Operating Room

Operating Room Skills Checklist

Answer Key:

1. No Experience 2. Limited Experience 3. Experienced 4. Very Experienced

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)

Work Settings

Rows	1	2	3	4
General OR
CVOR
Outpatient
Trauma
Peds-General OR
Peds-CVOR
First Assist
Scrub Experience
Robots / Da Vinci

General Surgery: CIRCULATE

Rows	1	2	3	4
Appendectomy
Breast Biopsy
Cholecystectomy
Abdominal-Perineal Resection
Bowel/Colon Resection
Hernia Repair
Thyroidectomy
Splenectomy
Vein Stripping
Radical Mastectomy
Tracheostomy
Gastrectomy
Hickman/Groshong/Portacath Insertion
Cholecystectomy
Hernia Repair
Bowel
Nissen
Bariatric

General Surgery: SCRUB

Rows	1	2	3	4
Appendectomy
Breast Biopsy
Cholecystectomy
Abdominal-Perineal Resection
Bowel/Colon Resection
Hernia Repair
Thyroidectomy
Splenectomy
Vein Stripping
Radical Mastectomy
Tracheostomy
Gastrectomy
Hickman/Groshong/Portacath Insertion
Cholecystectomy
Hernia Repair
Bowel
Nissen
Bariatric

Thoracic/CV: CIRCULATE

Rows	1	2	3	4
Abdominal Aortic Aneurysm
Aortic-Femoral Bypass Graft
AV Shunt/Graft
Carotid Endarterectomy
Lobectomy
Mediastinoscopy
Thoracoscopy
Thoracotomy

Thoracic/CV: SCRUB

Rows	1	2	3	4
Abdominal Aortic Aneurysm
Aortic-Femoral Bypass Graft
AV Shunt/Graft
Carotid Endarterectomy
Lobectomy
Mediastinoscopy
Thoracoscopy
Thoracotomy

Orthopedic/Podiatry: CIRCULATE

Rows	1	2	3	4
Knee Arthroscopy
ACL Repair
Shoulder Arthroscopy
Endoscopic Shoulder Repair
Open Shoulder Repair
Total Knee Replacement/Revision
Total Hip Replacement/Revision
Bipolar Hip Replacement
Hip Compression Nails and Lag Screw
Hand Surgery
External Fixation Devices
IM Roddings
Bunionectomy
Spinal Fusion With Instrumentation
Harrington Rod Insertion
Carpal Tunnel Repair
Chick Fracture Table
ORIF With Compression Set
Closed Reduction Fracture

Orthopedic/Podiatry: SCRUB

Rows	1	2	3	4
Knee Arthroscopy
ACL Repair
Shoulder Arthroscopy
Endoscopic Shoulder Repair
Open Shoulder Repair
Total Knee Replacement/Revision
Total Hip Replacement/Revision
Bipolar Hip Replacement
Hip Compression Nails and Lag Screw
Hand Surgery
External Fixation Devices
IM Roddings
Bunionectomy
Spinal Fusion With Instrumentation
Harrington Rod Insertion
Carpal Tunnel Repair
Chick Fracture Table
ORIF With Compression Set
Closed Reduction Fracture

Neurosurgery: CIRCULATE

Rows	1	2	3	4
Cervical Laminectomy (Anterior)
Cervical Laminectomy (Posterior)
Lumbar Laminectomy
VP Shunt (Ventricualr-Peitoneal)
Craniotomy
Burr Holes (Sub-Dural Hematoma)

Neurosurgery: SCRUB

Rows	1	2	3	4
Cervical Laminectomy (Anterior)
Cervical Laminectomy (Posterior)
Lumbar Laminectomy
VP Shunt (Ventricualr-Peitoneal)
Craniotomy
Burr Holes (Sub-Dural Hematoma)

Plastic/Reconstructive Surgery: CIRCULATE

Rows	1	2	3	4
Abdominoplasty
Facelift
Skin Grafts
Breast Reconstruction
Breast Augmentation
Breast Reduction
Rhinoplasty
Cleft Palate Repair
Liposuction
Blepharoplasty
Tissue Expanders

Plastic/Reconstructive Surgery: SCRUB

Rows	1	2	3	4
Abdominoplasty
Facelift
Skin Grafts
Breast Reconstruction
Breast Augmentation
Breast Reduction
Rhinoplasty
Cleft Palate Repair
Liposuction
Blepharoplasty
Tissue Expanders

Opthalmology: CIRCULATE

Rows	1	2	3	4
Cataract Extraction with IOL
Corneal Transplant
Dacryocystectomy
Phaco Emulsification
Orbital Implant
Enucleation
Vitrectomy
Scleral Buckle
Muscle Procedures

Opthalmology: SCRUB

Rows	1	2	3	4
Cataract Extraction with IOL
Corneal Transplant
Dacryocystectomy
Phaco Emulsification
Orbital Implant
Enucleation
Vitrectomy
Scleral Buckle
Muscle Procedures

ENT/Oral Surgery: CIRCULATE

Rows	1	2	3	4
Bronchoscopy
T&A
Myringotomy
Stapedectomy
Tympanoplasty
Sinus Endoscopy
Septoplasty
Parotidectomy
TMJ
Jaw Fractures
Mini AO Compression

