Skills Checklist – Labor and Delivery Skills Checklist – Labor and Delivery / Postpartum / Newborn Nursery Name First Last Phone Email CARE OF PATIENTS WITH* Rarely Some Experience Proficient Trainer / Preceptor N/A Abruptio Placenta Asthma Breech Cesarean Section Chronic Hypertension Diabetes Eclampsia Fetal Demise HELLP Syndrome Hemorrhage HIV Positive Hypertension CARE OF PATIENTS (INFANTS) WITH* Rarely Some Experience Proficient Trainer / Preceptor N/A a. IDM Protocol b. AGA Protocol c. LGA Protocol d. SGA Protocol Multiple Gestation NSVD Placentia Previa Preeclampsia Premature Labor Prolapsed Cord Rh Disease/Incompatibilities Seizure Stillborn Substance Abuse Vacuum Extraction Delivery VBAC ANTEPARTUM CARE/PROCEDURES* Rarely Some Experience Proficient Trainer / Preceptor N/A Triage of Obstetrical Patients Non Stress Tests (NST) Oxytocin Challenge Tests (OCT) Assist with Ultrasound Assist with Amniocentesis Assist with Sterile Speculum Exam Reflex Checks/Edema Assessment Pelvimetry L&D CARE/PROCEDURES* Rarely Some Experience Proficient Trainer / Preceptor N/A Sterile Vaginal Exams Ruptured Membrane Testing Fetal Scalp Electrode Placement Oxygen Therapy L&D CARE/PROCEDURES – INTRAVENOUS THERAPY* Rarely Some Experience Proficient Trainer / Preceptor N/A a. Blood/Blood Products Transfusion b. Central Line Maintenance c. Peripheral insertion/maintenance d. Saline/Heparin Lock Specimen Collection POSTPARTUM CARE/PROCEDURES* Rarely Some Experience Proficient Trainer / Preceptor N/A Couplet Care Parent/Infant Bonding/Teaching Breast Feeding Education/Support Bereavement Support Post Anesthesia Recovery Care Emergency Interventions Hemorrhage POSTPARTUM CARE/PROCEDURES – PAIN MANAGEMENT* Rarely Some Experience Proficient Trainer / Preceptor N/A a. Narcotic Agents b. Non-narcotic agents c. Non-pharmacological measures CARE OF NEWBORN Infant Feedings Specimen Collection Temperature MEDICATION ADMINISTRATION* Rarely Some Experience Proficient Trainer / Preceptor N/A Antibiotics Antihypertensives Cervical Ripening Agents Infant Meds Insulin Magnesium Sulfate Narcotics Oxytocin Terbutaline Eye Instillations IM Injections SQ Injections Z-Tract Injections EQUIPMENT* Rarely Some Experience Proficient Trainer / Preceptor N/A Breast Pump Infusion Pumps (specific brands) Infusion Pump Brand #1 Infusion Pump Brand #2 Infusion Pump Brand #3 Infusion Pump Brand expertise Rarely Some Experience Proficient Trainer / Preceptor N/A Infusion Pump Brand #1 Infusion Pump Brand #2 Infusion Pump Brand #3 EQUIPMENT – PHOTOTHERAPY EQUIPMENT* Rarely Some Experience Proficient Trainer / Preceptor N/A a. Bili Lights b. Bili Meter Transport Incubator ASSESSMENT/OTHER* Rarely Some Experience Proficient Trainer / Preceptor N/A Isolation Precautions Assess Breath Sounds Assess Heart Sounds Infection Prevention Charge Nurse responsibilities Circulation Checks Interpretation of Lab Values Fontanel Assessment Head circumference measurement Neurological Assessments Pain assessment using pain scales Patient Teaching Do you speak any languages other than English?* No If yes, enter languages above, separated by commas. 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) 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. Signature Date Date Format: MM slash DD slash YYYY