Skills Checklist – Neonatal ICU

Skills Checklist – Neonatal ICU

• Name
  
  First
  
  Last
• Phone
• Email
  
• CARE OF PATIENTS WITH*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Aortic/Pulmonary Valve Stenosis
  Atrial/Ventricular Septal Defects
  Bradycardia
  Coarctation of the Aorta
  Congenitial Heart Disease
  DIC
  Hemodynamic Instability
  Hypoplastic Left Heart System
  Hypovolemic Shock
  Patent Ductus Arteriosus
  Post Cardiac Surgery
  Tetralogy of Fallot
  Transient Tachypnea
  Transposition of the Great Arteries
  Apnea
  Bronchopulmonary Dysplasia (BPD)
  Diaphragmatic Hernia
  Meconium Aspiration Syndrome (MAS)
  Pneumothorax
  PPHN/PFC
  Respiratory Distress Syndrome (RDS)
  Respiratory Syncytial Virus (RSV)
  Tracheostomy – fresh
  Anencephaly
  Cerebral Palsy
  Hydrocephalus
  Intraventricular Hemorrhage (IVH)
  Meningitis
  Periventricular Leukomalacia (PVL)
  Seizures
  Spina Bifida
  Anal Atresia
  Cleft Lip/Palate
  Cystic Kidney Disease
  Esophageal Atresia
  Fetal Hydronephrosis
  Gastroschisis/Omphalocele
  IDM Hyperglycemia
  IDM Hypoglycemia
  Inguinal Hernia
  Intestinal Obstruction
  Jaundice/Hyperbilirubinemia
  Necrotizing Enterocolitis (NEC)
  Post Abdominal Surgery
  Pyloric Stenosis
  Tracheoesphogeal Fistula (TEF)
  Birth Injuries
  Congenital Hip Dislocation
  Drug Addiction/Exposure
  Fetal Alcohol Syndrome
  HIV Positive Mother
  HBsAg Positive Mother
  Retinopathy of Prematurity (ROP)
  Sepsis
  Brain Death/Organ Procurement

• MEDICATION ADMINISTRATION*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Aminophylline/Caffeine
  Anticoagulants
  Anticonvulsant Medications
  Dobutamine (Dobutrex)
  Dopamine (Intropin)
  Epinephrine
  Eye Prophylaxis
  Immunizations
  Insulin Drip
  NaHCO3
  Prostaglandin
  Respigam/Synagis Prophylaxis
  Steroids
  Vitamin K
  Pain Medications
  IM Meds
  IV drips
  IV push
  Eye Instillations
  Dosage calculations for neonates

• PROCEDURES/SKILLS – AIRWAY MANAGEMENT*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Bulb Syringe
  CPAP (nasal prongs)

• PROCEDURES/SKILLS – AIRWAY MANAGEMENT (ENDOTRACHEAL TUBE)*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  assist with insertion
  stabilization of ETT
  extubation

• PROCEDURES/SKILLS – AIRWAY MANAGEMENT (SUCTIONING)*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  ETT
  Nasal
  Oral
  Tracheostomy
  Cardiac Resuscitation
  Chest Physiotherapy

• PROCEDURES/SKILLS – CHEST TUBE & DRAINAGE SYSTEM*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  a. Set up
  b. Assist with insertion
  c. Care & maintenance
  d. Troubleshooting
  e. Removal
  Continuous Bladder Irrigation
  EKG Intrepretation
  Exchange Transfusion
  Extracorporeal Membrane Oxygenation

• PROCEDURES/SKILLS – HEMODYNAMIC MONITORING, NON-INVASIVE*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  a. Auscultation
  b. Doppler
  c. Automatic BP cuff
  d. Palpation
  Hemodynamic Monitoring – Invasive

• PROCEDURES/SKILLS – FEEDINGS*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Breastfeeding – assist
  Breastmilk handling/storage
  Bottle
  Continuous tube feeding
  Gavage
  Reflux precautions

• PROCEDURES/SKILLS – FEEDINGS (PLACEMENT OF TUBES)*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  orogastric tube
  nasogastric tube
  nasojejunal tube

