EP RN Skills Checklist One program to handle all talent management needs from acquisition to development Personal Information HiddenOverall ScoreOut of 4Name(Required) First Middle Last Last 4 Digits of Social Security Number Email(Required) HiddenDate MM slash DD slash YYYY Total Years of Experience(Required) Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyEXPERIENCE WITH AGESNewborn/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 Preschooler (3 years to 5 years)(Required) 1 2 3 4 School Age Child (5 years to 12 years)(Required) 1 2 3 4 Adolescents (12 years to 18 years)(Required) 1 2 3 4 Young Adults (18 years to 39 years)(Required) 1 2 3 4 Middle Adults (39 years to 64 years)(Required) 1 2 3 4 Older Adults (64 years to 79 years)(Required) 1 2 3 4 Elderly Adults (over 79+ years)(Required) 1 2 3 4 GENERAL SKILLSStandard Precautions(Required) 1 2 3 4 Isolation Precautions(Required) 1 2 3 4 Pediatric Respiratory/Cardiac Arrest(Required) 1 2 3 4 Adult Respiratory/Cardiac Arrest(Required) 1 2 3 4 Crash Carts(Required) 1 2 3 4 Defibrillators(Required) 1 2 3 4 Care of Patient in Restraints(Required) 1 2 3 4 Pain Management(Required) 1 2 3 4 Automated Med Dispensing Systems(Required) 1 2 3 4 Care Planning & Discharge Planning(Required) 1 2 3 4 Patient/Family Education(Required) 1 2 3 4 Electronic Documentation(Required) 1 2 3 4 Patient Head to Toe Assessment(Required) 1 2 3 4 Peripheral IV Insertion, Care and Maintenance(Required) 1 2 3 4 MEDICATIONSCalculate mcg/min and mcg/kg/min(Required) 1 2 3 4 Titrating Medications(Required) 1 2 3 4 Isuprel(Required) 1 2 3 4 Procainamide(Required) 1 2 3 4 Esmolol(Required) 1 2 3 4 Adenosine(Required) 1 2 3 4 Amiodarone(Required) 1 2 3 4 Antibiotics(Required) 1 2 3 4 Analgesics(Required) 1 2 3 4 Sedatives(Required) 1 2 3 4 ASSESSMENT AND MONITORINGLead Placement(Required) 1 2 3 4 Basic 12 Lead EKG Interpretation(Required) 1 2 3 4 Cardiac Rhythm Interpretation(Required) 1 2 3 4 Doppler(Required) 1 2 3 4 Blood Pressure Invasive and Noninvasive(Required) 1 2 3 4 HEMODYNAMIC MONITORINGArt Line(Required) 1 2 3 4 Swan Ganz(Required) 1 2 3 4 Waveform Assessment(Required) 1 2 3 4 General Lab work Interpretation(Required) 1 2 3 4 ABG Interpretation(Required) 1 2 3 4 Cardiac Enzyme Interpretation(Required) 1 2 3 4 Chemistry Interpretation(Required) 1 2 3 4 CARE AND MAINTENANCECentral Venous Access Device(Required) 1 2 3 4 Arterial Line(Required) 1 2 3 4 Swan Ganz(Required) 1 2 3 4 IABP(Required) 1 2 3 4 Sheaths(Required) 1 2 3 4 Removal of Sheath(Required) 1 2 3 4 Manual Pressure Hold(Required) 1 2 3 4 C-Clamp(Required) 1 2 3 4 FemStop(Required) 1 2 3 4 VasoSeal, Angioseal, PerClose(Required) 1 2 3 4 Hematoma Recognition/Management(Required) 1 2 3 4 PROCEDURE EQUIPMENTScrub EP Procedures(Required) 1 2 3 4 Circulate EP Procedures(Required) 1 2 3 4 Monitor EP Procedures(Required) 1 2 3 4 Ablation (Atrial/Ventricular)(Required) 1 2 3 4 Velocity Mapping(Required) 1 2 3 4 Cart/ Mapping(Required) 1 2 3 4 Rhythmia Mapping(Required) 1 2 3 4 Bloom Stimulator(Required) 1 2 3 4 Micropace Ep-4(Required) 1 2 3 4 Diagnostic Catheters(Required) 1 2 3 4 Bi-V(Required) 1 2 3 4 Stereotaxis(Required) 1 2 3 4 AICD Placement(Required) 1 2 3 4 Bovie(Required) 1 2 3 4 PPM(Required) 1 2 3 4 Baylis(Required) 1 2 3 4 Temporary Pacemaker(Required) 1 2 3 4 Peak Plasma Blade(Required) 1 2 3 4 Cardioversion(Required) 1 2 3 4 Internal Cardioversion Catheters / AICD Testing(Required) 1 2 3 4 NIPS Procedure(Required) 1 2 3 4 Pericardiocentesis(Required) 1 2 3 4 Demonstrate Proper Preservations of Tissue Specimen for Lead Extractions(Required) 1 2 3 4 ACT Machine(Required) 1 2 3 4 Lead Extractions - Spectranetics laser(Required) 1 2 3 4 Device Implants(Required) 1 2 3 4 Ablation Equipment (ie: Stockert, Maestro, Cool Flow, Tactisys)(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. By signing this document you are agreeing that you have reviewed this Consumer Disclosure and consent and intend to transact business electronically; to use electronic signatures instead of wet ink signatures and paper documents, and to receive notices and disclosures electronically. You are not required to sign documents electronically or to receive notices and disclosures electronically. If you prefer not to transact business electronically, you may request paper copies from the “sending party” and withdraw your consent at any time, as described below. Scope of Consent By utilizing this Service, you agree to receive electronic signature documents with all related and identified documents, notices, and disclosures provided during your relationship with the “sending party.” You may withdraw your consent, at any time, by following the procedures outlined below. 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