Med/Surgical Skills Checklist

  • Medical/Surgical Skills Checklist

  • MM slash DD slash YYYY
  • PLEASE CHECK THE APPROPRIATE COLUMN THAT MOST ACCURATELY REFLECTS YOUR LEVEL OF EXPERIENCE OR SKILL:


    LEVELS OF PROFICIENCY


    0 - No Experience or skills | 1 - Minimal experience, need review and supervision, have performed at least once | 2 - Comfortable performing with resource available | 3 -Competent to perform independently and safely | 4 -Expert, able to act as resource to others

  • 01234
    Communicates and obtains information while respecting the rights and privacy and confidentiality of information.
    Involves the patient and family and respects their role in determining the nature of care to be provided, including Advanced Directives.
    Complies with nursing staff responsibility include in the hospital policy related to Organ Donation.
    Meets patient and families needs regarding communication, including interpreter services.
    Provides accurate information to patient and families in a timely manner.
  • 01234
    Neuro Assessment/Neuro Vitals
    Seizure Precautions
    Stryker Frame
    Crutchfield Tongs
    Halo Traction
    Immobilization Techniques
    Managing patient with epidural catheter
    Managing patient with spinal precautions
  • 01234
    Spinal Cord Injury
    Pre/Post Neurological Surgery
    CNS Infections
    Degenerative Diseases of the Nervous System
    Drug Overdose
    Acute Head Injury
    Cerebral Aneurysm
    Acute/Chronic C.V.A/T.I.A.
    Rehabilitation of the Neuro patient
  • 01234
    Cardio pulmonary arrests
    Running code 99
    Caring for 48+ hour post-op Open Heart patient
    Caring for a pacemaker patient
    Pre/post-op angioplasty
    Post-op vascular surgery patients (i.e. aneurysms)
    Angina (acute and chronic)
    Ability to interpret cardiac rhythms
    Assessing and treating orthostatic BP
    Assessing abnormal heart tones
    Care of patient with: Valvular disease
    Care of patient with: Central lines
  • 01234
    Acetaminophen
    Acetylsalicylic Acid
    Antibiotics
    Beta blockers
    Calcium Channel Blockers
    Cimetidine
    Codeine
    Dexamethasone
    Diazepam
    Digoxin
    Duramorph
    Furosemide
    Heparin
    Insulin
    Lorazepam
    Morphine
    Naloxone
    Nitroglycerine
    Phenytoin
    Potassium Chloride
    Theophylline
    Verapamil
    Warfarin
    Inhalers
    Oral Medications
    Suppositories: Vaginal
    Suppositories: Rectal
    Ordering Meds
  • 01234
    Assessment of breath sounds
    Assist with set-up maintenance of chest tubes
    Administer oxygen (nasal canula, mask, endotracheal)
    Oxygen saturation monitor
    Use of chest drainage systems
    Care of patient with: Pulmonary emboli
    Care of patient with: Tracheostomy
    Care of patient with: Pre/post thoracic surgery
    Care of patient with: Asthma
    Care of patient with: COPD
    Care of patient with: CHF
    Care of patient with: Tuberculosis
    Nasal Tracheal Suctioning
    Changing Tracheostomy
    Instructing patient in use of incent. spirometer
  • 01234
    Assessment of bowel sounds
    Identification of abnormalities
    Stool tests
    Insert/Maintain Feeding tubes/NG tubes
    Administering Tube Feedings
    Checking Tube Feeding Residuals
    Inserting/maintaining intermittent & continuous suction NG tubes
    Checking tube feeding and NG tube placement
    Care of acute GI bleed
    Ileostomy/Colostomy and drain care
    Abdominal wounds or infections
    Pre/post-op GI Surgery
    Dehiscence
    Care of patient on Total Parenteral Nutrition
  • 01234
    Ability to insert/maintain urinary drainage tubes
    Care of patient with: Acute renal failure
    Care of patient with: Chronic renal failure
    Care of patient with: Post renal/genitourinary surgery
    Caring for a patient recovering from Peritoneal dialysis
    Caring for a patient recovering from Hemodialysis
    Assessment of fluid and electrolyte problems
    Knowledge of UA values
    Managing urostomy
    Managing suprapubic catheter
    Placing condom catheter
    Collecting specimens
  • 01234
    Caring for a diabetic patient
    Administration of IV insulin drip
    Capillary blood glucose checks
    Hormone therapy
  • 01234
    Caring for AIDS patient
    Isolation/Universal precautions
    Pain management
    Mixing/Administering chemo agents
  • 01234
    Traction
    Braces
    Casts
    Collars
    Slings
    Splints
    Skeletal traction
    Skin traction
    Using T.E.N.S. unit
    Beds i.e. Clinitron, Roto Rest
    Total knee replacement
    Total hip replacement
    Crutch walking/walkers
    Care of patient with: Joint disorders
    Care of patient with: Bone disorders
    Care of patient with: Amputation
    Caring for patient on CPM
  • 01234
    Pain management
    Burn patients
    Inserting IV’s/IV therapy
    Set-up for Cut Down
    Performing complex dressing changes
    Administration of blood and blood products
    Administering and monitoring IV Anticoagulants
    Obtaining peripheral venous blood
    Obtaining blood from central venous line
    Knowledge of Serum Lab Values: Chem 7, Chem 10
    Knowledge of Serum Lab Values: CBC
    Knowledge of Serum Lab Values: Serum Drug Levels
    IV Therapy
    Care of drains/tubes (i.e. hemovac, etc.)
    Monitoring and assessing I & O
    Using PCA System
    Using SCD or Venidyne Devices
    Using PICC, Hickman, Central Line
    Providing for safe patient environment
  • EXPERIENCE AREAS: Please provide the number of years/months of experience you have in each of the following. Insert zero (0) for those areas in which you have no experience.
  • YearsMonths
  • YearsMonths
  • YearsMonths
  • YearsMonths
  • YearsMonths
  • YearsMonths
  • YearsMonths
  • YearsMonths
  • YearsMonths
  • YearsMonths
  • YearsMonths
  • YearsMonths
  • YearsMonths
  • YearsMonths
  • YearsMonths
  • By clicking 'Submit', you acknowledge that the information provided is true and accurate to the best of your knowledge and further authorize Galileo Search, LLC. to share the above skills checklist with their clients/potential employees.