Telemetry / Progressive Care Skill Checklist

Name*
First Last
Email*
Phone*
Proficiency:
1 = Minimal Experience
2 = Limited Experience
3 = Competent
4 = Highly Skilled
Cardiac
Interpretation of Arrhythmias*
- 1
- 2
- 3
- 4
Pacemakers-Permanent*
- 1
- 2
- 3
- 4
Cardiac Arrest / CPR*
- 1
- 2
- 3
- 4
Telemetry*
- 1
- 2
- 3
- 4
Interpretation of Hemodynamic Monitoring*
- 1
- 2
- 3
- 4
Art Line (Transducer Setup-D/C)*
- 1
- 2
- 3
- 4
Swan Ganz (Transducer Setup-D/C)*
- 1
- 2
- 3
- 4
Sheath Removal-Femoral*
- 1
- 2
- 3
- 4
Aneurysm*
- 1
- 2
- 3
- 4
Angina*
- 1
- 2
- 3
- 4
CHF*
- 1
- 2
- 3
- 4
Post MI*
- 1
- 2
- 3
- 4
Pre / Post Cardiac Cath*
- 1
- 2
- 3
- 4
Pre / Post Cardiac Surgery*
- 1
- 2
- 3
- 4
Open Sternal Wounds (Debridement)*
- 1
- 2
- 3
- 4
Use & Administration of the Following*
- 1
- 2
- 3
- 4
Atropine*
- 1
- 2
- 3
- 4
Digoxin*
- 1
- 2
- 3
- 4
Dopamine*
- 1
- 2
- 3
- 4
Inderal*
- 1
- 2
- 3
- 4
Lidocaine*
- 1
- 2
- 3
- 4
Neosynephrine / Nipride*
- 1
- 2
- 3
- 4
Nitroglycerin*
- 1
- 2
- 3
- 4
Pronestyl*
- 1
- 2
- 3
- 4
Quinidine*
- 1
- 2
- 3
- 4
Titrate Morphine*
- 1
- 2
- 3
- 4
Verapamil*
- 1
- 2
- 3
- 4
Thrombolytic Agents*
- 1
- 2
- 3
- 4
Preparation of Emergency Drugs*
- 1
- 2
- 3
- 4
Respiratory
Establishing an Airway*
- 1
- 2
- 3
- 4
Ambuing Techniques*
- 1
- 2
- 3
- 4
Chest Tubes (Emerson / Pleur-evac)*
- 1
- 2
- 3
- 4
Pulse Oximetry*
- 1
- 2
- 3
- 4
Interpretation of ABG*
- 1
- 2
- 3
- 4
Use of IPPB*
- 1
- 2
- 3
- 4
Incentive Spirometer*
- 1
- 2
- 3
- 4
Oral Suctioning*
- 1
- 2
- 3
- 4
Nasotracheal Suctioning*
- 1
- 2
- 3
- 4
COPD*
- 1
- 2
- 3
- 4
ARDS*
- 1
- 2
- 3
- 4
Pre / Post Thoracic Surgery*
- 1
- 2
- 3
- 4
Pulmonary Embolism*
- 1
- 2
- 3
- 4
Pulmonary Edema*
- 1
- 2
- 3
- 4
Pneumothorax*
- 1
- 2
- 3
- 4
Pneumonia*
- 1
- 2
- 3
- 4
Inhalation Injuries*
- 1
- 2
- 3
- 4
Emphysema*
- 1
- 2
- 3
- 4
Asthma*
- 1
- 2
- 3
- 4
Aminophylline*
- 1
- 2
- 3
- 4
Corticosteroids*
- 1
- 2
- 3
- 4
Bronkosol*
- 1
- 2
- 3
- 4
Ventolin*
- 1
- 2
- 3
- 4
Alupent*
- 1
- 2
- 3
- 4
Neurology
Assessment of Neuro Signs*
- 1
- 2
- 3
- 4
Glasgow Coma Scale*
- 1
- 2
- 3
- 4
Seizure Precautions*
- 1
- 2
- 3
- 4
Assist with Lumbar Puncture*
- 1
- 2
- 3
- 4
