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Telemetry / Progressive 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
CARDIAC	1	2	3	4	1	2	3	4
Interpretation of Arrhythmias
Pacemakers-Permanent
Cardiac Arrest/CPR
Telemetry
Interpretation of Hemodynamic Monitoring
Art Line (Transducer setup-D/C)
Swan Ganz (Transducer setup-D/C)
Sheath Removal-Femoral
Care of Patient with
Aneurysm
Angina
CHF
Post MI
Pre/Post Cardiac Cath
Pre/Post Cardiac Surgery
Open Sternal Wound (Debridement)
Use & Administration of the Following
Atropine
Digoxin
Dopamine
Inderal
Lidocaine
Neosynephrine/Nipride
Nitroglycerin
Pronestyl
Quinidine
Titrate Morphine
Verapamil
Thrombolytic Agents
Preparation of Emergency Drugs
RESPIRATORY	1	2	3	4	1	2	3	4
Establishing an Airway
Ambuing Techniques
Chest Tubes (Emerson/Pleuravac)
Pulse Oximetry
Interpretation of ABG
Use of IPPB
Incentive Spirometer
Oral Suctioning
Nasotracheal Suctioning
Care of Patient with
COPD
ARDS
Pre/Post Thoracic Surgery
Pulmonary Embolism
Pulmonary Edema
Pneumothorax
Pneumonia
Inhalation Injuries
Emphysema
Asthma
Use & Administration of the Following
Aminophylline
Corticosteroids
Bronkosol
Ventolin
Alupent
NEUROLOGY	1	2	3	4	1	2	3	4
Assessment of Neuro Signs
Glascow Coma Scale
Seizure Precautions
Assist with Lumbar Puncture
Halo Traction
Care of Patient with
CVA
Seizure Activity
Overdose
Neuro Injury/Trauma
Head Injury/Trauma
Pre/Post Neuro Surgery
Cranial Hemorrhage
Multiple Sclerosis
Post-Op AV-Shunt
Use & Administration of the Following
Decadron
Dilantin
Magnesium Sulfate
Phenobarbital
Steroids
Valium
Versed
CARDIAC MONITORS	1	2	3	4	1	2	3	4
Hewlett-Packard
Spacelab
Siemens
Marquette
Mennen
Lifecare
Nihon-Koder
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)

	Experience				Frequency
VASCULAR	1	2	3	4	1	2	3	4
Peripheral Pulses
Fluid Overload
Ultrasonic Doppler
Starting IV's
Subcutaneous Central Line
Hickman/Broviac/Groshong Catheters
Maintenance of Heparin Lock
TPN/Hyperalimentation
Air Occlusive Dressing
Knowledge of Normal Serum Lab Values
Administration of Blood & Blood Products
Infusion Pumps
Peritoneal Dialysis
Hemodialysis
Heparin Drip (precautions & maintenance)
Sickle Cell Anemia
Thrombophlebitis
GASTROINTESTINAL	1	2	3	4	1	2	3	4
NG Tube Insertion
Gastrostomy Tube
Jejunostomy Tube
Enterostomal Care
Care of Patient with
Pancreatitis
G.I. Bleed
Esophageal Bleeding
Bowel Obstruction
Whipple Procedure
Liver Transplant
Paralytic Ileus
E.R.C.P.
GENITOURINARY/RENAL	1	2	3	4	1	2	3	4
Foley Catheter Insertion
GU Irrigations
Nephrostomy Tube
Suprapubic Tube
Electrolyte Imbalance/Replacement
Care of Patient with
T.U.R.P.
Shunts & Fistulas
Nephrectomy
Renal Transplant
Renal Trauma
Chronic/Acute Renal Failure
GYNECOLOGY	1	2	3	4	1	2	3	4
Endometriosis
GYN Exam/Pap
Self Breast Exam
Tubal Ligation
Ectopic Pregnancy
Mastectomy
Hysterectomy
Repair of Cystocele/Rectocele
ORTHOPEDIC	1	2	3	4	1	2	3	4
Total Joint Replacement
Arthroscopic Surgery
Bucks Extension
K-Wires/Steinman Pins
Removal of Hardware
Spica Cast/Body Cast
Cast Removal
Amputation
Skeletal Traction
Ortho Trauma
Laminectomy
Care of Patient with
Delirium Tremens
HIV Infection
AIDS
OTHER	0	1	2	3	0	1	2	3
Oncology
Chemotherapy
Isolation Techniques
Diabetic Teaching
Patient Teaching
Burn Patients
Accucheck
VENTILATORS	1	2	3	4	1	2	3	4
Bear I
Bear II
Bear IV
Bennett 7200
CPAP
Emerson
Engstrom/Erica
EMV
MA-I
MA-II
Monihan
Ohio 560
PEEP
Pressure Pre-Set
Servo 900b
Servo 900c
Servo 900e
Siemens

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.