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Neonatal Intensive Care Skills Checklist

Name
Phone Number
Email Address

Please rate your experience / frequency (within the last year) using the following scale
(check the appropriate boxes below):

1 - No Experience / Theory Only
2 - Limited Experience / Need Review
3 - Frequent Experience / May Need Some Review
4 - Experienced / Perform Well

1 - Observed Only / Never Done
2 - Rarely Done (<6 times/year)
3 - Occasionally Done (1 - 2 times/month)
4 - Frequently Done (daily or weekly)

	Experience				Frequency
CARDIOVASCULAR	1	2	3	4	1	2	3	4
Assessment
Auscultation (rate, rhythym, volume)
Blood pressure/invasive (arterial line)
Blood Pressure/non-invasive
Heart Sounds/Murmurs
Perfusion
Pulses
Equipment & Procedures
EKG Interpretation
Defibrillation/Cardioversion
Invasive hemodynamic monitoring
Central venous pressure
Care of the Neonate with
Cardiac Arrest
Cardiac Transplant
Cardiomyopathy
Congenital Heart Disease/Defects
Hemodynamic instability
Hypovolemic Shock
Post cardiac Surgery
Post Inteventional Cardiac Cath
Medications
Dobutamine
Dopamine
Epinephrine
Nipride
Sodium Bicarbonate
PULMONARY	1	2	3	4	1	2	3	4
Assessment
Breath Sounds
Rate and work of breathing
Interpretation of Lab Results
Blood gases
Interpretation of X-Ray results
Equipment & Procedures
Airway Management
Assist with Intubation
Bulb Syringe
CPAP (nasal prongs)
Endotracheal Tube Suctioning
In-Line Suction
Open ET catheter suction
Extubation
Intubation
Nasal airway/suctioning
Oral airway/suctioning
Tracheostomy/suctioning
Apnea Monitor
Cardiac Resuscitation
Chest Tube (assist with)
Insertion
Removal
Set-up
ECMO (Extracorporeal Membrane Oxygenation)
O2 Therapy Delivery Systems
Bag (anesthesia) & mask
Bag (self-inflating) & mask
Nasal cannula
Nebulizer
Oxyhood
Tent
Trach collar
Obtaining Blood Gases
Arterial
Heelstick
Peripheral
Umbilical Line
Thoracentesis
Use of artificial surfactant
Ventilator Care
CPAP/PEEP
High frequency jet ventilator
Home ventilator
IMV
Oscillating
Pressure ventilator
Volume ventilator
Weaning
Care of Neonate with
Bronchopulmonary dysplasia (BPD)
Cardiogenic/hypovolemic shock
Diaphragmatic hernia
Fresh tracheostomy
Meconium aspiration
Persistent pulmonary hypertension (PPHN)
Pneumothorax
Respiratory distress syndrome (RDS)
Respiratory failure
Medications
Aminophylline
Prostaglandin
NEUROLOGICAL	1	2	3	4	1	2	3	4
Assessment
Intracranial pressure monitoring
Neurological status
Care of Neonate with
Brain death/organ procurement
Externalized VP shunt/reservoirs
Increased intracranial pressure
Meningitis
Seizures
Medication-Anticonvulsant medication
GASTROINTESTINAL	1	2	3	4	1	2	3	4
Assessment
Abdominal girth
Bowel sounds
Palate
Suck/Swallow
Equipment & Procedures
Care of gastrostomy tube
Feedings
Assist with breast feeding
Bottle
Breast milk handling/storage
Gavage
Hospital grade electric breast pump
Placement of intestinal tubes
Jejunal/gastro
Nasogastric/orogastric
Test for occult blood
Care of Neonate with
Cleft palate
Colostomy/ileostomy
Gastroschesis/omphalocele
GI bleeding
Inguinal hernia
Necrotizing enterocolitis (NEC)
Post abdominal surgery
Reflux precautions
Tracheoesophageal fistula (TEF)

	Experience				Frequency
ENDOCRINE/METABOLIC	1	2	3	4	1	2	3	4
Assessment
Finnegan
Fluid & electrolyte balance
Interpretation of Lab Results
Bilirubin
Test Urine and Interpret
Glucose
Labstix
Occult Blood
pH
Specific gravity
Equipment & Procedures
Collection of urine specimens
Assist with suprapubic tab
Catheter
Diaper/bag
Phototherapy for jaundice
Post circumcision care
Care of Neonate with
Acute renal failure
DIC (disseminated intravascular coagulation)
Disorders of internal/external organs
Drug addiction/withdrawal
Hypo/hyperkalemia
Hypo/hypernatremia
IDM (infant of diabetic mother)
Hyperglycemia
Hypoglycemia
Malformations of the GU tract, kidney
Peritoneal dialysis
INFECTIOUS DISEASES	1	2	3	4	1	2	3	4
Interpretation of Lab Results
CBC/differential
Culture reports
Maternal lab results
Equipment & Procedures
Assist with lumbar puncture
Collect culture specimens
Isolation techniques
Standard (universal) precautions
Care of Neonate with
Hepatitis surface antigen+ mother
HIV positive mother
Neonatal sepsis
Medications - Immunizations
HBIG
HBV
HIB
Polio
DPT
RespiGam/synagis prophylaxis
PHLEBOTOMY/IV THERAPY	1	2	3	4	1	2	3	4
Equipment & Procedures
Administration of blood/blood products
Cryoprecipitate
Packed red blood cells
Plasma/albumin
Whole blood
Delivery Systems
IV pump
Syringe pump
Drawing blood from central line
Drawing venous blood
Hyperalimentation/TPN/PPN
Intralipid
Managing IV Therapy
Discontinuing
Dressing & tubing change
Rate Calculation
Site & patency assessment
Starting IV's
Angiocath
Butterfly
Heparin/Saline lock
Care of the Neonate with
Central Line/Catheter/Dressing
Broviac
Groshong
Hickman
Port-A-Cath
Quinton
Percutaneous arterial line
Percutaneous venous line
Peripheral line/dressing
PICC (peripherally inserted central catheter)
Umbilical artery line
Umbilical venous line
PAIN MANAGEMENT	1	2	3	4	1	2	3	4
Assessment of pain level
Care of Neonate with sedation
MISCELLANEOUS	1	2	3	4	1	2	3	4
Assessment
Apgar scoring
Eye exam (r/o retinopathy)
Gestational Age
Ballard
Dubowitz
Maternal history
Screen for hearing loss
Equipment & Procedures
Bereavement/postmortem care
Consents
Immunization
Procedural
Treatment
Cord care
Neonatal skin care
Positioning Devices
Preparation for transport/transfer
Thermoregulation
Isolette with humidity
Radiant warmer
Temperature (auxillary,rectal,skin)
Weaning to open crib/bassinet
Weights
Bed scale
Scale
Medications
Calculation of dosage
Emergency drug action & reaction
Eye Prophylaxis - Vitamin K
Neonatal drug action & reactions
AGE SPECIFIC COMPETENCY	1	2	3	4	1	2	3	4
Newborn/Neonate (birth - 30 days)
Infant (30 days - 1 year)
Toddler (1 - 3 years)
Preschooler (3 - 5 years)
School Age Children (5 - 12 years)
Adolescents (12 - 18 years)
Young Adults (18 - 39 years)
Middle Adults (39 years to 64 years)
Older Adults (64 years to 79 years)
Elderly Adults (over 79+ years)

I attest that the information I have given is true and accurate to the best of my knowledge and that I am the indivdual completing this form. I hereby authorize Texas Select Staffing to release this Skills Checklist to its client facilities for consideration of employment as a contractor at those facilities.