Skills Checklist – Oncology Skills Checklist – Oncology Name First Last Phone Email CARE OF PATIENTS WITH* Rarely Some Experience Proficient Trainer / Preceptor N/A Atelectasis/Pneumothorax Bowel Obstruction Cardiac Arrhythmias Diabetes DIC Electrolyte Imbalance Fever GI Bleed Hemodialysis Hemorrhage Hypercalcemia Hypokalemia/Hyperkalemia Infection Lymphedema Nausea/Vomiting/Diarrhea Neuropathy Neutropenia Oncologic Surgeries Pancreatitis Peritoneal Dialysis Pleural Effusion Pneumonia Pulmonary Embolism Renal Failure Respiratory Distress Septic Shock SIADH Spinal Cord Compression (SCC) Stomatitis Stress Fractures Superior Vena Cava Syndrome Thrombocytopenia Tumor Lysis Syndrome TURP MEDICATION ADMINISTRATION* Rarely Some Experience Proficient Trainer / Preceptor N/A Bleomycin (Blenoxane) Carmustine (BiCNU) Cistplatin Corticosteroids Coumadin/Heparin Cyclophosphamide (Cytoxan) Decardron Dilantin Dopamine Doxorubicin (Adriamycin) Epogen/Neupogen Etoposide (VP-16-213) Fluorouracil (5-FU) Fluxuridine (FUDR) Hydroxyurea (Hydrea) Melphalan (Alkeran) Methotrexate (Amethopterin) Mitomycin (Mutamycin) Titrate Morphine Usulfan (Myleran) Vinblastine (Velban) Vincristine (Oncovin) PROCEDURES/SKILLS – INTRAVENOUS THERAPY* Rarely Some Experience Proficient Trainer / Preceptor N/A Peripheral line insertions Assessment of IV site Care of IV Extravasation PROCEDURES/SKILLS – INTRAVENOUS THERAPY* Rarely Some Experience Proficient Trainer / Preceptor N/A Peripheral line insertions Assessment of IV site Care of IV Extravasation TPN Antibiotics Antifungals/Antivirals IV Push Oral Chemotherapy IM Injections SQ Injections Intrathecal Continuous Narcotic Infusion Suctioning – Oral Suctioning – Nasotracheal Tube Feeding NG Tube Insertion GastrostomyJejunostomy Tube Care Colostomy/Enterostomal Care Ileostomy Care Platelet Precautions PROCEDURES/SKILLS – INTRAVENOUS THERAPY (BLOOD/BLOOD PRODUCTS)* Rarely Some Experience Proficient Trainer / Preceptor N/A PRBCs Platelets FFP Leukocytes/WBC PROCEDURES/SKILLS – FOLEY CATHETER* Rarely Some Experience Proficient Trainer / Preceptor N/A Insertion/Care Irrigations Suprapubic Catheter Care PROCEDURES/SKILLS – CHEST TUBE & DRAINAGE SYSTEM* Rarely Some Experience Proficient Trainer / Preceptor N/A Set up Assist with insertion Care & maintenance Troubleshooting Removal Thoracentesis – assist Paracentesis – assist Liver Biopsy – assist Bone Marrow Biopsy – assist Central Line Placement – assist Skin Care Immunosuppression/Laminar Airflow PROCEDURES/SKILLS – VENOUS ACCESS DEVICES* Rarely Some Experience Proficient Trainer / Preceptor N/A Hickman/Broviac/Groshong PICC lines Site Care/Dressing Changes Assist with Insertion Declot Occluded Ports/Catheters Temporary Repair of Catheters Flush Lumens Change Caps Obtain Blood Specimens PROCEDURES/SKILLS – VASCULAR ACCESS PORTS* Rarely Some Experience Proficient Trainer / Preceptor N/A Port-a-Cath Opti-Port S.E.A. Port Omega Port Chemo Port Access the Catheter Port Flush Catheter Troubleshooting/Maintain Patency Obtain Blood Specimens Patient/Family Teaching RADIATION THERAPY* Rarely Some Experience Proficient Trainer / Preceptor N/A External Radiotherapy Total Body Irradiation Intraoperative Radiation Therapy IORT Implants Brachytherapy Radiation Safety Procedures Patient/Family Teaching Management of Side Effects BONE MARROW TRANSPLANT* Rarely Some Experience Proficient Trainer / Preceptor N/A Peripheral Blood Stem Cells Autologous BMT Allogeneic BMT Patient/Donor Education Infection Graft Rejection GVHD Graft vs. Host Disease Venocclusive Disease Pneumonitis EQUIPMENT – AMBULATORY INFUSION PUMPS* Rarely Some Experience Proficient Trainer / Preceptor N/A Cormed Auto Syringe Pharmacia Pancretec Synchromed Patient/Family Teaching of Automated Med. Dispensing Systems Automatic BP cuffs Computer Charting Systems EQUIPMENT – IMPLANTABLE INFUSION PUMPS* Rarely Some Experience Proficient Trainer / Preceptor N/A Infusaid Implantable Pump Medtronic Glucometer/Accucheck Isolation PCA Pumps Pressure Relief Devices Pulse Oximetry Reverse Isolation PSYCHOSOCIAL CARE/SUPPORT* Rarely Some Experience Proficient Trainer / Preceptor N/A Identify/Refer to Resources Available Participation in Support Groups Palliative Care Advanced Directives Death & Dying Counseling Hospice Care Support During Ethical Decision Making Family Support PAIN MANAGEMENT* Rarely Some Experience Proficient Trainer / Preceptor N/A Pain assessment using pain scales Epidural analgesia IV conscious sedation Patient controlled analgesia (PCA) Narcotic Agents Non-narcotic agents Non-pharmacological measures ASSESSMENT/OTHER* Rarely Some Experience Proficient Trainer / Preceptor N/A Admission of patients to unit Assess Breath Sounds Assess Heart Sounds Care Planning Charge Nurse responsibilities Circulation Checks Computerized Charting Manage Cytotoxic Spills Neurological Assessments Patient Teaching – General re: Oncology Universal Precautions Vital Signs 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. Signature Date Date Format: MM slash DD slash YYYY