PICU 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 independentlyWORK SETTINGSPICU(Required) 1 2 3 4 Pediatric CVICU(Required) 1 2 3 4 Pediatric Step Down(Required) 1 2 3 4 Pediatric PACU(Required) 1 2 3 4 CARDIOVASCULARCongenital Heart Disease/Repair(Required) 1 2 3 4 Post Cardiac Surgery (Directly from OR)(Required) 1 2 3 4 Post Cardiac Surgery (NOT Directly from OR)(Required) 1 2 3 4 Post Diagnostic/Interventional Cardiac Cath(Required) 1 2 3 4 Heart Failure/Cardiogenic Shock(Required) 1 2 3 4 Cardiac Transplant(Required) 1 2 3 4 Hemodynamic Monitoring(Required) 1 2 3 4 Arrhythmia Interpretation(Required) 1 2 3 4 Pacemaker - Temporary/Permanent(Required) 1 2 3 4 SVO2 Monitoring(Required) 1 2 3 4 Intra-Aortic Balloon Pump(Required) 1 2 3 4 Ventricular Assist Device(Required) 1 2 3 4 ECMO(Required) 1 2 3 4 PULMONARYRespiratory Distress Syndrome/Resp. Failure(Required) 1 2 3 4 Reactive Airway Disease(Required) 1 2 3 4 ENT Surgery(Required) 1 2 3 4 Epiglottis(Required) 1 2 3 4 Cystic Fibrosis(Required) 1 2 3 4 Tuberculosis(Required) 1 2 3 4 Intubation/Extubation(Required) 1 2 3 4 Endotracheal Tube Management(Required) 1 2 3 4 Tracheostomy Management(Required) 1 2 3 4 Modes of Ventilation: AC/PC/SIMV/CPAP(Required) 1 2 3 4 Modes of Ventilation: Jet/Oscillator(Required) 1 2 3 4 Nitric Oxide(Required) 1 2 3 4 Hemo/Pneumothorax(Required) 1 2 3 4 NEUROLOGIC/ORTHOPEDICBrain Injury(Required) 1 2 3 4 Craniotomy(Required) 1 2 3 4 Spinal Cord Injury(Required) 1 2 3 4 Seizure Disorders(Required) 1 2 3 4 ICP Monitoring(Required) 1 2 3 4 VP Shunt(Required) 1 2 3 4 Meningitis(Required) 1 2 3 4 Neuromuscular Disease(Required) 1 2 3 4 Post Vertebral Surgery(Required) 1 2 3 4 Traction - Halo(Required) 1 2 3 4 GASTROINTESTINALAcute Surgical Abdomen(Required) 1 2 3 4 GI Bleeding(Required) 1 2 3 4 Pancreatitis(Required) 1 2 3 4 Hepatic Failure(Required) 1 2 3 4 Ostomy Management(Required) 1 2 3 4 Management of Gastric Tubes(Required) 1 2 3 4 Breast Milk Handling/Storage(Required) 1 2 3 4 RENAL/GENITOURINARYNephrotic Syndrome(Required) 1 2 3 4 Renal Transplant(Required) 1 2 3 4 Renal Replacement Therapy(Required) 1 2 3 4 Peritoneal Dialysis(Required) 1 2 3 4 ENDOCRINE/METABOLICDiabetes - Hypo/Hyperglycemic Crisis(Required) 1 2 3 4 Diabetic Ketoacidosis(Required) 1 2 3 4 IV Insulin Pumps(Required) 1 2 3 4 Indwelling Insulin Pumps(Required) 1 2 3 4 TRAUMA/OTHERBlunt/Penetrating Trauma(Required) 1 2 3 4 Burns(Required) 1 2 3 4 Craniofacial Reconstruction(Required) 1 2 3 4 Near Drowning(Required) 1 2 3 4 Poison Ingestion/Overdose(Required) 1 2 3 4 Suicide Precautions(Required) 1 2 3 4 Wound Management/VAC(Required) 1 2 3 4 Specialty Beds(Required) 1 2 3 4 ONCOLOGYBone Marrow Transplant(Required) 1 2 3 4 Immunosuppressive Disorder(Required) 1 2 3 4 Hemophilia Crisis(Required) 1 2 3 4 Sickle Cell Crisis(Required) 1 2 3 4 MEDICATIONSPediatric Dosage Calculations(Required) 1 2 3 4 Anti-Arrhythmics(Required) 1 2 3 4 Anticoagulants (IV, Oral & Injection)(Required) 