PEDS ER Skills Checklist

PEDS ER 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

Provision of Care for*

Rows	Proficiency	Frequency
Hypovolemic Shock
Neurogenic Shock
Septic Shock
Traumatic Amputation
Bites, Animal
Bites, Human
Bites, Venomous Snake
Bites, Venomous Spider
Burns, Rule of Nines
Burns, First Degree
Burns, Second Degree
Burns, Third Degree
Dehydration
Gunshot / Stab Wound
Electrocution
Hazardous Material Exposure
Heat Exhaustion / Stroke
Hypothermia
Hair Tourniquet
Major Trauma
Minor Trauma
Radiation Exposure
Anaphylactic Shock
Cardiogenic Shock

Equipment and Procedures*

Rows	Proficiency	Frequency
Air Transport of Trauma Patient
Application of Mast Suit
Ground Transport
Application of Mat Tourniquet

Assessment*

Rows	Proficiency	Frequency
Trauma Score
Poison Index
Triage

Provision of Care for*

Rows	Proficiency	Frequency
Acquired Immune Deficiency Syndrome / HIV
Hepatitis
Influenza
Tuberculosis
MRSA
COVID-19
VRE
Varicella (Chicken Pox)
Pertussis
Meningitis
Systemic Inflammatory Response Syndrome (SIRS)
RSV

Equipment & Procedures*

Rows	Proficiency	Frequency
Isolation Precautions
N-95
PAPR

Assessment of*

Rows	Proficiency	Frequency
Wound Characteristics
Wound Location
Wound Staging

Equipment & Procedures*

Rows	Proficiency	Frequency
Application of Steristrips
Assist With Staples
Assist With Sutures
Set Up Suture Tray
Staple Removal
Suture Removal

Assessment of*

Rows	Proficiency	Frequency
Pain Level / Tolerance
Therapeutic Response to Pain Medications

Provision of Care for*

Rows	Proficiency	Frequency
IV Conscious Sedation
Narcotic Analgesia
Non-Pharmacological Comfort Measures

Provision of Care for*

Rows	Proficiency	Frequency
Abruptic Placenta
DIC
Placenta Previa
Precipitous Delivery
Spontaneous Abortion
Preeclampsia / Eclampsia
Ovarian Cysts
Ovarian Torsion
Ectopic Pregnancy

Equipment & Procedures*

Rows	Proficiency	Frequency
Set Up Pelvic Tray
Assist With Pelvic Exam

Procedures*

Rows	Proficiency	Frequency
Recognition of Suspected Child Abuse / Neglect
Reporting of Suspected Child Abuse / Neglect
Obtaining Consent to Treat

Provision of Care for*

Rows	Proficiency	Frequency
Angiography Prep
Broviac / Hickman
Groshong
PICC
Portacath
Syringe Pumps
Pericardiocentesis
IO Insertion
Peripheral Line / Dressing

Equipment & Procedures*

Rows	Proficiency	Frequency
Administration of Blood / Blood Products
Drawing Venous Blood
Starting IVs

Labs*

Rows	Proficiency	Frequency
Interpretation of ABG Results
Interpretation of Chemistry
Interpretation of CBC

General*

Rows	Proficiency	Frequency
Provide Care for End-of-Life Decisions that Families Face in the ED such as Withdrawal of Life Support
Adhere to Legal Procedures Regarding Notification of Organ Donation Provider
Demonstrate Spiritual and Cultural Considerations for the ED Pediatric Patient
Demonstrate Effective Coping Skills in Caring for the ED Pediatric Patient

General*

Rows	Proficiency	Frequency
Provides Education to Patient and Parents Regarding Medications and Disease Process
Provides Education to Patient and Parents Regarding Follow Up Care as Indicated
Provides Education to Patient and Parents Regarding Preparation for Invasive Procedures

