CVICU Skills Checklist

CVICU Skills Checklist

First Name*

Last Name*

Years of Experience*

E-mail*

example@example.com

ANSWER KEY

PROFICIENCY

1=Not Applicable 2=No Experience 3=Some Experience

4=Experienced 5=Very Experienced

FREQUENCY

1=Never Performed 2=Assisted Only 3=Rarely Performed

4=Occasionally Performed 5=Regularly Performed

General Skills*

	Proficiency	Frequency
Standard Precautions
Isolation Precautions
Pediatric Respiratory / Cardiac Arrest
Adult Respiratory / Cardiac Arrest
Crash Carts
Defibrillators
Care of Patient in Restraints
Pain Management
Automated Med Dispensing System
Care Planning and Discharge Planning
Patient / Family Education
Electronic Documentation
Patient Head to Toe Assessment
Dressing Changes
Knowledge of Normal Serum Lab Values
Obtaining Cultures (Blood, Sputum, Swab, Urine)
Administration of Blood and Blood Products
PCA Pumps
Infusion Pumps
Calculate Mcg / Min and Mcg / Kg / Min
Titrating Medications
Moderate / Conscious Sedation & Reversal Agents

Neuro Assessment*

	Proficiency	Frequency
Cranial Nerves
Glasgow Coma Scale
Level of Consciousness
Pathological Reflexes
Motor Deficits

Neuro Equipment & Procedures*

	Proficiency	Frequency
Assist With Lumber Puncture
Halo Traction / Cervical Tongs
Intercranial Pressure Monitoring
Nerve Stimulator
Rotating Bed
Seizure Precautions
Stryker Frame
Use of Hyper / Hypothermia Blanket

Neuro Care of Patients With*

	Proficiency	Frequency
Aneurysm Precautions
Basal Skull Fracture
Closed Head Injury
Coma
CVA
DT's
Encephalopathy
Externalized VP Shunts
Increased ICP
Meningitis
Metastatic Tumor / Cranial Tumor
Multiple Sclerosis
Post Craniotomy
Spinal Cord Injury
Ventriculostomy

Interpretation of Lab Results*

	Proficiency	Frequency
Blood Glucose
Thyroid Panel

Equipment & Procedures*

	Proficiency	Frequency
Blood Glucose Measuring Devices
Blood Glucose Monitoring
Performing Finger Stick

Care of Patient With*

	Proficiency	Frequency
Diabetes Mellitus
Addison's Disease
Disorders of the Pituitary Gland (DI)
Drug Overdose
Hyperthyroidism (Graves' Disease)
Hypothyroidism
Insulin Shock
Thyroidectomy

Assessment*

	Proficiency	Frequency
Adventitious Breath Sounds
Rate and Work of Breathing

Interpretation of Lab Results*

	Proficiency	Frequency
Arterial Blood Gases

Equipment & Procedures*

	Proficiency	Frequency
Air Leak Troubleshooting
Medicinal Chest Tube Removal
Pleural Chest Tube Removal
Airway Management Devices / Suctioning
Endotracheal Tube / Suctioning
Assist With Extubation
Nasal Airway Suctioning
Oximetry
Sputum Specimen Collection
Tracheostomy / Suctioning
Bronchoscope
Chest Tube Insertion
Emergency Tracheostomy
Thoracentesis
Establishing an Airway
Assist With Intubation
Laryngospasm
Tension Pneumothorax
Tension Pneumothorax
Use of Pleur-EVAC or Thora-Klex Drainage
Use of Water Seal Drainage
O2 Therapy & Medication Delivery Systems
Ambu Bag & Mask
ET Tube
Face Mask
Nasal Cannula
Portable O2 Tank
Trach Collar
Ventilator Management
External CPAP
High Frequency Jet Ventilation
IMV
PEEP
Pressure Support
Weaning Modes & T-Piece Weaning

Care of Patient With*

	Proficiency	Frequency
Acute Pneumonia
ARDS
Chest Trauma
COPD
Fresh Tracheostomy
Lobectomy
Lung Transplant
Pneumonectomy
Pulmonary Edema / Hypertension
Pulmonary Embolism
Status Asthmaticus
Thoracotomy
Tuberculosis

Assessment*

	Proficiency	Frequency
Abnormal Heart Tones (i.e. Murmur, Gallop, Friction Rub)
Auscultation (Rate, Rhythm, Volume)
Blood Pressure (Non-Invasive)
Pulses / Circulation Checks (Doppler, Palpation)

