Endoscopy Tech Skills Checklist One program to handle all talent management needs from acquisition to development Personal Information HiddenOverall ScoreName(Required) First Middle Last Last 4 Digits of Social Security Number Email(Required) HiddenDate MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyAGE SPECIFIC COMPETENCIESNewborn/ Neonate (birth to 30 days)(Required) 1 2 3 4 Infant (1 month to 1 year)(Required) 1 2 3 4 Toddler (1 year to 3 years)(Required) 1 2 3 4 Child (3-13 yrs)(Required) 1 2 3 4 Adolescents (12 years to 18 years)(Required) 1 2 3 4 Adults (18 years to 65 years)(Required) 1 2 3 4 Older Adults/Geriatrics (65+)(Required) 1 2 3 4 GENERALAssessments, Family History, and Risk Factors(Required) 1 2 3 4 Start and Maintain Peripheral IV(Required) 1 2 3 4 Complete Pre-Procedure Checklist(Required) 1 2 3 4 Consent Forms/Permits(Required) 1 2 3 4 Discharge Instructions(Required) 1 2 3 4 Interpretation of Lab Values(Required) 1 2 3 4 Set-Up of Scope & Video Equipment(Required) 1 2 3 4 Cleaning of Scopes(Required) 1 2 3 4 Transport Pre-Procedure Patient to Lab(Required) 1 2 3 4 Provide Care for the Post- Procedure Patient(Required) 1 2 3 4 Transport Post- Procedure Patient to Unit(Required) 1 2 3 4 National Patient Safety Goals(Required) 1 2 3 4 Automated Med Dispensing System(Required) 1 2 3 4 Electronic Documentation(Required) 1 2 3 4 PROCEDURESEGDs(Required) 1 2 3 4 Active GI Bleed(Required) 1 2 3 4 Bronchoscopy(Required) 1 2 3 4 Cautery Devices(Required) 1 2 3 4 Collection of Hot & Cold Biopsies(Required) 1 2 3 4 Colonoscopy(Required) 1 2 3 4 Endoscopic Ultrasound(Required) 1 2 3 4 ERCP(Required) 1 2 3 4 Esophageal Dilations(Required) 1 2 3 4 Manometry Studies(Required) 1 2 3 4 PEG Placement(Required) 1 2 3 4 Polypectomy(Required) 1 2 3 4 Sclerotherapy(Required) 1 2 3 4 Specimen Collection and Labeling(Required) 1 2 3 4 TEE(Required) 1 2 3 4 Variceal Banding(Required) 1 2 3 4 CARDIOVASCULARAssess heart Sounds and Peripheral Pulses(Required) 1 2 3 4 EKG Interpretation and Monitoring(Required) 1 2 3 4 Non-invasive Cardiac Monitoring(Required) 1 2 3 4 Participate as a Team Member in Resuscitation(Required) 1 2 3 4 Perform Defibrillation(Required) 1 2 3 4 Recognize and Interpret Arrhythmias(Required) 1 2 3 4 PULMONARYABG’s Interpretation of Values(Required) 1 2 3 4 Airway Management(Required) 1 2 3 4 Assess Lung Sounds(Required) 1 2 3 4 Assist with Intubation(Required) 1 2 3 4 Care of Patient with Mechanical Ventilation(Required) 1 2 3 4 Pulse Oximetry(Required) 1 2 3 4 Set Up Oxygen(Required) 1 2 3 4 Use of Ambu Bag(Required) 1 2 3 4 NEUROLOGICALIdentify Changes in Level of Consciousness(Required) 1 2 3 4 Assess Sensory, Motor, Speech(Required) 1 2 3 4 Assess Reflexes- Babinski, Gag(Required) 1 2 3 4 MEDICATIONSCalculate mcg/min and mcg/kg/min(Required) 1 2 3 4 Monitor Conscious Sedation(Required) 1 2 3 4 Use of Sedation Reversal Agents(Required) 1 2 3 4 Use of IV Infusion Pumps(Required) 1 2 3 4 Antibiotics(Required) 1 2 3 4 Benzodiazepines- Valium, Versed, Ativan(Required) 1 2 3 4 Insulin(Required) 1 2 3 4 Narcan(Required) 1 2 3 4 Narcotics- Morphine, Fentanyl(Required) 1 2 3 4 Neuromuscular Blocking Agents- Pavulon, Norcuron(Required) 1 2 3 4 Propofol- Diprivan(Required) 1 2 3 4 Romazicon-Flumazenil(Required) 1 2 3 4 Thrombolytics(Required) 1 2 3 4 AuthorizationsLegal Consent(Required) I agree to the terms and conditions.Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. 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