ENT/Oral Surgery: SCRUB

Rows	1	2	3	4
Bronchoscopy
T&A
Myringotomy
Stapedectomy
Tympanoplasty
Sinus Endoscopy
Septoplasty
Parotidectomy
TMJ
Jaw Fractures
Mini AO Compression

Urology and Cysto: CIRCULATE

Rows	1	2	3	4
Nephrectomy
Prostatectomy
Vasectomy
Cystectomy
Penile Prosthesis
TURP
Cystoscopy/Ureteroscopy
Lithotripsy
Hypospadias Repair
Orchiopexy

Urology and Cysto: SCRUB

Rows	1	2	3	4
Nephrectomy
Prostatectomy
Vasectomy
Cystectomy
Penile Prosthesis
TURP
Cystoscopy/Ureteroscopy
Lithotripsy
Hypospadias Repair
Orchiopexy

GYN Surgery: CIRCULATE

Rows	1	2	3	4
AP Repair (Anterior and Posterior)
D&C
LEEP (Loop Electrode Excision Repair)
Abdominal Hysterectomy
Vaginal Hysterectomy
Laparoscopy
Laparoscopic Tubal Ligation
Laser Vaporization Condyloma
MMK (Marshall Marchetti Krantz)
Tubal Ligation
Hysteroscopy

GYN Surgery: SCRUB

Rows	1	2	3	4
AP Repair (Anterior and Posterior)
D&C
LEEP (Loop Electrode Excision Repair)
Abdominal Hysterectomy
Vaginal Hysterectomy
Laparoscopy
Laparoscopic Tubal Ligation
Laser Vaporization Condyloma
MMK (Marshall Marchetti Krantz)
Tubal Ligation
Hysteroscopy

Pediatrics: CIRCULATE

Rows	1	2	3	4
Exploratory Laparotomy
Otoplasty
Circumcision
Hypospadias Repair
Herniorrhaphy
Cleft lip/Palate

Pediatrics: SCRUB

Rows	1	2	3	4
Exploratory Laparotomy
Otoplasty
Circumcision
Hypospadias Repair
Herniorrhaphy
Cleft lip/Palate

Open Heart: CIRCULATE

Rows	1	2	3	4
CABG
ASD(Atrial Septal Defect)
VSD (Ventral Septal Defect)
Mitral or Aortic Valve Replacement
Tetrology of Fallot
Emergent Bring Back Heart

Open Heart: SCRUB

Rows	1	2	3	4
CABG
ASD(Atrial Septal Defect)
VSD (Ventral Septal Defect)
Mitral or Aortic Valve Replacement
Tetrology of Fallot
Emergent Bring Back Heart

Transplants: CIRCULATE

Rows	1	2	3	4
Kidney Transplant Recipient
Kidney Transplant Donor
Heart Transplant
Liver Transplant
Lung Transplant
Multi-Organ (Harvest)

Transplants: SCRUB

Rows	1	2	3	4
Kidney Transplant Recipient
Kidney Transplant Donor
Heart Transplant
Liver Transplant
Lung Transplant
Multi-Organ (Harvest)

Rows	1	2	3	4
Argon Beam Coagulator
Brown Dermatome
Crainotome
Cry-Ophthalmic Unit
Fragmatomore
Leg Holder
Neoprobe
Pena Stimulator
Sternal Saw
Vac-Pac Positioner/Bean Bag
Wilson Frame
Brainlab Navigation
Chick Table
Emerson Thoracic Pump
Eye Magnet
Laser
Midas Rex
Nitrous Oxide Bank
Spy Fluorescence Machine
Sterrad Machine
Vacuum Curettage
Zimmer Dermatome

Rows	1	2	3	4
Bair Hugger
Candy Cane Stirrups
Cryomachine
Extremity Microscope
Image Intensifier
Microscopic Instruments
Nerve Stimulator
Pneumatic Tourniquet
Sterilizer
Ultrasonic Cleaner
Water Pik
Allen Stirrups
Bipolar Cautery
Cell Saver
Electrosurgical Unit
Fracture Tables
Gardner-Wells Tongs
Mayfield Headrest
Ohio Suction Units
Stealth Navigation
Stryker Drills
Washer Sanitizer

Rows	1	2	3	4
Donning of Surgical Attire
Aseptic Technique
Procedure Set Up
Hemodynamic Monitoring During Anesthesia
Sponge & Lap Counts
Airway Maintenance
Patient Charge Capture Systems
Patient Prep

IV Therapy

Rows	1	2	3	4
Assist with IA/IV Therapy
PIV Insertion
Admin Blood/Blood Products
Central Vascular Access Device
Care/Maintenance

Pain Management/Anesthesia

Rows	1	2	3	4
General Anesthesia
Positioning Patients for Anesthesia
Epidural Anesthesia/Analgesia
Spinal
Moderate Sedation
Assess Pain Level/Tolerance
Regional Anesthesia
Malignant Hyperthermia
Anesthesia Toxicity
Signs & Symptoms of Dural Puncture

Oxygen Administration

Rows	1	2	3	4
Nasal Cannula
Trach Collar
Non-Rebreather Mask
Ventilator
Ambu-Bag
Tracheostomy
Portable Oxygen
Venturi Masks

I attest that this checklist represents a true reflection of my experience to the best of my knowledge. By electronically signing this form I give my permission for it to be shared with facilities as a way to assess my skill level and be considered for employment opportunities.

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Case Experience

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Procedures

Medications & Therapeutic Interventions