Interpretation of Lab Results*

	Proficiency	Frequency
Cardiac Enzymes & Isoenzymes
Coagulation Studies

Equipment & Procedures*

	Proficiency	Frequency
Arterial Line Insertion
Central Line Insertion
Open Chest Emergency
PA Catheter / Swan Ganz Insertion
Pericardiocentesis
Transesophageal Echocardiogram
Automatic Internal Cardioverter
Cardioversion
CAVH-D
Hemodynamic Monitoring
Cardiac Index
Cardiac Output
CVP Monitoring
Femoral Artery Sheath Removal
MAP
PA / Swan-Ganz
PCW Pressure
PVR
Radial A-Line
SV02
SVR
Intra Aortic Balloon Pump
Monitoring:
12 Lead EKG Interpretation
Arrhythmia Interpretation
Lead Placement
Rhythm Strip Assessment
Set Up and Re-Run 12 Lead EKD
Pacemakers
External
Temporary
Permanent
Transthoracic Ventricular Device (RVAD / LVAD)

Care of Patient With*

	Proficiency	Frequency
Abdominal Aortic Aneurysm Repair
MI
Cardiac Arrest
Cardiac Tamponade
Congestive Heart Failure
EP Study & Ablation
Heart Transplant
Infective Endocarditis
Immediate Open Heart Surgery
Infective Endocarditis
Myocardial Contusion
Pericarditis
Post AICD Insertion
Post Atherectomy DCA
Post Commissurotomy Valve
Post Percutaneous Balloon Valvuloplasty
Post Rotoblade
Pre / Post Angioplasty
Pre / Post Cardiac Catheterization

Assessment*

	Proficiency	Frequency
Arteriovenous Fistula / Shunt
Fluid Status

Interpretation of Lab Results*

	Proficiency	Frequency
BUN & Creatinine
Electrolytes

Equipment & Procedures*

	Proficiency	Frequency
Bladder Irrigations
Insertion & Care of Straight Foley Catheter
3-Way Foley
Female
Male
Supra-Pubic

Care of Patients With*

	Proficiency	Frequency
Acute Renal Failure
CAVH Dialysis
Hemodialysis
Nephrectomy
Peritoneal Dialysis
Renal Rejection Syndrome
TURP
Urinary Diversion (Ileal Conduit Nephrostomy)
Urinary Tract Infection

Assessment of Pain Level Tolerance*

	Proficiency	Frequency
Assessment of Pain Level Tolerance

Care of Patient With*

	Proficiency	Frequency
Epidural Anesthesia / Analgesia
IV Conscious Sedation
Patient Controlled Analgesia

Medication Knowledge and Use of*

	Proficiency	Frequency
Alupent (Metaproterenol)
Amicar
Aminophylline (Theophylline)
Amiodarone (Cordarone)
Apresoline
Atropine
Bretylium (Bretylol)
Corticosteroids
Digoxin (Lanoxin)
Dobutamine (Dobutrex)
Dopamine (Intropin)
Electrolyte Replacement Therapy
Epinephrine (Adrenalin)
Esmolol (Brevibloc)
Heparin Dip
Inocor (Amrinone)
Levophed
Lidocaine
Metoprolol (Lopressor)
Neosynephrine
Nipride (Nitroprusside)
Nitroglycerin (Tridil)
Procainamide (Pronestyl)
Propofol (Diprivan)
Sodium Bicarbonate
Succinylcholine
Vasopressin
Verapamil (Calan, Isoptin, Verelan)

Age Specific Criteria*

	Proficiency	Frequency
Newborn / Neonatal (up to 30 days)
Infant (30 days to 1 year)
Toddler (1 to 3 years)
Preschooler (3 to 5 years)
School Age (5 to 12 years)
Adolescents (12 to 18 years)
Young Adults (18 to 39 years)
Middle Adults (40 to 64 years)
Older Adults (65 & up)

Background Experience*

	Proficiency	Frequency
Small Hospital
Large Hospital
Outpatient
Acute Care / Hospital
Cancer Center
Clinic
Managed Care
SNF / Long Term Care
Home Health

The information provided is true and to the best of my knowledge. I hereby authorize Summit Medical Staffing to present my Skills Checklist to facilities for the purpose of employment. Please Type Your Name in This Box to Electronically Sign this Form.*

First NameLast Name

Date*

MonthDayYear

Hour MinutesAM/PM Option

Form Reply Email Address

Salesforce Check

Endocrine / Metabolic

Pulmonary

Cardiovascular

Renal / Genitourinary

Pain Management