Long Term Care 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 Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyCARDIACUse of cardiac monitors(Required) 1 2 3 4 Assessment of heart sounds(Required) 1 2 3 4 Cardiac Arrest(Required) 1 2 3 4 CPR(Required) 1 2 3 4 Care of patients with CHF(Required) 1 2 3 4 Atropine administration(Required) 1 2 3 4 Digoxin administration(Required) 1 2 3 4 Dopamine administration(Required) 1 2 3 4 Inderal administration(Required) 1 2 3 4 Lidocaine administration(Required) 1 2 3 4 GENITOURINARYFluid Balance(Required) 1 2 3 4 Foley Catheter Insertion(Required) 1 2 3 4 Ileostomy(Required) 1 2 3 4 GU Irrigations(Required) 1 2 3 4 Nephrostomy Tube(Required) 1 2 3 4 ENDOCRINEBlood Glucose Checks(Required) 1 2 3 4 Insulin Administration(Required) 1 2 3 4 Care of patients with Diabetes(Required) 1 2 3 4 GASTROINTESTINALNG tube care and feedings(Required) 1 2 3 4 Gastrostomy tube care and feedings(Required) 1 2 3 4 Colostomy Care(Required) 1 2 3 4 Assessment of Bowel Sounds(Required) 1 2 3 4 LEADERSHIP/PATIENT CARETaking Charge(Required) 1 2 3 4 Admission Procedures(Required) 1 2 3 4 Discharge Procedures(Required) 1 2 3 4 Patient Education(Required) 1 2 3 4 Patient Care Plans(Required) 1 2 3 4 MEDICATIONS/IV THERAPYMedication Calculation(Required) 1 2 3 4 Reconstitution(Required) 1 2 3 4 Oral Administration(Required) 1 2 3 4 Eye Administration(Required) 1 2 3 4 IM Administration(Required) 1 2 3 4 SQ Administration(Required) 1 2 3 4 Rectal Administration(Required) 1 2 3 4 Starting IV’s(Required) 1 2 3 4 IV Medication Administration(Required) 1 2 3 4 Central Line Care(Required) 1 2 3 4 NEUROLOGYAssessment of Neurological Status(Required) 1 2 3 4 Seizure Precautions(Required) 1 2 3 4 Care of a patient with a CVA(Required) 1 2 3 4 Care of a patient with Alzheimer’s(Required) 1 2 3 4 Care of patients with Spinal Cord Injury(Required) 1 2 3 4 Decadron Administration(Required) 1 2 3 4 Dilantin Administration(Required) 1 2 3 4 Phenobarbital Administration(Required) 1 2 3 4 Valium Administration(Required) 1 2 3 4 ORTHO/SKINAssessment of skin(Required) 1 2 3 4 Wound Care and Treatments(Required) 1 2 3 4 Use of special pressure relief devices(Required) 1 2 3 4 Care of pts with a total hip replacement(Required) 1 2 3 4 Care of pts with a total knee replacement(Required) 1 2 3 4 Crutch Walking(Required) 1 2 3 4 RESPIRATORYPulse Oximetry(Required) 1 2 3 4 Oxygen Administration via nasal cannuia(Required) 1 2 3 4 Oxygen Administration via face mask(Required) 1 2 3 4 Principles of chest percussion(Required) 1 2 3 4 Care of patients with ventilator(Required) 1 2 3 4 Care of patients with COPD(Required) 1 2 3 4 Care of patients with ARDS(Required) 1 2 3 4 Care of patients with ARDS(Required) 1 2 3 4 Age Specific CompetenciesInfant (Birth - 1 year)(Required) 1 2 3 4 Preschooler (ages 2-5 years)(Required) 1 2 3 4 Childhood (ages 6-12 years)(Required) 1 2 3 4 Adolescents (ages 13-21 years)(Required) 1 2 3 4 Young Adults (ages 22-39 years)(Required) 1 2 3 4 Adults (ages 40-64 years)(Required) 1 2 3 4 Older Adults (ages 65-79 years)(Required) 1 2 3 4 Elderly (ages 80+ years)(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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In order to withdraw consent you must notify the “sending party” that you wish to withdraw your consent to transact business electronically and to provide your future documents, notices, and disclosures in paper format. If at any time, after withdrawing your consent you choose to use our electronic signature system your use of this Service will, once again, evidence your consent to receive documents, notices, and disclosures, electronically. You may withdraw your consent to receive electronic notices and disclosures or execute an electronic signature by following the procedures described below. Withdrawing your consent, requesting a paper copy, or updating your contact information You always have the ability to download and print any documents sent to you through our electronic signature system. 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