Home Health Skills Checklist
   NAME  
   Email-Id
   DATE    
I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

Instructions:

This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

 
Proficiency Scale: 1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

 
Rating Stars (Click)
CARDIOVASCULAR 1
2
3
4
ACS/Post MI
Heart Failure
Post Cardiac Surgery
Cardiac Auscultation (Rate/Rhythm)
Peripheral Pulse/Circulation Checks
Rating Stars (Click)
PULMONARY 1
2
3
4
Asthma
COPD
Pneumonia
Lung Cancer
Pulmonary Emboli
Auscultate Lung Sounds
Oxygen Administration
Oxygen Safety
Oro/Nasotracheal Suctioning
CPAP/BiPAP
Rating Stars (Click)
NEUROLOGICAL 1
2
3
4
CVA
Alzheimers Disease/Dementia
Parkinsons
Degenerative Neurologic Disorders (ALS, MS, etc.)
Brain Tumor
Brain Injury
Para/Quadriplegia
Seizure Disorder
Level of Consciousness/Neuro Changes
Rating Stars (Click)
ORTHOPEDICS 1
2
3
4
Joint Replacement
DVT Prophylaxis/Recognition
Incision Checks
Staple Removal
Fractures
Cast/Brace
Amputation
Arthritis
Assistive Equipment/Lift Devices
In Home PT/INR (Specify):
Rating Stars (Click)
GASTROINTESTINAL 1
2
3
4
Nutritional Assessment
Colostomy/Ileostomy Management
Fecal Incontinence/Diarrhea
Bowel Obstruction
GI Bleed
Post GI Surgery
Hepatitis Liver Failure
NG Tubes
Feeding Tubes
Drainage Devices
Rating Stars (Click)
RENAL/GENITOURINARY 1
2
3
4
Hemodialysis
AV Fistula/Shunt
Peritoneal Dialysis
Post Bladder Surgery
Post Prostate Surgery
Urostomy
Urinary Incontinence
Bladder Catheter Insertion/Maintenance
Suprapubic Catheter Insertion/Maintenance
Rating Stars (Click)
ENDOCRINE/METABOLIC 1
2
3
4
Diabetes
Hyper/Hypoglycemia
Diabetic Skin Assessment
Cushings / Addisons Disease
Thyroid Disease
Insulin Pumps
Glucometers
Rating Stars (Click)
WOUND/SKIN CARE 1
2
3
4
Braden Scale
Pressure Ulcer Prevention
Pressure Ulcer Staging
Pressure Ulcer Management
Burns
Wound Care
Wound Cultures
Wound Vac
Rating Stars (Click)
ONCOLOGY 1
2
3
4
Risk for Infection
Symptom Management
Side Effects of Treatment
Terminal Disease
Rating Stars (Click)
INFECTIOUS DISEASE 1
2
3
4
MRSA
VRE
C. Difficile
HIV
Tuberculosis
Isolation Precautions
Rating Stars (Click)
PHLEBOTOMY/IV THERAPY 1
2
3
4
Peripheral Venipuncture for Labs
Start Ivs
Peripheral Ivs
PICC/CVP Lines
Venous Access Ports
Infusion Pump Set up and Management
Rating Stars (Click)
PSYCHIATRIC 1
2
3
4
Cognitive Disorders
Mood Disorders
Schizophrenia/Psychotic Disorders
Medication Compliance
Rating Stars (Click)
WOMEN S HEALTH/MATERNAL-INFANT CARE 1
2
3
4
Pregnancy Related Complications
Fetal Heart Tones
Contractions
Post Partum Mother/Baby Visit
Newborn Care
Phototherapy
Breast Feeding Support
Rating Stars (Click)
PEDIATRICS 1
2
3
4
Growth and Development
Respiratory Distress Syndrome
Bronchopulmonary Dysplasia
Cystic Fibrosis
Muscular Dystrophy
Spina Bifida
Spinal Surgery
Sickle Cell Disease
Trach Care/Suctioning
Ventilator Management
Rating Stars (Click)
PAIN MANAGEMENT 1
2
3
4
Verbal/Nonverbal Pain Scales
Response to Pain Management Interventions
PCA Pump
Epidural Cath/Site Monitoring/Pump
Non-Pharmacologic Pain Measures
Rating Stars (Click)
PALLIATIVE AND END OF LIFE CARE 1
2
3
4
Palliative Symptom Management
Pain Management/Response
Family Support/Teaching
After Death Protocols
Rating Stars (Click)
MEDICATIONS 1
2
3
4
Alzheimers Medications
Antiarrhythmics
Antibiotics/Antivirals
Anti-Depressants
Anti-Hypertensives
Anti-Psychotics
Anti-Seizure Medications
Benzodiazepines
Calculation of Pediatric Dosages
Coumadin
Diuretics
Enoxaparin
Inhaled Medications
Nebulizer Medications
Insulin
Opioid and Non-Opioid Analgesics
Oral Chemotherapy
Oral Hypoglycemics
Oral & Topics Nitrates
Rivaroxaban
Sedative/Hypnotics
Steroids
Rating Stars (Click)
HOME HEALTH 1
2
3
4
Intake/Admissions
Case Manager
Case Load - Pts/Day(specify)
Supervise LVNs/HHAs
Medicare/Medicaid
Long/Short Term Disability
Private Insurance
Telephonic Assessments
Management of Complaints
APS Reports
OASIS
Diagnosis Coding
Document Plan of Care
Clinical Assessment Documentation
Rating Stars (Click)
PROFESSIONAL KNOWLEDGE AND SKILLS 1
2
3
4
National Patient Safety Goals/Core Measures
Safety Assessment
Fall Assessment and Prevention
Patient/Family Teaching
Age Specific/Population Based Care
Rating Stars (Click)
EMR 1
2
3
4
Allscripts
Cerner
Epic
HomeCare Home Base
McKesson
Meditech
Other Computerized Documentation System
Rating Stars (Click)
Age Specific Competencies 1
2
3
4
Infant (Birth - 1 year)
Preschooler (ages 2-5 years)
Childhood (ages 6-12 years)
Adolescents (ages 13-21 years)
Young Adults (ages 22-39 years)
Adults (ages 40-64 years)
Older Adults (ages 65-79 years)
Elderly (ages 80+ years)