Skills Checklist – Home Health

Skills Checklist – Home Health

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• GENERAL SKILLS*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Standard Precautions
  Isolation Precautions
  Pediatric Respiratory/Cardiac Arrest
  Adult Respiratory/Cardiac Arrest
  Defibrillators
  Care Planning & Discharge Planning
  Patient/Family Education
  Pain Management
  Patient Head to Toe Assessment
  Electronic Documentation

• GENERAL SKILLS – TYPES OF ELECTRONIC DOCUMENTATION:(if applicable)
• CARDIOVASCULAR – Assesssment:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Angina
  Apical Pulse Rate/Rhythm
  Cardiac Auscultation (Rate, Rhythm)
  Clinical Identification of Arrhythmias
  Fluid Overload
  Peripheral Pulses/Circulation Checks

• CARDIOVASCULAR – Interpretation of Lab Results:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  PT/PTT/INR
  Serum Electrolytes

• CARDIOVASCULAR – Equipment & Procedures:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Holter Monitor
  Pacemaker/AID

• CARDIOVASCULAR – Care of Patient With:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Hypotension
  CAD/Post Myocardial Infarction (MI)
  Congestive Heart Failure (CHF)
  Fluid Retention
  Hypertension
  Pre/Post Cardiac Surgery
  Pre/Post Vascular Surgery

• CARDIOVASCULAR – Medication Administration:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  ACE Inhibitors
  Anti-arrhythmic
  Antibiotics
  Anticoagulants
  Antihypertensives
  Antiplatelet Medications
  Beta Blockers
  Calcium Channel Blockers
  Diuretics
  Digoxin (Lanoxin)
  Oral and Topical Nitrates
  Narcotics
  Potassium Supplements
  Statin Medications

• PULMONARY – Assessment:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Auscultation of Lung Sounds/Rate & Work of Breathing
  Pulse Oximetry
  ABGs

• PULMONARY – Equipment & Procedures:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Administration of O2 via Nasal Cannula
  Apnea Monitor
  Chest Percussion
  Establishing an Airway
  Incentive Spirometry
  Orotracheal and Nasotracheal Suctioning
  Sputum Specimen Collection
  Nebulizer
  CPAP
  BiPAP
  Ventilator Management

• PULMONARY – Care of Patient With:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Asthma
  Chronic Obstructive Pulmonary Disease (COPD)
  Lung Cancer
  Primary Pulmonary Hypertension
  Pulmonary Fibrosis
  Pulmonary Emboli

• PULMONARY – Medication Administration:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Bronchodilators
  Steroids
  Expectorants
  Inhalers

• NEUROLOGICAL – ASSESSMENT:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Neurological Signs/Level of Consciousness (LOC)
  Neuro-Motor/Sensory Functions

• NEUROLOGICAL – Equipment & Procedures:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Seizure Precautions
  Traction

• NEUROLOGICAL – Care of Patient With:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Alzheimer’s Disease
  Dementia
  Degenerative Neurological Disorders (ALS, MS, etc.)
  Cerebral Tumors
  Post-Cerebrovascular Accident
  Guillain-Barre Syndrome
  Hemiparesis
  Meningitis
  Parkinson’s Disease
  Seizure Disorders
  Paraplegia/Quadriplegia
  Traumatic Brain Injury (TBI)
  Transient Ischemic Attacks (TIAs)

• NEUROLOGICAL – Medication Administration:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Alzheimer’s Medications
  Anti-Parkinson’s Medications
  Anti-Seizure Medications
  Corticosteroids
  Sedative/Hypnotics

• ORTHOPEDICS – ASSESSMENT:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Incision Checks
  Circulation/Skin Checks
  Gait
  Range of Motion

• ORTHOPEDICS – Equipment & Procedures:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Range of Motion (Active & Passive)
  Cast/Brace
  Crutch/Walking
  Assistive Devices
  TENS Units
  Wheelchairs/Lift Equipment
  Total Hip/Knee/Joint Replacement

