Pediatric Skills Checklist

Name*
First Last
Date*
Date Format: MM slash DD slash YYYY
Please use the following key:
1 = Done Frequently; well skilled
2 = Occasionally Done; moderately skilled
3 = Rarely Done; skill limited
4 = Observed only; never done
Blood / Blood Product Administration / Precautions*
- 1
- 2
- 3
- 4
Calculation of Rates*
- 1
- 2
- 3
- 4
Mcg / min*
- 1
- 2
- 3
- 4
Mcg / kg / min*
- 1
- 2
- 3
- 4
Mg / min*
- 1
- 2
- 3
- 4
Hang IV Piggyback*
- 1
- 2
- 3
- 4
Heparin Lock*
- 1
- 2
- 3
- 4
Hyperalimentation*
- 1
- 2
- 3
- 4
Peripheral / Central Line*
- 1
- 2
- 3
- 4
Knowledge of Solution*
- 1
- 2
- 3
- 4
Insertion of Central Line*
- 1
- 2
- 3
- 4
Use of Broviac / Hickman / Groshong Catheters*
- 1
- 2
- 3
- 4
Lab Assessment*
- 1
- 2
- 3
- 4
Implanted Venous Access Ports*
- 1
- 2
- 3
- 4
Dressing Changes*
- 1
- 2
- 3
- 4
Insertion of Peripheral Line*
- 1
- 2
- 3
- 4
Dressing Change*
- 1
- 2
- 3
- 4
D / C Line*
- 1
- 2
- 3
- 4
Universal Precautions*
- 1
- 2
- 3
- 4
Isolation Procedures*
- 1
- 2
- 3
- 4
Airborne Isolations*
- 1
- 2
- 3
- 4
Wound / Blood Isolations*
- 1
- 2
- 3
- 4
Specimen Collection*
- 1
- 2
- 3
- 4
Arterial Line Blood Draw*
- 1
- 2
- 3
- 4
Blood Culture*
- 1
- 2
- 3
- 4
Capillary Blood Draw*
- 1
- 2
- 3
- 4
Central Line Blood Draw*
- 1
- 2
- 3
- 4
PICC Line Blood Draw*
- 1
- 2
- 3
- 4
Sputum*
- 1
- 2
- 3
- 4
Stool*
- 1
- 2
- 3
- 4
Urine Culture*
- 1
- 2
- 3
- 4
Urinalysis*
- 1
- 2
- 3
- 4
Venipuncture*
- 1
- 2
- 3
- 4
Wound Culture*
- 1
- 2
- 3
- 4
Normal Anatomy of the Heart*
- 1
- 2
- 3
- 4
Left Side*
- 1
- 2
- 3
- 4
Right Side*
- 1
- 2
- 3
- 4
Resuscitation*
- 1
- 2
- 3
- 4
Team Member*
- 1
- 2
- 3
- 4
Perform Defibrillation*
- 1
- 2
- 3
- 4
Perform / Set Up Emergent Cardioversion*
- 1
- 2
- 3
- 4
Prepare and Administer Meds*
- 1
- 2
- 3
- 4
Set Up and Interpret 12 Lead EKG*
- 1
- 2
- 3
- 4
Administer Oxygen*
- 1
- 2
- 3
- 4
Use of Apnea Monitor*
- 1
- 2
- 3
- 4
Assess Lung Sounds*
- 1
- 2
- 3
- 4
Incentive Spirometer*
- 1
- 2
- 3
- 4
Nebulizer*
- 1
- 2
- 3
- 4
Normal Physiology of Pulmonary Vascular System*
- 1
- 2
- 3
- 4
Obtain Arterial Blood Gas*
- 1
- 2
- 3
- 4
Result Interpretation*
- 1
- 2
- 3
- 4
Pavulonized Patient*
- 1
- 2
- 3
- 4