Halo Traction*
- 1
- 2
- 3
- 4
CVA*
- 1
- 2
- 3
- 4
Seizure Activity*
- 1
- 2
- 3
- 4
Overdose*
- 1
- 2
- 3
- 4
Neuro Injury / Trauma*
- 1
- 2
- 3
- 4
Head Injury / Trauma*
- 1
- 2
- 3
- 4
Pre / Post Neuro Surgery*
- 1
- 2
- 3
- 4
Cranial Hemorrhage*
- 1
- 2
- 3
- 4
Multiple Sclerosis*
- 1
- 2
- 3
- 4
Post-Op AV-Shunt*
- 1
- 2
- 3
- 4
Decadron*
- 1
- 2
- 3
- 4
Dilantin*
- 1
- 2
- 3
- 4
Magnesium Sulfate*
- 1
- 2
- 3
- 4
Phenobarbital*
- 1
- 2
- 3
- 4
Steroids*
- 1
- 2
- 3
- 4
Valium*
- 1
- 2
- 3
- 4
Versed*
- 1
- 2
- 3
- 4
Cardiac Monitors
Hewlett-Packard*
- 1
- 2
- 3
- 4
Spacelab*
- 1
- 2
- 3
- 4
Siemens*
- 1
- 2
- 3
- 4
Marquette*
- 1
- 2
- 3
- 4
Mennen*
- 1
- 2
- 3
- 4
Lifecare*
- 1
- 2
- 3
- 4
Nihon Koder*
- 1
- 2
- 3
- 4
Vascular
Peripheral Pulses*
- 1
- 2
- 3
- 4
Fluid Overload*
- 1
- 2
- 3
- 4
Ultrasonic Doppler*
- 1
- 2
- 3
- 4
Starting IV's*
- 1
- 2
- 3
- 4
Subcutaneous Central Line*
- 1
- 2
- 3
- 4
Hickman / Broviac / Groshong Catheters*
- 1
- 2
- 3
- 4
Maintenance of Heparin Lock*
- 1
- 2
- 3
- 4
TPN / Hyperalimentation*
- 1
- 2
- 3
- 4
Air Occlusive Dressing*
- 1
- 2
- 3
- 4
Knowledge of Normal Serum Lab Values*
- 1
- 2
- 3
- 4
Administration of Blood & Blood Products*
- 1
- 2
- 3
- 4
Infusion Pumps*
- 1
- 2
- 3
- 4
Peritoneal Dialysis*
- 1
- 2
- 3
- 4
Hemodialysis*
- 1
- 2
- 3
- 4
Heparin Drip (Precautions & Maintenance)*
- 1
- 2
- 3
- 4
Sickle Cell Anemia*
- 1
- 2
- 3
- 4
Thrombophlebitis*
- 1
- 2
- 3
- 4
Gastrointestinal
NG Tube Insertion*
- 1
- 2
- 3
- 4
Gastrostomy Tube*
- 1
- 2
- 3
- 4
Jejunostomy Tube*
- 1
- 2
- 3
- 4
Enterostomal Care*
- 1
- 2
- 3
- 4
Pancreatitis*
- 1
- 2
- 3
- 4
G.I. Bleed*
- 1
- 2
- 3
- 4
Esophageal Bleeding*
- 1
- 2
- 3
- 4
Bowel Obstruction*
- 1
- 2
- 3
- 4
Whipple Procedure*
- 1
- 2
- 3
- 4
Liver Transplant*
- 1
- 2
- 3
- 4
Paralytic Ileus*
- 1
- 2
- 3
- 4
E.R.C.P.*
- 1
- 2
- 3
- 4
Genitourinary / Renal
Foley Catheter Insertion*
- 1
- 2
- 3
- 4
GU Irrigations*
- 1
- 2
- 3
- 4
Nephrostomy Tube*
- 1
- 2
- 3
- 4
Suprapubic Tube*
- 1
- 2
- 3
- 4
Electrolyte Imbalance / Replacement*
- 1
- 2
- 3
- 4
T.U.R.P.*
- 1
- 2
- 3
- 4
Shunts & Fistulas*
- 1
- 2
- 3
- 4
Nephrectomy*
- 1
- 2
- 3
- 4
Renal Transplant*
- 1
- 2