1 2 3 4 Anti-Hypertensives(Required) 1 2 3 4 Anti-Seizure Medications(Required) 1 2 3 4 Benzodiazepines(Required) 1 2 3 4 Continuous IV Paralytics(Required) 1 2 3 4 Continuous IV Sedation(Required) 1 2 3 4 Procedural Sedation - Administration(Required) 1 2 3 4 Diuretics(Required) 1 2 3 4 Emergency Medication(Required) 1 2 3 4 Inhaled Medications(Required) 1 2 3 4 Insulin(Required) 1 2 3 4 IV Vasopressors(Required) 1 2 3 4 Narcotics/Opioid Analgesics (IV, Oral & Injection)(Required) 1 2 3 4 Non-Opioid Analgesics (IV, Oral & Injection)(Required) 1 2 3 4 Reversal Agents(Required) 1 2 3 4 Steroids (IV, Oral, Inhaled)(Required) 1 2 3 4 Automated Medication Dispensing (i.e. Pyxis, Omnicell)(Required) 1 2 3 4 IV THERAPYStarting Ivs(Required) 1 2 3 4 Central Line Blood Draw(Required) 1 2 3 4 Central Line/Implanted Line Care(Required) 1 2 3 4 TPN/Lipids(Required) 1 2 3 4 Blood Product Administration(Required) 1 2 3 4 Administration of Chemotherapy(Required) 1 2 3 4 CARDIAC MONITORING & EMERG. RESPONSEDysrhythmia Interpretation(Required) 1 2 3 4 Dysrhythmia Management(Required) 1 2 3 4 Management of Cardiac Arrest(Required) 1 2 3 4 Shock Management(Required) 1 2 3 4 Malignant Hyperthermia(Required) 1 2 3 4 Multisystem Organ Failure(Required) 1 2 3 4 PROFESSIONAL KNOWLEDGE AND SKILLSNational Patient Safety Goals/Core Measures(Required) 1 2 3 4 Recognize/Report Signs of Abuse(Required) 1 2 3 4 EMTALA(Required) 1 2 3 4 Fall Risk Assessment/Prevention(Required) 1 2 3 4 Pressure Ulcer Risk Assessment/Prevention(Required) 1 2 3 4 Restraints/Use of Least Restrictive Device(Required) 1 2 3 4 Normal Growth and Development(Required) 1 2 3 4 Age Specific/Population Based Care(Required) 1 2 3 4 Patient Family Teaching(Required) 1 2 3 4 Isolation Precautions(Required) 1 2 3 4 Infection Prevention(Required) 1 2 3 4 Reporting Communicable Diseases(Required) 1 2 3 4 Pain Assessment & Management(Required) 1 2 3 4 Charge Experience(Required) 1 2 3 4 Interpretation and Communication of Lab Values(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 EMREpic(Required) 1 2 3 4 Cerner(Required) 1 2 3 4 Eclipsys(Required) 1 2 3 4 McKesson(Required) 1 2 3 4 Meditech(Required) 1 2 3 4 Other Computerized System(Required) 1 2 3 4 Computerized Physician Order Entry(Required) 1 2 3 4 Bar Coding for Medication Administration(Required) 1 2 3 4 EMR Conversion(Required) Yes No AuthorizationsBLS(Required) Yes No BLS Expiry Date: MM slash DD slash YYYY PALS(Required) Yes No PALS Expiry Date: MM slash DD slash YYYY ACLS(Required) Yes No ACLS Expiry Date: MM slash DD slash YYYY PEARS(Required) Yes No PEARS Expiry Date: MM slash DD slash YYYY ENPC(Required) Yes No ENPC Expiry Date: MM slash DD slash YYYY CEN(Required) Yes No CEN Expiry Date: MM slash DD slash YYYY TNCC(Required) Yes No TNCC Expiry Date: MM slash DD slash YYYY Other: Specify Other Expiry Date: MM slash DD slash YYYY 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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