostomy/Continence 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 Care - Adult
1
2
3
4
Clinic - Adult
1
2
3
4
SNF/LTAC/Subacute
1
2
3
4
Hospice/Palliative Care
1
2
3
4
Acute/Long Term Care - Pediatrics
1
2
3
4
Clinic - Pediatrics
1
2
3
4
PRESSURE ULCERS
1
2
3
4
Assessment
1
2
3
4
Staging
1
2
3
4
Prevention/Risk Assessment Tools -Adult
1
2
3
4
Prevention/Risk Assessment Tools - Pediatrics
1
2
3
4
Support Surface Selection
1
2
3
4
NEUROPATHIC ULCERS
1
2
3
4
Assessment
1
2
3
4
Management
1
2
3
4
VENOUS STASIS ULCERS
1
2
3
4
Assessment
1
2
3
4
Management
1
2
3
4
PERIPHERAL ARTERIAL ULCERS
1
2
3
4
Assessment
1
2
3
4
Ankle Brachial Index
1
2
3
4
Management
1
2
3
4
OTHER WOUNDS
1
2
3
4
Fistulae- Pouching/Skin Care
1
2
3
4
Skin Care/Management of Drains
1
2
3
4
WOUND DEBRIDEMENT
1
2
3
4
Autolytic
1
2
3
4
Enzymatic
1
2
3
4
Mechanical
1
2
3
4
Sharp
1
2
3
4
DRESSINGS/TREATMENTS
1
2
3
4
Hydrogels
1
2
3
4
Hydrocolloids
1
2
3
4
Silver Products
1
2
3
4
Foams
1
2
3
4
Alginates
1
2
3
4
Vacuum Assisted Closure
1
2
3
4
Growth Factors
1
2
3
4
Skin Substitutes
1
2
3
4
Hyperbaric Oxygen Therapy
1
2
3
4
Wound Cultures
1
2
3
4
Electrical Stimulation
1
2
3
4
Enzymatic Debriding Agents
1
2
3
4
Mist Therapy
1
2
3
4
COLOSTOMY/ILEOSTOMY
1
2
3
4
Ostomy Equipment Selection
1
2
3
4
Continence Skin Care Management
1
2
3
4
Loop with Rod Stoma
1
2
3
4
End Stoma
1
2
3
4
Mucous Fistula
1
2
3
4
Double Barrel Stoma
1
2
3
4
Irrigation
1
2
3
4
Ileal Lavage
1
2
3
4
CONTINENT ILEOSTOMY
1
2
3
4
Kock Pouch
1
2
3
4
Pelvic Pouch
1
2
3
4
UROSTOMY/CONTINENT
1
2
3
4
Catheterization for C&S
1
2
3
4
Kock Pouch
1
2
3
4
Indiana Pouch
1
2
3
4
Neobladder
1
2
3
4
CONTINENCE EVALUATION
1
2
3
4
Urodynamics
1
2
3
4
Manometry
1
2
3
4
Electromyography
1
2
3
4
Leak Point Pressures
1
2
3
4
Cystometrogram
1
2
3
4
Uroflometry
1
2
3
4
Biofeedback
1
2
3
4
Pudendal Nerve Terminal Motor Latency
1
2
3
4
CONTINENCE THERAPEUTIC DEVICES
1
2
3
4
Vaginal Cones
1
2
3
4
Penile Clamps
1
2
3
4
Male External Catheters
1
2
3
4
Internal Urethral Inserts
1
2
3
4
Catheters - Mgmt& Self Care Teaching
1
2
3
4
Magnetic Therapy
1
2
3
4
Urinary Incontinence Program
1
2
3
4
Fecal Incontinence Program
1
2
3
4
BURNS
1
2
3
4
Burn Management
1
2
3
4
PROFESSIONAL KNOWLEDGE AND SKILLS
1
2
3
4
National Patient Safety Goals/Core Measures
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
Interpretation & 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