Neuro ICU Skills Checklist

Neuro ICU 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

Pacemaker*

	Proficiency	Frequency
PPM
Transvenous
Transcutaneous

Assessment*

	Proficiency	Frequency
Normal Heart Tones (i.e.: S1, S2)
Abnormal Heart Tones (i.e.: Murmur, Gallop, Friction Rub)
Identification of PMI (Point Maximal Intensity)
Blood Pressure (Non-Invasive)
Pulses / Circulation Via Palpation
Pulses / Circulation Via Doppler
Insertion Site Invasive Lines
12-Lead EKG Interpretation
EKG Changes for MI
Rhythm Interpretation
S/S DVT

Provision of Care for*

	Proficiency	Frequency
Cardiac Arrest
Carotid Endarterectomy
Cardiac Tamponade
CHF
MI
Myocardial Contusion
Pericardial Effusion
Pericarditis

Procedures*

	Proficiency	Frequency
Obtain Cardiac Output
Obtain MAP
PCWP Measurement
Obtain CVP Measurement
Removal of Radial Arterial Line
Removal of Femoral Sheath
Perform Venipuncture
Obtain Lab Specimens From A-Line
Obtain Lab Specimens From Central Line
Perform 12-Lead EKG
Proper Cardiac Monitor Lead Placement

Management of*

	Proficiency	Frequency
Blood and Blood Product Administration
Blood Transfusion Reactions

Hemodynamic Monitoring*

	Proficiency	Frequency
Management of Arterial Line
Management of PA / Swan-Ganz
Management of CVP Line
Zero and Calibration of Transducers
Assess Adequate Perfusion With Invasive Lines

Management of Temporary Pacemaker*

	Proficiency	Frequency
Recognition of Failure to Sense, Capture
Manipulation of TPM Settings
Troubleshoot TPM Settings

Identification and Interpretation of*

	Proficiency	Frequency
Arterial Waveform
PA / Swan-Ganz Waveform
PCWP Waveform
CVP Waveform
SVO2 Data

Perform Calculations for*

	Proficiency	Frequency
PVR
SVR

Assist With*

	Proficiency	Frequency
Set-Up for Cardioversion
Cardioversion
Central Line Insertion
CAVH-D
Arterial Line Insertion
PA / Swan-Ganz Insertion
Chest Tube Insertion
Chest Tube Removal
Emergency Tracheostomy
Pericardiocentesis
Thoracentesis
Transesophageal Echocardiogram
Emergency Intubation

Assist With*

	Proficiency	Frequency
Caloric Reflex Testing
Application of Halo to Patient With C-Spine Injury
Assist in Placement and Changing of Head Dressings
Lumbar Puncture
Intracranial Pressure Monitoring
Nerve Stimulators
Rotating Bed
Seizure Precautions
Spinal Precautions
Stryker Frame
Use of Hyper / Hypothermia Blanket

Assessment*

	Proficiency	Frequency
Analyze ICP Waveforms
Troubleshoot ICP Monitoring
Cranial Nerves
Glasgow Coma Scale
Pathologic Reflexes
Reflex / Motor Deficits
Visual / Communication Deficits

Provision of Care*

	Proficiency	Frequency
CVA
TIA
Encephalopathy
Aneurysm Precautions
Basilar Skull Fracture
Closed Head Injury
Coma
Seizure Disorder
DT's
Encephalitis
Externalized VP Shunts
Increased ICP
Laminectomy
Meningitis
Metastatic Tumor / Intracranial Tumor Resection
Multiple Sclerosis
Post Craniotomy
Spinal Cord Injury
Ventriculostomy
Neurogenic Shock

Care of Patient With*

	Proficiency	Frequency
Epidural Anesthesia / Analgesia
IV Conscious Sedation
Patient Controlled Analgesia
Broviac Catheter
Groshong
Hickman
Portacath
Quinton
Peripheral Line / Dressing
PICC Line

Assessment*

	Proficiency	Frequency
Perform Comprehensive Multi-System Assessment

Provision of Care for*

	Proficiency	Frequency
Hypovolemic Shock
Cardiogenic Shock
Disseminated Intravascular Coagulation (DIC)
Organ / Tissue Donation
Anaphylactic Shock
Multi-System Organ Failure
Alcohol Overdose
Gunshot Wounds
AIDS
Implementation of Core Measures
Drug Overdose

Pain Management*

	Proficiency	Frequency
Assessment of Pain Level
Assessment of Therapeutic Response

Provision of Care for*

	Proficiency	Frequency
Burns
Pressure Sores
Staged Decubitus Ulcers
Surgical Wounds With Drains
Traumatic Wounds

Equipment*

	Proficiency	Frequency
Air Fluidized, Low Airloss Beds

Assess for*

	Proficiency	Frequency
Skin Intact
Stasis Ulcers
Surgical Wound Healing

Procedures*

	Proficiency	Frequency
Sterile Dressing Changes
Wound Care / Irrigations

Medications*

	Proficiency	Frequency
Alupent (Metaproterenol)
Aminophylline (Theophylline)
Amiodarone (Cordarone)
Atropine
AquaMephyton (Vitamin K)
Apresoline
Barbiturate Induced Coma
Bretylium (Bretylol)
Corticosteroids
Decadron (Dexamethasone)
Digoxin (Lanoxin)
Dilantin (Phenytoin)
Diltiazem (Cardizem)
Dobutamine (Dobutrex)
Dopamine (Intropin)
Lasix (Furosemide)
Epinephrine (Adrenalin)
Esmolol (Brevibloc)
Heparin Drip
Inderal (Propranolol)
Inocor (Amrinone)
Kayexelate
Lactulose (Cephulac)
Levophed
Lidocaine
Metoprolol (Lopressor)
Mannitol
Nipride (Nitroprusside)
Nitroglycerin (Tridil)
Phenobarbital
Pitressin (Vasopressin)
Procainamide (Pronestyl)
Sodium Bicarbonate
Succinylcholine
Propofol (Diprivan)
Valium (Diazepam)
Verapamil (Calan, Isoptin, Verelan)
Vecuronium
Ventolin (Albuterol)
Neosynephrine
Management of Epidural Administration