Pulse Oximetry*
- 1
- 2
- 3
- 4
Suctioning*
- 1
- 2
- 3
- 4
Use of Emergency Equipment*
- 1
- 2
- 3
- 4
Insulin Preparation and Administration*
- 1
- 2
- 3
- 4
Blood Glucose Monitoring*
- 1
- 2
- 3
- 4
Equipment Used*
- 1
- 2
- 3
- 4
Jejunostomy Care*
- 1
- 2
- 3
- 4
NG Tube Insertion / Lavage*
- 1
- 2
- 3
- 4
Normal Physiology of Renal and GI System*
- 1
- 2
- 3
- 4
Ostomy / Stoma Care*
- 1
- 2
- 3
- 4
Peritoneal Lavage*
- 1
- 2
- 3
- 4
Poison Control*
- 1
- 2
- 3
- 4
Wound Care Irrigations*
- 1
- 2
- 3
- 4
Consent for Treatment of a Minor*
- 1
- 2
- 3
- 4
Procedure for Patient Signing AMA*
- 1
- 2
- 3
- 4
Disaster Protocols*
- 1
- 2
- 3
- 4
Assist with Peritoneal Lavage*
- 1
- 2
- 3
- 4
Misc. Trays / Instruments*
- 1
- 2
- 3
- 4
Pelvic Tray*
- 1
- 2
- 3
- 4
Cut Down Tray*
- 1
- 2
- 3
- 4
Procto Tray*
- 1
- 2
- 3
- 4
CVP Tray*
- 1
- 2
- 3
- 4
Culdocentesis Tray*
- 1
- 2
- 3
- 4
Thoracentesis Tray*
- 1
- 2
- 3
- 4
Pediatrics*
- 1
- 2
- 3
- 4
Administration of Medication*
- 1
- 2
- 3
- 4
Oral*
- 1
- 2
- 3
- 4
Subcutaneous*
- 1
- 2
- 3
- 4
Intramuscular*
- 1
- 2
- 3
- 4
Pediatric Nursing*
- 1
- 2
- 3
- 4
Anorexic Patient Care*
- 1
- 2
- 3
- 4
Assist with Lumbar Puncture*
- 1
- 2
- 3
- 4
Respiratory Distress Syndrome*
- 1
- 2
- 3
- 4
Broncho-pulmonary Dysplasia*
- 1
- 2
- 3
- 4
Croup*
- 1
- 2
- 3
- 4
Epiglottitis*
- 1
- 2
- 3
- 4
Asthma*
- 1
- 2
- 3
- 4
Cystic Fibrosis*
- 1
- 2
- 3
- 4
Pneumonia*
- 1
- 2
- 3
- 4
Near Drowning*
- 1
- 2
- 3
- 4
Near SIDS*
- 1
- 2
- 3
- 4
Chest Tubes*
- 1
- 2
- 3
- 4
Reye's Syndrome*
- 1
- 2
- 3
- 4
Meningitis*
- 1
- 2
- 3
- 4
Hydrocephalus*
- 1
- 2
- 3
- 4
Spina Bifida*
- 1
- 2
- 3
- 4
Lead Play Therapy*
- 1
- 2
- 3
- 4
Care of the Child with Seizures*
- 1
- 2
- 3
- 4
Sickle Cell*
- 1
- 2
- 3
- 4
Equipment*
- 1
- 2
- 3
- 4
Apnea Monitor*
- 1
- 2
- 3
- 4
Cardiac Monitor*
- 1
- 2
- 3
- 4
Ventilator*
- 1
- 2
- 3
- 4
ECMO*
- 1
- 2
- 3
- 4
Care of the Child with*
- 1
- 2
- 3
- 4
Child Abuse*
- 1
- 2
- 3
- 4
Failure to Thrive*
- 1
- 2
- 3
- 4
Cleft Palate*
- 1
- 2
- 3
- 4
Post Tonsillectomy*
- 1
- 2
- 3
- 4
Dying Infant / Child*
- 1
- 2
- 3
- 4
Diabetes Mellitus*
- 1
- 2
- 3
- 4
Psych Patients*
- 1
- 2
- 3
- 4

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