CVPICU Skills Checklist

CVPICU 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

Cardiovascular*

	Proficiency	Frequency
Abnormal Heart Sounds / Murmurs
Hypovolemic Shock
EKG Monitoring
Capillary Refill
Pre and Post Cardiac Catheter
Vital Sign Monitoring
Congestive Heart Failure
Hemodynamic (PA-Swan-Ganz)
Auscultation (Rate, Rhythm)
Congenital Heart Defects and Disease
Cardiogenic Shock
Color
Pre and Post Cardiac Surgery

General*

	Proficiency	Frequency
Discharge
Pre-Operative Care / Prep
Electronic Medical Records
Postmortem Care
Reporting of Child Protective Agency
Advance Directives
Organ / Tissue Donation
Care of the Dying Pediatric Patient
Patient and Family Teaching
Admission
Intercession for the Parent of the Sick Child
Preoperative Teaching

Pulmonary*

	Proficiency	Frequency
Oxygenation Status
Chest Trauma
Intussusception
Tracheo-Esophageal Fistula
Pulse Oximetry
Airway Obstruction
Cystic Fibrosis
Near SIDS
Tuberculosis
Nasal Flaring
Bronchiolitis (RSV)
Foreign Body Aspiration
Status Asthmaticus
Entidal CO2
Adventitious Breath Sounds
Broncho-Pulmonary Dysplasia
Epiglottitis and Tonsillitis
Pneumonia
Apnea
Rate and Work of Breathing
Croup
Near Drowning
Tracheostomy
Interpretation of ABGs

Gastrointestinal*

	Proficiency	Frequency
Anorexia / Bulimia
Hepatic Failure
LFTs (Liver Function Test)
Bowel Sounds
Gastroenteritis / Severe Dehydration
Ingestions
Nutritional Status
GI Bleed
Pre / Post Abdominal Surgery
GI Assessment
Failure to Thrive
Inflammatory Bowel Disease
Serum Amylase
Colostomy / Illeostomy
Hepatitis
Serum Ammonia

Neurology*

	Proficiency	Frequency
Level of Consciousness
Excess Muscle Involvement
Acute Spinal Cord Injury
ICP Monitoring
Open and Closed Head Injury
Neurological Assessment
Attention Span
Color Changes
Halo Traction / Cervical Tongs
Overdose and Ingestion
Glasgow Coma Scale
Suicidal Ideation
Mirroring Movement
Febrile Seizure
Neuromuscular Disease
Status Epilepticus
Non-Accidental Trauma
Hyperkinesia's
Battered Child Syndrome
Internal and External Shunts
Seizure Precautions
Reflex / Motor Deficits
Language
Coma
Meningitis and Encephalitis
Spina Bifida

Musculoskeletal*

	Proficiency	Frequency
Pulse / Circulation Checks
Cast Care
Multiple Trauma / Fractures
Spica Casts
ROM
Crutch Walking
Muscular Dystrophy
Buck's Traction
Skeletal / Skin Traction
Amputation
Cervical Collars
Post Harrington Rod Insertion
Balanced Suspension Traction
External Fixation
Osteomyelitis

Immunology / Hematology / Oncology*

	Proficiency	Frequency
Acute Lymphocytic Leukemia
DIC
Spleen Trauma / Splenectomy
Blood Transfusions
Bone Marrow Transplant
Sepsis
Anaphylactic Shock
Dehydration
Hemophilia
Treatment Side Effects Chemo / Radiation
Acetaminophen Toxicity
Depressed Immune System
HIV / AIDS
Immunization Schedule
Cancer
Sickle Cell Anemia
Hematology

Wounds / Integument*

	Proficiency	Frequency
Skin Turgor
Skin Assessment
Burns
S/S Infection
Wounds / Incisions

Genitourinary*

	Proficiency	Frequency
Acute / Chronic Renal Failure
Nephrostomy Tube
BUN & Creatinine
Skin Turgor
Shunts & Fistulas
Measurement of I & O
Genitourinary Trauma
Urinary Tract Infection
Serum Electrolytes
Hemodialysis
Diaper Weights
Urinalysis
Assess Fluid Balance
Nephritis
Fluid Status

