Skills Checklist – Pediatrics ICU

Skills Checklist – Pediatrics ICU

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

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Acute Renal Failure
  Acyanotic Heart Disease
  Anorexia/Bulimia
  Bacterial Endocarditis
  Blunt Trauma
  Bone Marrow Transplant
  Brain Death/Organ Procurement
  Bronchiolitis
  Burns
  Cardiac Defects
  Transposition of the Great Vessels
  Cardiac Transplant
  Cardiomyopathy
  Chronic Respiratory Disease
  Crohn’s Disease
  Coma
  Craniofacial Reconstruction
  Cystic Fibrosis
  Diabetes Insipidus
  Diabetic Coma
  Encephalitis
  Epiglottitis
  Foreign Body Aspiration
  Gun Shot/Stab Wound
  Head Trauma
  Hepatic Failure
  Hepatitis
  Hemolytic Uremic Syndrome
  Hemothorax
  HIV/AIDS
  Intussusception
  Kawasaki Disease
  Meningitis
  MRSA
  Myocarditis
  Near Drowning
  Poison Ingestion/Overdoses
  Pneumonia
  Pneumothorax
  Renal Transplant
  Respiratory Failure
  Respiratory Syncytial Virus (RSV)
  Severe Respiratory Distress
  Shock
  Sickle Cell Anemia
  Spinal Cord Injuries
  Status Asthmaticus
  Status Epilepticus
  Tuberculosis
  VRE

• CARE OF PATIENTS (POST-OPERATIVE) FOR*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Cardiothoracic Surgery
  GI Surgery
  Neurosurgery
  Orthopedic Surgery
  Tracheostomy
  ENT Surgery

• MEDICATION ADMINISTRATION*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Pediatric Dosage Calculation
  Antiarrhythmics
  Anticoagulants
  Antihyperintensives
  Antiseizures
  Benzodiazepines
  Continuous Paralytic (IV)
  Continuous IV Sedation
  Emergency Medications
  Diuretics
  Inhaled Medications
  Antibiotics
  Narcotics
  NSAID
  Reversal Agents
  Steroids
  Growth Hormone
  Insulin
  Lasix
  Continuous IV infusion
  Eye/ear Instillations
  IM Injections
  IV Push

• PROCEDURES/SKILLS*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Chest tube & drainage system
  EKG Intrepretation
  Feedings
  Foley/Straight Cath insertion & care
  Hemodynamic Monitoring, Invasive
  Hemodynamic Monitoring, non-invasive
  Interpretation of Lab Results
  Intestinal Tract Tube Insertion/Care
  Intravenous Infusions
  Blood & Blood Products
  Central line care
  Peripheral IV insertion & care
  Oxygen Therapy Administration
  Peritoneal Dialysis
  Specimen Collection
  Cultures
  Urine
  Suctioning
  Temperature
  Wound/Ostomy Care
  Pressure Ulcers
  Pain Management
  EQUIPMENT
  Blood Warmer
  BP Transducer
  Cardiac Monitor
  Centrifuge
  Defibrillator
  Glucometer
  Infusion Pumps
  Phototherapy Equipment
  Specialty Beds
  Ventilator

• ASSESSMENT/OTHER*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Abdominal Girth Measurement
  Admission of patients to unit
  Assess Heart Sounds
  Charge Nurse responsibilities
  Circulation Checks
  Computerized Charting
  Fontanel Assessment
  Neurological Assessments
  Patient Teaching

• 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