Provision of Care*

	Proficiency	Frequency
Titrate Vasopressors to Effect / Parameters
Assess for Therapeutic Response
Perform Manage Dosage Drip Calculations

General*

	Proficiency	Frequency
Turn, Cough, and Deep Breathing Technique
Splinting Technique Post-Op
Use of Incentive Spirometer
Importance of Increasing Mobility Post-Op When Applicable

Assessment*

	Proficiency	Frequency
Auscultate Breath Sounds
Identify Adventitious Lung Sounds
Auscultate for Confirmation of ET Tube Placement
Implement Ventilator Acquired Pneumonia Protocols
Assess and Confirm Proper Vent Settings
Manage Patient on Mechanical Ventilation
Assist With Post-Extubation Care
Application of BiPAP
Application of CPAP
Maintain Pulmonary Stability Post-Extubation
Application of Oximetry
Interpretation of Oximetry Values

Provision of Care for*

	Proficiency	Frequency
Acute Pneumonia
ARDS
Chest Trauma
COPD
Cor Pulmonale
Fresh Tracheostomy
Near Drowning
Pulmonary Edema
Pulmonary Hypertension
Pulmonary Embolism
Status Asthmaticus
Thoracotomy
Tuberculosis

Chest Tubes*

	Proficiency	Frequency
Perform Chest Tube Set-Up
Monitor & Record Chest Tube Output
Identify and Troubleshoot Clotted Chest Tube
Identify and Troubleshoot Patient Bleeding from Chest Tube
Identify Presence of Air Leak

Procedures*

	Proficiency	Frequency
Perform ET Tube Suctioning
Perform NT (Nasotracheal) Suctioning
Perform Suctioning of Tracheostomy
Collection of Sputum Via NT Suction
Collection of Sputum Specimen Via ET (Closed System)
Assist With Extubation of Patient

Assessment*

	Proficiency	Frequency
Bowel Sounds
Nutritional Status
Proper N/G Tube Placement

Provision of Care*

	Proficiency	Frequency
Blunt Abdominal Trauma
Bowel Obstruction
Colostomy
Esophageal Bleed
GI Bleed
GI Surgery
Hemicolectomy
Hepatitis
Ileostomy
Inflammatory Bowel Disease
Liver Failure
Pancreatitis
Paralytic Ileus
Penetrating Trauma

Procedures*

	Proficiency	Frequency
Administration of Tube Feeding
Flexible Feeding Tube (Dobhoff)
N/G Tube to Continuous Suction
Gravity Feeding
Iced Saline Lavage
Insertion and Maintenance of N/G Tube
Insertion and Maintenance of Rectal Tube
PPN ( Peripheral Parenteral Nutrition)
Removal of N/G Tube
TPN and Lipids Administration
Utilization of Feeding Pump

Provision of Care*

	Proficiency	Frequency
Addison's Disease
Diabetes Mellitus
Diabetic Ketoacidosis
Diabetes Insipidus
Hyperthyroidism
Hypothyroidism
Insulin Shock
Cushing's Syndrome

Procedures*

	Proficiency	Frequency
Fingerstick Blood Glucose
Implementation of Sliding Scale

Equipment*

	Proficiency	Frequency
Blood Glucose Monitoring Devices
Use of Insulin Pen
Use of Lancet

Assessment*

	Proficiency	Frequency
A-V Fistula / Shunt
Fluid Status

Provision of Care for*

	Proficiency	Frequency
Acute Renal Failure
CAVH Dialysis
Hemodialysis
CRRT
Peritoneal Dialysis
Urinary Tract Infection

Procedures*

	Proficiency	Frequency
CRRT
CAVH Dialysis
Hemodialysis
Bladder Irrigation
Insertion of Male Foley Catheter
Insertion of Female Foley Catheter
Suprapubic Catheter

Interpretation of*

	Proficiency	Frequency
ABG's
BUN / Creatinine
Coagulation Studies
Electrolytes
Cardiac Enzymes
Blood Glucose
Thyroid Panel

General*

	Proficiency	Frequency
Provide Care for End-of-Life Decisions that Families Face in ICU such as Withdrawal of Life Support
Adhere to Legal Procedures Regarding Notification of Organ Donation Provider
Demonstrate Spiritual and Cultural Considerations for the Critical Care Patient
Provide for the integration of Comfort Care and Death With Dignity
Demonstrate Effective Coping Skills in Caring for the Critical Care Patient

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)

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

Cardiovascular

Neurology

Multisystem

Integumentary

Neuro ICU Pharmacology

Patient Education

Pulmonary

Gastroenterology

Endocrine

Renal

Labs

Patient Advocacy