Endocrine*

	Proficiency	Frequency
DKA
Thyroid Studies
Pituitary Disorders (SAIDH, DI)
Juvenile Diabetes
Cushing's Syndrome
Thyroid Disorders
Insulin Shock
Blood Glucose

ENT / Plastics*

	Proficiency	Frequency
Cleft Lip / Palate
Craniofacial Reconstruction

General*

	Proficiency	Frequency
Amiodarone
Dobutamine (Dobutrex)
Valium
Aminophylline
Diltiazem (Cardizem)
Insulin Drip
Versed
Atropine
Diprivan (Propofol)
Levophed
Bicarbonate
Epinephrine (Adrenalin)
Verapamil (Calan, Isoptin, Verelan)
Ativan
Dopamine (Intropin)
Paralytics

Medications Administration*

	Proficiency	Frequency
Calculation of Pediatric Doses
Needleless Systems
Eye / Ear Meds
PO Medications
Bladder Irrigation and Instillation
Emergency Meds
NG Medications
IM & SQ Meds
Rectal Medications
Metered Dose Inhaler

IV Therapy*

	Proficiency	Frequency
Adverse Reactions
Butterfly
Insertion of Peripheral IV
Administer IV Drips
Fluid Resuscitation
PCA Pumps
Administer IV Medications
Heparin Locks
IV Insertion Scalp Vein
Infusion Pumps
Syringe Pumps
Assess / Maintain IV
Vascular Access Device - Care / Maintenance
Mix IV Infusion With Additives

Oxygen Administration*

	Proficiency	Frequency
Aerosol Treatments
Isolette
Venti Mask
CPAP / PEEP / IMV
Pressure Ventilator
Tracheostomy
ECMO
Non-Rebreather Mask
Volume Ventilator
Ambu-Bag
Nasal Cannula
Ventilation With Ambu Bag
Hood and Tent
Portable Oxygen

Nutritional Therapy*

	Proficiency	Frequency
Enteral Administration
TPN and Hyperalimentation
Assist With Bottle & Breast Feeding
Procalamine
PEG
NGT Insertion
Dobhoff Insertion
Tube Feeding Pumps

Pain Management*

	Proficiency	Frequency
Narcotic Analgesia
Epidural Anesthesia / Analgesia
Moderate Sedation
Assess Pain Level / Tolerance
Ramsey Scale
Patient Controlled Analgesia

Blood*

	Proficiency	Frequency
Albumin
Administer Blood / Blood Products

Specimen Collection*

	Proficiency	Frequency
Dextrostick
Venipuncture
Assist With Rape Exam
Stool
Butterfly Stick
Diaper A'spiration
Throat Swab
Scalp Vein
Sputum
Central Line Draw
Finger Stick
Cultures
Urine

General*

	Proficiency	Frequency
Chest Physical Therapy
Foley, Male
Infant & Child CPR
Suctioning (Oro-Naso-Pharynx)
Wound Vac
CPM Machine
Drains (JP-Hemovac-Penrose)
Iced Saline Lavage
Specialty Beds
Vaporizer
Doppler
Hyper / Hypothermia Blanket
Isolation
Trach Care and Suctioning
Dressing Changes
Insertion of NGT / Suction
Phototherapy
Use of Bulb Syringe
Chest Tube Drainage Systems
Foley, Female
Incentive Spirometry
Thermoregulators
Wound Care / Irrigations

Assist*

	Proficiency	Frequency
Chest Tube Insertion
Intraosseous Infusion
Bronchoscopy
Halo Traction / Cervical Tongs Placement
Central Line Insertion
ET Intubation and Extubation
Assist With Supra-Pubic Tap
Chest Tub Removal
IV Cutdown
Bedside Invasive Procedures
Emergency Tracheostomy
Lumbar Puncture

Clinical Settings*

	Proficiency	Frequency
Specialty PICU
General ICU

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. *

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