• ORTHOPEDICS – Medication Administration:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Enoxaparin (Lovenox)

• GASTROINTESTINAL – Assessment:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Bowel Habits
  Fluid Balance
  Nutritional Status

• GASTROINTESTINAL – Equipment & Procedures:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Colostomy/Ileostomy Care
  Long-Term Feeding Tube
  Nasogastric (NG) Tube
  PEG/Gastronomy Tube
  Drainage Devices/Tubes
  Tube Feeding
  Feeding Pumps

• GASTROINTESTINAL – Care of Patient With:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Bowel Obstruction
  Fecal Incontinence
  Gastrointestinal Bleeding (G.I. Bleed)
  Post-Gastrointestinal Surgery
  Hepatitis
  Inflammatory Bowel Disease
  Liver Failure/Transplant

• RENAL/GENITOURINARY – Assessment:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Arterio-Venous Fistula/Shunt
  Fluid Balance

• RENAL/GENITOURINARY – Interpretation of Lab Results:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Blood Urea Nitrogen (BUN)
  Serum Creatinine
  Serum Electrolytes

• RENAL/GENITOURINARY – Equipment & Procedures:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  3-Way Bladder Catheter
  Foley Catheter Insertion/Maintenance
  Straight Catheterization
  Self-Catheterization
  Ileostomy
  Irrigations
  Nephrostomy Tube
  Suprapubic Catheter

• RENAL/GENITOURINARY – Care of Patient With:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Hemodialysis (Receiving in an Out Pt. Clinic Setting)
  Home Hemodialysis
  Peritoneal Dialysis
  Post-Bladder Surgery
  Post-Prostate Surgery
  Shunts and Fistulas
  Urinary Incontinence

• ENDOCRINE/METABOLIC – Assessment:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Diabetic Skin Assessment*
  Hyper- and Hypoglycemia*

• ENDOCRINE/METABOLIC – Interpretation of Lab Results:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Hemoglobin A1C
  Serum Glucose

• ENDOCRINE/METABOLIC – Equipment & Procedures:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Glucometers
  Insulin Pumps

• ENDOCRINE/METABOLIC – Care of Patient With:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Diabetes
  Post-Tranplantation Surgery

• ENDOCRINE/METABOLIC – Medication Administration:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Insulin
  Oral Hypoglycemics

• WOUND/SKIN CARE MANAGEMENT – Assessment:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Wound Assessment Scale
  Skin Assessment
  Surgical Wound Healing
  Skin Grafts

• WOUND/SKIN CARE MANAGEMENT – Equipment & Procedures:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Burns
  Care of Pressure Ulcers
  Dry and Wet to Dry Dressing Changes
  Positioning of Patients
  Specialty Beds
  Special Mattresses and Positioning Devices
  Wound Care (Sterile)
  Wound Cultures
  Wound Irrigations
  Wound Vac

• WOUND/SKIN CARE MANAGEMENT – Care of Patient With:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Burns
  Pressure Ulcers
  Surgical Wounds
  Skin Grafts

• ONCOLOGY – Assessment:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Immune Status
  Symptoms Management
  Signs/Symptoms of Infection

• ONCOLOGY – Interpretation of Lab Results:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  CBC with Differential
  CMP

• ONCOLOGY – Equipment & Procedures:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Reverse Isolation

• ONCOLOGY – Care of Patient With:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Radiation Therapy
  Leukemia/Lymphoma
  Post-Oncology Surgery

• ONCOLOGY – Medication Administration:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Oral Chemotherapy
  Intravenous Chemotherapy Administration
  Intravenous Chemotherapy Monitoring
  Bone Marrow Stimulating Agents

• INFECTIOUS DISEASE – Assessment:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Signs/Symptoms of Infection

• INFECTIOUS DISEASE – Interpretation of Lab Results:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Blood Counts
  Culture and Sensitivity

• INFECTIOUS DISEASE – Equipment & Procedures:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Isolation Precautions

