Iv Therapy Skills Checklist 2qq6s

IV THERAPY KNOWLEDGE & SKILLS CHECKLIST NAME:       ID #:       DATE:       This Skills Checklist is for use by nurses with more than one year experience in their discipline and specialty. Please be accurate with your assessment. DESCRIPTION 1 2 3 4 PATIENT RIGHTS 1. Communicates and obtains information while respecting the rights, privacy, and confidentiality of information in accordance with the Health Insurance Portability and ability Act of 1996 (HIPPA) 2. Involves the patient and family and respects their role in determining the nature of care to be provided, including Advance Directives. 3. Complies with nursing staff responsibility included in the hospital policy related to Organ Donation. 4. Meets patient’s and families’ needs regarding communication, including interpreter services. 5. Provides accurate information to patient and families in a timely manner. INFECTION CONTROL 1. Proper Use of Specific Barrier Methods: a. Gloves b. Gown c. Mask / Goggles 2. Protective / Reverse Isolation 3. Body Substance Isolation 4. TB Precautions 5. MRSA Precautions 1 | Page

6. Hand Washing 7. Infectious / Hazardous Waste Disposal 8. Supply / Equipment Disposal 9. Use of Disposable Thermometer 10. Use of R Mask / Bag 11. AIDS DIRECTIONS: Please indicate your level of experience by placing a check (√) in the box. Experience level: 1 NO EXPERIENCE 2 MINIMAL EXPERIENCE-requires supervision/assistance

3 4

MODERATELY EXPERIENCED-requires initial review, then performs independently VERY EXPERIENCED- proficient

DESCRIPTION 1 2 3 4 12. Hepatitis B VITAL SIGNS AND WEIGHTS 1. Recognizing Cardiac Arrest 2. Activating Code Team 3. Initiating R 4. Bringing Emergency Equipment to Room 5. Providing Appropriate Code 6. Use of Electronic VS Equipment a. Automatic BP Machine (Dynamap) b. Electronic Thermometer c. Applying Oximeter SAFETY AND ACTIVITY 1. Determining Patient ID 2. Identifying Safety Hazards 3. Determining Need for Additional Help 4. Assessing Safety and ADL Needs and Restraints 5. Maintaining Orderly Work Area 6. Disposing of Sharps

IV THERAPY KNOWLEDGE & SKILLS CHECKLIST 7. 8. 9. 10. 11. 12. 13.

Handling Hazardous Materials Proper Body Mechanics Reporting Broken Equipment Responding to Safety Hazards Use of Wheel Locks Use of Call Light Application of Restraints SPECIMENS 1. Venipuncture 2. Arterial Draw 3. Line Draw 4. Culture Specimens 5. Labeling Specimens and Preparing for Transport

2 | Page

IV THERAPY KNOWLEDGE & SKILLS CHECKLIST Name:       ID #:       DESCRIPTION

1 2 3 4

SKIN HYGIENE 1. Risk Factors for Skin Breakdown 2. Observing Sites for Redness or Breakdown 3. Treatment of Infiltrates 4. Reducing Pressure and Friction PROCEDURES 1. Insertion of: a. Peripheral IV – Adult b. Peripheral IV – Child c. Peripheral IV – Neonate d. PICC Line e. Interosseous Needles CARE OF AND DRESSING CHANGE TO: 1. Interosseous Line 2. Subcutaneous Needles 3. Groshong 4. Portacath 5. Hickman 6. Access Ports 7. Vascath 8. Multilumen Catheters 9. Scalp Vein 10. Heparin Lock 11. Subclavian Line 12. Interjugular Line FLUIDS / MEDICATIONS 1. Chemotherapy 2. Dopamine 3. Heparin 4. Lidocaine 5. Regitine 6. Streptokinase 7. TpA 8. TPN / Lipids 9. Wydase 10. Blood Products

3 | Page

DESCRIPTION 1 2 3 4 EQUIPMENT AND TROUBLESHOOTING 1. CADD Pumps 2. IVAC Pumps 3. Blood Warmer 4. Needleless Systems 5. Pressure Lines 6. Bard Pumps 7. PCA Pumps 8. Repair PICC Line 9. Declotting Peripheral Site 10. Declotting Central Lines 11. Sterile Dressing Change, One Person 12. Sterile Dressing Change, Two Person COMPUTERIZED CHARTING 1. Cerner 2. Eclipsys 3. Epic 4. McKesson 5. Meditech 6. Other:

IV THERAPY KNOWLEDGE & SKILLS CHECKLIST Name:      

MY EXPERIENCE IS PRIMARILY IN:

Please check the boxes below for each age group for which you have expertise in providing age-appropriate nursing care.

NEUROLOGY PULMONARY SURGICAL MEDICAL CARDIAC CARE TELEMETRY

A. Newborn/Neonatal (birth – 30 days) B. Infant (30 days – 1 year) C. Toddler (1 – 3 years) D. Preschool (3 – 5 years) E. School Age Children (5 – 12 years) F. Adolescent (12 – 18 years) G. Young Adults (18 – 39 years) H. Middle Adults (40 – 64 years) I. Older Adults (64 + years)

B

C

D

E

F

G

H

I

2. Able to adapt care according to normal growth and development. A

B

C

D

E

F

G

years years years years years years

I HAVE CURRENT CERTIFICATIONS FOR:

EXPERIENCE WITH AGE GROUPS: 1. Able to assess age appropriate behavior, motor skills and physiological norms. A

                                   

H

I

3. Able to communicate and instruct patient according to their age, maturity and comprehension ability.

TYPE DATE (MM/DD/YY) ARRHYTHMIA CRITICAL CARE ACLS BLS TNCC NRP PALS NALS Other       Other       Other       Other      

COURSE                                                                        

The information I have provided in this knowledge and skills checklist it true and accurate to the best of my knowledge.       Signature

      Date

(Written/Electronic)

ID #:       A

B

C

D

E

F

G

H

I This skills checklist has been reviewed and approved by Nicole Bloxham, RN.

4. Able to provide a safe environment according to the specific needs of various age groups.

      Signature

(Written/Electronic)

A

B

C

D

E

F

G

H

I

      Date

ID #:       Please return to: NORTHWEST COMPANY, PA ATTN: Records Dept. Fax: (866) 352-4338

4 | Page

NURSE

STAFFING

IV THERAPY KNOWLEDGE & SKILLS CHECKLIST Email: [email protected]

5 | Page