- 3
- 4
Renal Trauma*
- 1
- 2
- 3
- 4
Chronic / Acute Renal Failure*
- 1
- 2
- 3
- 4
Gynecology
GYN Exam / Pap*
- 1
- 2
- 3
- 4
Self Breast Exam*
- 1
- 2
- 3
- 4
Tubal Ligation*
- 1
- 2
- 3
- 4
Ectopic Pregnancy*
- 1
- 2
- 3
- 4
Mastectomy*
- 1
- 2
- 3
- 4
Hysterectomy*
- 1
- 2
- 3
- 4
Repair of Cystocele / Rectocele*
- 1
- 2
- 3
- 4
Orthopedic
Total Joint Replacement*
- 1
- 2
- 3
- 4
Arthroscopic Surgery*
- 1
- 2
- 3
- 4
Bucks Extension*
- 1
- 2
- 3
- 4
K-Wires / Steinmann Pins*
- 1
- 2
- 3
- 4
Removal of Hardware*
- 1
- 2
- 3
- 4
Spica Cast / Body Cast*
- 1
- 2
- 3
- 4
Cast Removal*
- 1
- 2
- 3
- 4
Amputation*
- 1
- 2
- 3
- 4
Skeletal Traction*
- 1
- 2
- 3
- 4
Ortho Trauma*
- 1
- 2
- 3
- 4
Laminectomy*
- 1
- 2
- 3
- 4
Delirium Tremens*
- 1
- 2
- 3
- 4
HIV Infection*
- 1
- 2
- 3
- 4
AIDS*
- 1
- 2
- 3
- 4
Oncology*
- 1
- 2
- 3
- 4
Chemotherapy*
- 1
- 2
- 3
- 4
Isolation Techniques*
- 1
- 2
- 3
- 4
Diabetic Teaching*
- 1
- 2
- 3
- 4
Patient Teaching*
- 1
- 2
- 3
- 4
Burn Patients*
- 1
- 2
- 3
- 4
Accu-Check*
- 1
- 2
- 3
- 4
Ventilators
Bear I*
- 1
- 2
- 3
- 4
Bear II*
- 1
- 2
- 3
- 4
Bear IV*
- 1
- 2
- 3
- 4
Bennett 7200*
- 1
- 2
- 3
- 4
CPAP*
- 1
- 2
- 3
- 4
Emerson*
- 1
- 2
- 3
- 4
Engstrom / Erica*
- 1
- 2
- 3
- 4
EMV*
- 1
- 2
- 3
- 4
MA-I*
- 1
- 2
- 3
- 4
MA-II*
- 1
- 2
- 3
- 4
Monaghan*
- 1
- 2
- 3
- 4
Ohio 560*
- 1
- 2
- 3
- 4
PEEP*
- 1
- 2
- 3
- 4
Pressure Pre-Set*
- 1
- 2
- 3
- 4
Servo 900b*
- 1
- 2
- 3
- 4
Servo 900c*
- 1
- 2
- 3
- 4
Servo 900e*
- 1
- 2
- 3
- 4
Siemens*
- 1
- 2
- 3
- 4
Age Specific Competency
Newborn / Neonate (Birth - 30 days)*
- 1
- 2
- 3
- 4
Infant (30 days - 1 year)*
- 1
- 2
- 3
- 4
Toddler (1 - 3 years)*
- 1
- 2
- 3
- 4
Preschooler (3 - 5 years)*
- 1
- 2
- 3
- 4
School Age Children (5 - 12 years)*
- 1
- 2
- 3
- 4
Adolescents (12 - 18 years)*
- 1
- 2
- 3
- 4
Young Adults (18 - 39 years)*
- 1
- 2
- 3
- 4
Middle Adults (39 - 64 years)*
- 1
- 2
- 3
- 4
Older Adults (64 - 79 years)*
- 1
- 2
- 3
- 4
Elderly Adults (Over 79+ years)*
- 1
- 2
- 3
- 4

Proficiency:

Cardiac

Respiratory

Neurology

Cardiac Monitors

Vascular

Gastrointestinal

Genitourinary / Renal

Gynecology

Orthopedic

Ventilators

Age Specific Competency