Long Term Care Skills Checklist
Answer Key
1. No Experience 2. Requires Supervision 3. Proficient 4. Can Teach Others
Type of Facility Experience
*
Rows
1
2
3
Any thoughts?
Nursing Home
Assisted Living
Skilled Nursing Facility (SNF)
Continuing Care Retirement Community
General Skills
*
Rows
1
2
3
4
Standard Precautions
Isolation Precautions
Pain Management
Care of Patient in Restraints
Peripheral IV Insertion, Care and Maintenance
Access/Management of Implanted Ports
Access/Management of Central Lines (CVL, Hickman, Broviac, etc.)
Patient/Family Education
Knowledge of "Do Not Use Abbreviations"
Knowledge of current Joint Commission National Patient Safety Goals
Knowledge/familiarity with HCAHPS scores
Medication Use
*
Rows
1
2
3
4
Pouring From Stock Medications
Narcotic Administration
IV Push/Drip Medications
Antibiotics
Oral
Topical
Otic
Rectal
Vaginal
Ophthalmic
Continuous Subcutaneous Infusion Pumps
Total Parenteral Nutrition (TPN)
Peripheral Parenteral Nutrition
Patient Controlled Analgesia (PCA)
Phlebotomy / IV Therapy
*
Rows
1
2
3
4
Blood Draw-Peripheral
Mixing IVs
Regulating IVs
IV Infusion Pumps
Blood/Blood Product Administration
Respiratory
*
Rows
1
2
3
4
Emphysema
COPD
Asthma Exacerbation
Tracheostomy
Pneumonia
Pre/Post Thoracic Surgery
Chest Tubes
Collection of Sputum Specimen
O2 Cannulas/Masks
Non-rebreather Mask
Nebulizer Set-up/Use
Incentive Spirometry
Chest PT
Suctioning (Oral/Nasotracheal)
Suctioning (Tracheostomy Tube)
Ventilator Patient (Mouth Care, Suctioning, Ambu bag)
Bronchodilators (Oral, IV, Inhaler)
Steroids
Neuro
*
Rows
1
2
3
4
Spinal Cord Injury - Acute
Spinal Cord Injury - Long Term
CVA Stroke
Neuromuscular Disease
Alzheimer Disease
Wandering
Hallucinations
Anxiousness
Agitation
Reality Orientation
Assessing Levels of Consciousness
Pupil Checks
Seizure Precautions
Stroke Precautions
Swallow Precautions
Assisting with Lumbar Puncture
Use of Hyper/Hypothermia Blanket
Dentures
Hearing Aid Devices
Care of Patients with Hearing Loss
Prosthetic Eye
Contact Lens Care
Cataracts
Blindness
Macular Degeneration
Anticonvulsant
Sedative
Wound / Skin Care
*
Rows
1
2
3
4
Acute Dressing Changes
Wound Care
Irrigations
Identifying Common Skin Problems
Recognizing Normal Skin Changes
Use of Special Pressure Relief Devices
Pressure Relief Mattress/Seat Cushion
Hemovacs
Jackson-Pratt Tubes
enrose Drains
T-Tubes
Age Specific
*
Rows
1
2
3
4
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)
Undertaking
*
The Information I Provided is True & Accurate
Name
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: