Skills Checklist – Pediatrics

Skills Checklist – Pediatrics

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

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Pre & Post Cardiac Surgery
  Colostomy/Iloestomy
  Renal Failure
  Congenital Heart Disease
  Kawasaki’s Disease
  Asthma
  Croup
  Epiglottitis
  Pneumonia
  Respiratory Synticial Virus (RSV)
  Rheumatic Fever
  Tuberculosis
  Closed Head Injuries
  Encephalitis
  Epilepsy
  Reye’s Syndrome
  Seizures
  Gastroenteritis
  Juvenile Diabetes
  Poison Ingestion/Overdose
  Tonsillitis
  Urinary Tract Infection
  Hepatitis
  Osteomyelitis
  Fractures – Pinned Traction
  Devised Traction (casts, splints, braces)
  Pituitary Disorders
  Thyroid Dysfunction
  Anemia
  Hemophilia
  Leukemia
  Bone Marrow Transplant
  Hodgkin’s Disease
  Malignant Tumors
  Childhood Communicable Diseases
  Cytomegalovirus (CMV)
  HIV/AIDS
  Burns
  Battered Child Syndrome
  Child Abuse/Neglect
  Failure to Thrive
  Multiple Trauma
  Developmental Delay
  Cleft Lip/Palate

• CARE OF PATIENTS (POST-OPERATIVE CARE) WITH*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Abdominal Surgery
  Orthopedic Surgery
  Craniofacial Surgery
  ENT Surgery

• MEDICATION ADMINISTRATION*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Pediatric Calculations
  Antihyperintensives
  Anticoagulants
  Antiseizure
  Benzodiazepines
  Diuretics
  Narcotics/Opiods
  Emergency Medication
  Reversal Agents
  Steroids IV/Oral
  Procedural Sedation
  Automated Medication Dispensing
  Inhaled Medications
  Non-Narcotic Agents
  Insulin
  Continuous IV infusion
  Eye/ear Installations
  IM Injections
  Rectal Infusion/Suppository
  SQ Injections
  Z-track Injections

• PROCEDURES/SKILLS*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Cast Care
  Chemotherapy – Peds Protocols
  Chest tube & drainage system
  a. Breastfeeding – assist
  b. Bottle
  c. Continuous tube feeding
  d. Gavage, intermittent
  Hemodynamic Monitoring, non-invasive
  Interpretation of Lab Results
  Intestinal Tract Tube Insertion/Care
  Intravenous Infusions
  a. Blood & Blood Products
  b. Central line care
  c. Peripheral IV insertion & care
  Oxygen Therapy Administration
  Peritoneal Dialysis
  Suctioning
  Temperature
  Wound/Ostomy Care
  Pressure Ulcers
  Patient Controlled Analgesia (PCA)

• PROCEDURES/SKILLS – SPECIMEN COLLECTION (BLOOD)*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Central line
  Heel stick
  Venous stick

• PROCEDURES/SKILLS – SPECIMEN COLLECTION (CULTURES)*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  General

• PROCEDURES/SKILLS – SPECIMEN COLLECTION (URINE)*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Catheter
  Diaper
  Suprapubic tap (assist)
  Urine bag

• ASSESSMENT/OTHER*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Abdominal Girth Measurement
  Isolation Precautions
  Assess Breath Sounds
  Assess Heart Sounds
  Infection Prevention
  Recognize/Report Signs of Abuse
  Circulation Checks
  Pain Assessment and Management
  Fontanel Assessment
  Head Circumference Measurement
  Neurological Assessments
  Patient Teaching
  Use of Restraints
  Vital Signs

• EQUIPMENT*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Apnea Monitor
  Glucometer
  Specialty Beds

• 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