General*

Rows	Proficiency	Frequency
Acetaminophen (Tylenol)
Albuterol (ProAir)
Acetylcysteine (Mucomyst)
Adenosine (Adenocard)
Amiodarone (Cordarone, Pacerone)
Atropine (Atropen)
Charcoal
Dexamethasone (Decadron)
Dilantin (Phenytoin)
Desmopressin (DDAVP)
Dobutamine (Dobutrex)
Dopamine (Inotropin)
Epinephrine (Adrenalin)
Enoxaparin (Lovenox)
Esmolol (Brevibloc)
Fentanyl (Sublimaze)
Furosemide (Lasix)
Heparin Drip
Hydrocodone / Acetaminophen
Hydromorphone (Dilaudid)
Ibuprofen (Advil, Motrin)
Insulin
Ipratropium (Atrovent)
Labetalol (Normodyne)
Lidocaine (Lidoderm)
Propofol (Diprivan)
Ketamine (Ketalar)
Ketorolac (Toradol)
Morphine (MS Contin)
Nitroglycerin (Tridil, Nitrobid)
Norepinephrine (Levophed)
Nitroprusside (Nipride)
Ondansetron (Zofran)
Oxycodone (Percocet)
Phenylephrine (Neo-Synephrine)
Phenobarbital (Luminal)
Potassium
Prednisolone (Orapred)
Procainamide (Pronestyl)
RHo (D) Immune Globulin (RhoGAM)
Sodium Bicarbonate
Sodium Polystyrene Sulfonate (Kayexalate)
Succinylcholine (Anectine)
Tamsulosin (Flomax)
Thrombolytic Therapy
Valium (Diazepam)
Vitamin K (AquaMephyton)
Vecuronium (Norcuron)
Verapamil (Calan, Isoptin, Verlan)

Provision of Care*

Rows	Proficiency	Frequency
Rights of Medication Administration
Perform Mathematical Calculations for Accurate Medication Administration (Dosage Calculations, Weight Calculations, Metric Conversions)
Perform and Manage IV Dosage Drip Calculations (Formulas for Fluid Rate Calculations)
Verification of Accurate IV Pump Delivery
Administer Medications Through Various Routes of Delivery (PO, IM, IV, IO, ET, SQ, IN, Intradermal, Topical, Rectal, etc.)
Assess for Therapeutic Response, Expected Outcomes

Professional Issues*

Rows	Proficiency	Frequency
Maintain Privacy and Dignity for Each Patient
Perform all Nursing Functions With RNs Scope of Practice
Maintain Nursing Competencies / Certifications Required by Facility / State
Utilize EMR for Accurate Patient Documentation

Interdisciplinary Communication*

Rows	Proficiency	Frequency
Communicate With Patient Using Age and Cultural Appropriate Methods
Collaborate With Interdisciplinary Teams for Care of Patient
Maintain Patient Confidentiality per HIPAA Guidelines
Complies With Joint Commission, CMS, and Other Federal / State Regulations and Guidelines

Assessment*

Rows	Proficiency	Frequency
Normal Heart Tones (i.e., S1, S2)
Abnormal Heart Tones (i.e., Murmur, Friction Rub)
Blood Pressure (Non-Invasive)
Pulses / Circulation Via Palpation
Pulses / Circulation Via Doppler
Apply / Perform 12-Lead ECG
ECG Changes for MI
Rhythm Interpretation

Provision of Care for*

Rows	Proficiency	Frequency
Congenital Heart Disease and Defects
Heart Failure
Myocardial Infarction
Cardiac Arrest
Dysrhythmias
Aortic Aneurysm and Dissection
Kawasaki Disease
Blunt and Penetrating Cardiac Trauma
Pericarditis

Assist With and Set Up*

Rows	Proficiency	Frequency
Arterial Line Insertion
Central Line Insertion
PA Catheter / Swan-Ganz Insertion
Temporary Pacemaker Insertion
Cardioversion
Pericardiocentesis
Cardiac Pacing
Defibrillation
Automatic CPR Machine

Assessment*

Rows	Proficiency	Frequency
Auscultate Breath Sounds
Identify Adventitious Lung Sounds
Auscultate for Confirmation of ET Tube Placement
Application of BiPAP
Application of CPAP
Application of Oximetry
Interpretation of Oximetry Values
Application of Capnography Monitoring
Interpretation of Capnography Values

Provision of Care for*

Rows	Proficiency	Frequency
Respiratory Syncytial Virus (RSV)
Pneumonia
Reactive Airway Disease / Asthma
Status Asthmaticus
Malacia
Croup
Epiglottitis
Foreign Body Aspiration
Respiratory Failure
Cystic Fibrosis
Hemothorax
Pneumothorax
Blunt and Penetrating Chest Trauma
Stenosis
Tuberculosis
Near Drowning

