LTAC RN Skills Checklist

LTAC RN 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

Assessment / Patient Care*

	Proficiency	Frequency
Collect Appropriate Data
Advance Directives
Electronic Medical Records
Collect Appropriate Data
Organ / Tissue Donation
Admission
Patient and Family Teaching

Neurology*

	Proficiency	Frequency
Level of Consciousness
Coma
Traumatic Brain Injury
Alzheimer's Disease
Spinal Cord Injury
Neuro Assessment
CVA / Stroke
Halo Traction / Cervical Tongs
Reflex / Motor Deficits
Neuromuscular Disease
Visual / Communication Deficits
Seizure Disorder

Gastrointestinal*

	Proficiency	Frequency
Abdominal Wounds
Hepatitis
GI Assessment
Liver Failure
Liver Function Tests
Bowel Obstruction
Pancreatitis
Serum Ammonia
Nutritional Status
Colostomy
Cancer
Bowel Sounds
GI / Esophageal Bleeding
Serum Amylase
Nephrostomy
Serum Electrolytes
Acute Renal Failure
Suprapubic Cath
BUN and Creatinine
End Stage Renal Failure
Fistula / Shunt

Cardiovascular*

	Proficiency	Frequency
Capillary Refill
Congestive Heart Failure
Arterial Line
Troponin
Abnormal Heart Sounds / Murmurs
Angina
AICD (Automatic Implanted Cardioverter / Defibrillator)
BNP (Brain Natriuretic Peptide)
Acute MI
Pacemaker
Cardiac Monitoring
Cardiac Arrest / CPR
Post Cardio-Thoracic Surgery
Coagulation Studies
Apical Pulse
Cardiomyopathy
CVP Monitoring
Cardiac Enzymes & Isoenzymes

Pulmonary*

	Proficiency	Frequency
Chest Tube
Pulmonary Edema
End Tidal CO2
Oxygenation Status
Pulmonary Embolism
ABGs
Adventitious Breath Sounds
COPD
Pulse Oximetry
Acute Pneumonia
Tracheostomy
Rate and Work of Breathing
Tuberculosis

Musculoskeletal*

	Proficiency	Frequency
Pulse / Circulation Checks
Amputation
Cast Care
Joint Replacement
Skeletal / Skin Traction

Immunology / Hematology / Oncology*

	Proficiency	Frequency
HIV / AIDS
Cancer
Treatment Side Effects Chemo / Radiation
Sepsis

Wounds / Integument*

	Proficiency	Frequency
Burns
Skin Breakdown
S/S Infection
Wounds
Staging of Pressure Ulcers
Surgical Wounds and Drains
Skin Assessment
Stasis Ulcers
Pressure Ulcers

Endocrine / Metabolic*

	Proficiency	Frequency
Blood Glucose
Hemoglobin A1C
Diabetes

Procedures / Equipment*

	Proficiency	Frequency
Drains (JP-Hemovac-Penrose)
Dressing Changes
Isolation
Central-Line Blood Draw
Venipuncture
Endotracheal Intubation
Suctioning (Oral-Naso-Pharnyx)
Wound Vac
Clean Catch Urine
Bedside Invasive Procedures
Procedural / Moderate Sedation
Doppler
Indwelling Urinary Catheter
Butterfly Stick
24 Hour Urine
Chest Tube Insertion
Chest Tube Drainage Systems
Tracheostomy Care / Suctioning
Finger Stick
Blood Cultures
Central Line Insertion
Wound Care / Irrigations
Urine Catheter Culture Collection
Bronchoscopy

Medication / Therapeutic Interventions*

	Proficiency	Frequency
Administer PO Medications
Administer Meds Per Feeding Tubes
Administer Blood / Blood Products
NGT / SBFT Insertion
Trach Collar
Patient Controlled Analgesia
Administer IVP Medications
Assess / Maintain IV
Tube Feeding Pumps
Venti Mask
Ventilator (IMV, AC, PEEP)
Administer IVPB Medications
Vascular Access Device -- Care / Maintenance
Enteral Feeding Administration
Nasal Cannula
Portable Oxygen
Functional Pain Goal
Administer IVPB Medications
Heparin Lock
TPN / Procalamine
PEG / G-Tube
Ambu-Bag
Epidural Analgesia
Administer IM and SQ Meds
Administer IV Drips and Titration
Peripheral IV Insertion
Bolus Tube Feedings
Non-Rebreather Mask
Assess Pain Level / Tolerance

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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