Skills Checklist – Telemetry

Skills Checklist – Telemetry/Step-down

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

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Abdominal Aortic Aneurysm
  Angina
  Cardiac Arrest
  Cardiac Catherization
  Cardiogenic Shock
  Carotid Endarterectomy
  Congestive Heart Failure
  Cardiac Stents
  Deep Vein Thrombosis
  Post Acute MI (>48 hrs)
  Post Angioplasty
  Asthma
  Bronchoscopy
  COPD
  Fresh Tracheostomy
  Pneumonia
  Pneumothorax
  CVA/TIA
  Heart Transplant
  Head Injuries/Intercranial bleeds
  Respiratory Distress
  Assess Breath Sounds
  Stroke Scale Assessment
  Seizures
  Spinal Cord Injuries
  Renal Failure
  Dsyrhythmia Interpretation
  Hepatic Failure
  Hepatitis
  GI Bleed
  TURP/TURBP
  Total Hip Replacement
  Total Knee Replacement
  Diabetes Insipidus
  Diabetes Mellitus
  Leukemia
  Malignant Tumors
  Pituitary Disorders
  Burns
  Delirium Tremens
  HIV/AIDS

• CARE OF PATIENTS (POST-OPERATIVE) FOR*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Post Open Heart (12-24 hrs)
  Post Thoracic Surgery
  Post Craniotomy
  Vascular Surgery

• MEDICATION ADMINISTRATION*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Aminophylline
  Antibiotics
  Anticoagulants
  Antihypertensives
  Beta-Blockers
  Ca+ Channel Blockers
  Chemotherapeutic Agents
  Corticosteroids
  Digoxin
  Heparin
  Insulin
  Antiarrhythmics
  Nitroglycerine
  Oral Hypoglycemics
  Antipsychotics
  Antiseizure
  Procedural Sedation
  Benzodiazepines
  Thrombolytics
  TPN Administration
  Patient Controlled Analgesia (PCA)
  Blood/Blood Product Administration
  Diuretics
  CAD Pump
  Emergency Medications
  Inhaled Medications
  Insulin Pump
  Non-opiod Analgesics
  Reversal Agents
  Automated Dispensers (Pyxis)
  IV Insulin Protocol

• PROCEDURES/SKILLS*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  A-V Fistula Care
  Foley/Straight Cath insertion & care
  Central line care
  Chest tube & drainage system
  CVP Measurment
  Cardioversion
  Defibrillation
  EKG – obtaining 12 lead
  EKG arrhythmia interpretation
  EKG – lead placement
  Femoral Sheaths-Mgmt/Discontinuing
  Continuous Tube Feeding
  Glascow Coma Scale
  Gastric Suction
  Interpretation of Lab Results
  Intestinal Tract Tube Insertion/Care
  Oxygen Therapy Administration
  Assist with Intubation/Extubation
  Pacemaker
  Peritoneal Dialysis
  Specimen Collection
  Blood
  Suctioning
  Temperature
  Wound/Ostomy Care
  Pressure Ulcers

• ASSESSMENT/OTHER*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Assess Breath Sounds
  Assess Heart Sounds
  Charge Nurse responsibilities
  Circulation Checks
  Patient Teaching
  Neurological Assessments
  Pain Management
  IV Conscious Sedation
  Patient Controlled Analgesia (PCA)

• EQUIPMENT*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Automatic BP cuffs
  Cardiac/Tele Monitor
  Femoral Hemostasis Devices
  Glucometer

• EQUIPMENT – SPECIALTY BEDS*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Ventilator Management/Troubleshooting

• 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