• PROCEDURES/SKILLS – FEEDINGS (ASSESSING FEEDING TOLERANCE)*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Gastric Suctioning – Intermittent
  Gastric Suctioning – Continuous

• PROCEDURES/SKILLS – INTERPRETATION OF LAB RESULTS*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Blood gases
  Bilirubin
  CBC/Diff
  Cultures
  Maternal lab results

• PROCEDURES/SKILLS – INTERPRETATION OF LAB RESULTS (URINE TEST & INTERPRET)*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Glucose
  Labstix
  pH
  Specific Gravity
  Occult Blood
  Intracranial Pressure Monitoring

• PROCEDURES/SKILLS – IV'S*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Starting IV
  Site & Patency Assessment
  Administration Blood/Blood Products

• PROCEDURES/SKILLS – IV'S (MAINTENANCE/DISCONTINUATION OF)*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Broviac
  Hickman
  Heparin/Saline Lock
  Percutaneous Arterial Line
  Peripheral IV
  PICC
  Umbilical Arterial Catheter
  Umbilical Venous Catheter
  Hyperalimenation
  Lumbar Puncture (assist with)
  Nitric Oxide Therapy
  Orthopedic Devices – casts, splints, etc

• PROCEDURES/SKILLS – OXYGEN THERAPY ADMINISTRATION*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Bag & mask
  ET tube
  Oxyhood
  Nasal CPAP
  Nebulizer
  Trach Collar

• PROCEDURES/SKILLS – SKIN*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Skin breakdown prevention
  Wound healing

• PROCEDURES/SKILLS – SKIN (COLOR CHANGE)*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  mottling
  petechiae
  cyanosis
  jaundice

• PROCEDURES/SKILLS – SPECIMEN COLLECTION (BLOOD)*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  arterial stick
  heel stick
  peripheral
  Umbilical

• PROCEDURES/SKILLS – SPECIMEN COLLECTION (CULTURES)*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  blood
  wound
  sputum
  stool testing

• PROCEDURES/SKILLS – TEMPERATURE*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Rectal
  Skin
  Axillary
  Transillumination

• PROCEDURES/SKILLS – WOUND/OSTOMY CARE*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Colostomy care/bag change
  Ileostomy care/bag change
  Irrigations
  Sterile Dressing changes
  Surgical wounds with drains

• EQUIPMENT*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Cardiac Monitor
  Centrifuge
  Defibrillator
  Glucometer
  O2 Analyzer
  Oxygen Flow Meter
  Oxyhood

• INFUSION PUMP BRAND #1
• INFUSION PUMP BRAND #2
• INFUSION PUMP BRAND #3
• EQUIPMENT – INFUSION PUMPS EXPERTISE
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  BRAND #1
  BRAND #2
  BRAND #3

• EQUIPMENT – PHOTOTHERAPY EQUIPMENT*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Bili blanket
  Bili lights
  Bili meter
  Computer Charting Systems
  Positioning Devices
  Pulse Oximeter
  Oxyhood

• EQUIPMENT – THERMOREGULATION*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Isolette with Humidity
  Radiant Warmer
  Warming Lights
  Transport Incubator

• EQUIPMENT – VENTILATOR*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  CPAP/PEEP
  High frequency jet
  IMV
  Transport
  Oscillating
  Home Ventilator

• ASSESSMENT/OTHER*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Level II Nursery
  Level III Nursery
  Abdominal Girth Measurement
  Admission of patients to unit
  APGAR Scoring
  Assess Breath Sounds
  Assess Heart Sounds
  Ballard Score
  Bereavement support
  Breastfeeding Teaching
  Care Planning
  Charge Nurse responsibilities
  Circulation Checks
  Computerized Charting
  Developmental Intervention/Assessment
  Dubowitz Score
  Fontanel Assessment
  Head circumference measurement
  Isolation Procedures
  Neurological Assessments
  Pain Assessment
  Pain Management
  Parent Teaching of Normal Infant
  Patient Teaching
  ROM exercises
  Sedation
  Use of Restraints
  Vital Signs

• 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