Skills Checklist – OR Technician

Skills Checklist – Surgical Tech (CST)

• Name
  
  First
  
  Last
• Phone
• Email
  
• EXPERIENCE*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Endoscopy
  ENT
  General Surgery –
  GYN
  Neuro
  Opthamology
  Oral
  Ortho
  Plastics
  Thoracic/open heart
  Transplant
  Trauma
  Urology
  Vascular

• EAR, NOSE, & THROAT*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Adenoidectomy
  Caldswell – Luc
  Cleft lip/palate repair
  Closed reduction nasal fracture
  Laryngectomy
  Mandibulectomy
  Maxillary advancement with hip graft
  Myringoplasty
  Myringoplasty with PE tube insertion
  Open reduction facial fracture
  Open reduction nasal fracture
  Radical neck dissection
  Rhinoplasty/septoplasty
  Stapedectomy
  Tonsillectomy
  Tracheostomy
  Tympanoplasty

• ENDOSCOPIC PROCEDURE*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Bronchoscopy
  Colonscopy
  Cystoscopy
  Esophagoscopy
  Gastroscopy
  Hyteroscopy
  Laprascpoic Procedures
  General Surgery
  Hickman/Groshong/Portacatch insertion
  Imperforate anus reconstruction
  Lumbar sympathectomy
  Omphalocele repair
  Pilonidal cyctectomy
  Portal caval shunt
  Pyloric stenosis
  Radical mastectomy
  Saphenous vein ligation & stripping
  Sentinel node biopsy
  Splenectomy
  Thyroglossal duct cyst excision
  Thyroidectomy
  Tracheostomy.
  Vagotomy

• GYNECOLOGY*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Vaginectomy/Vulvectomy

• NEUROSURGERY*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  A-V malformation
  Anterior cervical fusion
  Anterior laparoscopic spine procedures
  Anterior lumbar interbody fusion (ALIF )
  Burr holes for subdural hematoma
  Cervical sympathectomy
  Craniectomy for decompression fracture
  Insersion nerve stimulators/medication pumps
  Laminectomy
  Posterior lumbar interbody fusion(PLIF)
  Shunt procedure/VP,VA/LP
  Spine fusion
  Ulnar nerve transfer

• OPTHAMOLOGY*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Opthamology Proficiency

• ORAL*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Oral Proficiency

• ORTHOPEDICS*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Acetabular/peivic QRIF
  Achilles tendon repair
  Amputation – leg, arm
  Anterior cruciate ligament repair
  Application of halo traction
  Arthrotomy
  Bipolar/unipolar hips
  Bunionectomy
  Calcaneal reconstruction
  Carpal tunnel release
  Application of external fixators
  Arthroscopy
  Hip compression nails & leg screws
  Total joint replacements / revisions
  Intramedullary rods

• PLASTICS*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Abdominal lipectomy
  Blepharoplasty
  Face lift
  Scar revisions
  Split thickness skin grafting
  Tissue expanders
  Mammoplasty

• THORACIC & OPEN HEART*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Pacemaker implantation – endocardial
  Pacemaker implantation – myocardial
  Open heart procedures
  Transplant.

• TRAUMA*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Gunshot/Stab wounds

• UROLOGY*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Adult circumcision
  Cystectomy
  Cystoscopy/ureteroscopy
  Nephrectomy
  Nephrolithotomy
  Orchiopexy
  Pyeioplasty
  Radical node dissection
  TURP
  Vasectomy
  Vasovasostomy

• VASCULAR*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  A – V access graft
  Aortic aneur ysm with graft replacement
  Endarterectomy/carotid – femoral
  Peripheral vascular bypass procedure
  Thrombectomy/embolectomy
  Vena cava fitter/umbrella

• EQUIPMENT*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Eye Magnet
  Fiber optic luminator – list types
  Flash autoclave – AMSCO
  Mesh graft
  Microscopes, types
  Nerve stimulator
  Orthopedic arm board with drain
  Sterad machine
  Steri-vac aeration cabinet, 3M, portable
  Steris unit
  Suction unit, disposable
  Tele-thermometer
  Ultrasonic cleaner – AMSCO
  Vac-pac positioner
  Vacuum curettage
  Washer sanitizer – AMSCO
  Washer sterilizer – AMSCO
  Bair Hugger
  Blood/fluid warmer
  Cidex soak
  Electrosurgical unit
  Emerson thoracic pump
  Ethylene oxide sterilizer – AMSCO

• 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)

• YEARS EXPERIENCE IN CLINICAL

• Specialty
• Most recent facility worked at
• 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