Equipment & Procedures*

Rows	Proficiency	Frequency
Airway Management Devices / Suctioning
Assist With Intubation
Assist With Rapid Sequence Intubation (RSI)
Assist With Thoracentesis
Assist With Chest Tube Insertion
Care of the Patient on the Ventilator
Care of the Patient With a Chest Tube
Obtaining Arterial Blood Gas
Oxygen Therapy and Medication Delivery Systems
Pulse Oximetry
Capnography
Troubleshooting Ventilator Alarms

Assessment*

Rows	Proficiency	Frequency
Bowel Sounds
Nutritional Status
Proper NG Tube Placement

Provision of Care for*

Rows	Proficiency	Frequency
Abdominal Trauma
Intussusception
GI Bleed
Foreign Body
Pyloric Stenosis
Volvulus
Constipation
Inflammatory Bowel Disease
Appendicitis
Failure to Thrive
Fluid-Electrolyte Imbalance
Gastroesophageal Reflux Disease (GERD)

Procedures*

Rows	Proficiency	Frequency
Insertion and Maintenance of NG Tube
Removal of NG Tube
Saline Lavage
NG Tube to Suction

Assessment*

Rows	Proficiency	Frequency
S/S Diabetic Ketoacidosis (DKA)
S/S Hypoglycemia / Hyperglycemia

Provision of Care for*

Rows	Proficiency	Frequency
Diabetes Mellitus
DKA

Procedures*

Rows	Proficiency	Frequency
Fingerstick Blood Glucose
Implementation of Sliding Scale
Use of Insulin Pen

Assessment*

Rows	Proficiency	Frequency
Glasgow Coma Scale (GCS)
NIH Stroke Scale (NIHSS)
Reflex / Motor Deficits
Visual or Communication Deficits
Cranial Nerves
Pathologic Reflexes

Provision of Care for*

Rows	Proficiency	Frequency
Traumatic Brain Injury (TBI)
Cerebrovascular Accident (CVA)
VP Shunt
Seizures
Status Epilepticus
Headaches / Migraines
Encephalopathy
Spinal Cord Dysfunction
Increased Intracranial Pressure
Meningitis
Shunt Dysfunction
Hydrocephalus
Arteriovenous Malformation
Spinal Cord Injury
Aneurysm Precautions

Assist With*

Rows	Proficiency	Frequency
Lumbar Puncture
Spinal Precautions

Assessment*

Rows	Proficiency	Frequency
Cast / Splint Circulation Checks
Gait
Range of Motion

Provision of Care for*

Rows	Proficiency	Frequency
Ankle Brace
Ankle Splint
Cast
Knee Immobilizer
Pinned Fractures
Wrist Splint
Placement of Fiberglass Splint
Fracture / Dislocation Reductions
Pelvic Sheeting / Pelvic Binder

Assessment*

Rows	Proficiency	Frequency
Fluid Status
AV Fistula / Shunt

Provision of Care for*

Rows	Proficiency	Frequency
Renal Calculi
Pyelonephritis
Vaginal Bleeding
Acute Kidney Injury
Acute Renal Failure
Urinary Tract Infection (UTI)
Testicular Torsion
Sexually Transmitted Infections (STIs)
Insertion and Care of Male Foley Catheter
Insertion and Care of Female Foley Catheter
Urine Specimen Collection

Assessment of*

Rows	Proficiency	Frequency
Visual Acuity
Maxillofacial Injuries
Eye Injuries

Equipment & Procedures*

Rows	Proficiency	Frequency
Application of Eye Patch
Ear Irrigation
Eye Irrigation
Set Up of Fluorescent / Woods Lamp Exam
Morgan Lens Irrigation
Nasal Packing
Removal of Contact Lens

Age Specific Criteria*

Rows	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

Trauma / Shock

Infectious Diseases

Wound Management / Surgery

Pain Management

Obstetrics / Gynecology

Phlebotomy / IV Therapy / Invasive Procedures

Patient Advocacy

Patient Education

ED Pharmacology

Professional Practice

Cardiovascular

Pulmonary

Gastroenterology

Endocrine

Neurological

Orthopedics

Renal / Genitourinary

Maxillofacial / Ocular