• INFECTIOUS DISEASE – Care of Patient With:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  C. Diff
  HIV Infection
  Tuberculosis
  MRSA/VRE

• INFECTIOUS DISEASE – Medication Administration:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Antibiotics
  Antivirals
  Anti-HIV
  Immunizations

• PSYCHIATRY – Assessment:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Monitoring Symptoms
  Compliance with Medications

• PSYCHIATRY – Care of Patient With:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Cognitive Disorders
  Schizophrenia/Psychotic Disorders
  Substance-Related Disorders
  Mood Disorders (Anxiety/Depression, etc)

• WOMEN’S HEALTH/MATERNAL-INFANT CARE – Assessment:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Fetal Heart Tones
  Contractions

• WOMEN’S HEALTH/MATERNAL-INFANT CARE – Care of Patient With:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Breast Feeding
  Pregnancy-Related Complications
  Post-Mastectomy
  Post-Partum Mother/Baby Visit
  Newborn Care
  Bulb Suctioning
  Cord and Circumcision Care
  Phototherapy

• PEDIATRICS – Assessment:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Growth
  Development Stages
  Nutrition
  Family/Caregiver Interaction

• PEDIATRICS – Equipment & Procedures:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Calculations of Pediatric Dosages
  Croup Tent
  Ventilator
  Trach
  Pediatric Ambu
  Near Drowning
  Pre- and Post-Cardiac Surgery

• PEDIATRICS – Care of Patient With:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Broncho Pulmonary Dysplasia
  Cystic Fibrosis
  Respiratory Distress Syndrome (RDS)
  Reye’s Syndrome
  Pre- and Post-Spinal Surgery
  Sickle Cell Disease
  Spina Bifida

• PAIN MANAGEMENT – Assessment:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Pain Scale
  Response to Pain Management Interventions

• PAIN MANAGEMENT – Equipment & Procedures:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Pharmacologic Pain Relief
  Non-pharmacologic Pain Relief Measures
  PCA Pump

• PAIN MANAGEMENT – Care of Patient With:*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Epidural Catheter/Site Monitoring/Pump
  Patient Controlled Analgesia

• PALLIATIVE AND END-OF-LIFE CARE*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Family Support and Teaching
  Medication Protocols
  Symptom Management
  After Death Protocol and Management

• PATIENT AND FAMILY TEACHING*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Diabetic
  Pre- and Post-Procedure
  Post-partum/Infant Care
  Medications
  Monitoring
  Nutrition
  Safety
  Self-care
  Equipment
  Resources

• MISCELLANEOUS*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  APS/ CPS Reporting
  Fall Assessment and Prevention
  National Patient Safety Goals
  Safety Assessment
  Recognizing Failure to Thrive Across the Lifespan
  Advanced Directives
  Wheelchairs/Lift Equipment

• CASE MANAGEMENT*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Experience as a Case Manager
  Case Load
  Supervision of Home Health Aides

• EXPERIENCE WITH*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Long-term/Short-term Disability
  Management of Complaints
  Medicare/Medicaid
  Pre-certifications
  Private Insurance
  Telephone Assessments
  Utilization Review
  Workman’s Compensation

• DOCUMENTATION*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Diagnosis Coding (ICD Coding)
  Document Plan of Care (Form 485)
  OASIS Documentation

• Age Group Experience*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Newborn (birth – 30 days)
  Infant (30 days – 1 year)
  Toddler (1 – 3 years)
  Preschooler (3 – 5 years)
  School Age (5 – 12 years)
  Adolescents (12 – 18 years)
  Young Adults (18 – 39 years)
  Middle Adults (39-64 years)
  Older Adults (64+ years)

• Do you speak any languages other than English?*
  • No

  If yes, enter languages above, separated by commas.

• Confirmation*
  • 
    I attest that the information I have given is both true and, to the best of my knowledge, represents an accurate self assessment of my professional skills and/or education.
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• Date
  
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