Cardiac Echo 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)
WORK SETTINGS 1
2
3
4
Adult Acute Care
ED/ICU
Adult Outpatient
Pediatric Acute Care
Pediatric Outpatient
Rating Stars (Click)
ADULT ECHO 1
2
3
4
Routine
3-D Echo
Pedoff Probe
Transesophageal Echo
Stress Echo
Pharmacologic Stress Echo
Post-Cath Echo
Post-Surgical Echo
Imaging with Contrast Agents
Sterilization Procedures
Rating Stars (Click)
SPECIAL VIEWS 1
2
3
4
Pulmonary Veins
Hepatic Veins
Suprasternal Notch
Rating Stars (Click)
CALCULATIONS 1
2
3
4
Simpson s Rule
Proximal Isovelocity Surface Area
Distology with TDI
LV Strain/LV Volume
Rating Stars (Click)
PEDIATRIC ECHO 1
2
3
4
Routine
3-D Echo
Pedoff Probe
Transesophageal Echo
Rating Stars (Click)
PEDIATRIC ANOMALIES 1
2
3
4
Aortic Arch Abnormalities/Vascular Ring
Arch Sidedness
Coarctation of the Aorta
Coronary Artery Anomalies
Double Outlet Ventricle
Hypoplastic Heart Syndrome
Pulmonary Venous Return Anomalies
Tetralogy of Fallot
Transposition of the Great Vessels
Triscupid and Pulmonary Atresia
Truncus Arteriosis
Univentricular Heart Anomalies
Rating Stars (Click)
PEDIATRIC POST-SURGICAL SCANS 1
2
3
4
Arterial Switch
Blalock - Taussig
Damus-Kaye-Stansel
Fontan
Glenn
Konno
Mustard
Norwood
Rastelli
Sano
Sennig
Rating Stars (Click)
EQUIPMENT 1
2
3
4
Phillips/ATL (List Types)
GE (List Types)
Siemens (List Types)
Toshiba (List Types)
Hitachi (List Types)
SonoSite (List Types)
Other: List
Rating Stars (Click)
TECHNOLOGY 1
2
3
4
McKesson
Epic
Horizon
SCI- Imaging
Online Reporting
EMR Conversion
Rating Stars (Click)
MISCELLANEOUS 1
2
3
4
12 Lead ECG
Stress Testing
Holter Monitor
Rating Stars (Click)
PROFESSIONAL KNOWLEDGE AND SKILLS 1
2
3
4
National Patient Safety Goals
Supervisory /Management Experience
Isolation/Infection Prevention
Procedures for Patients on Ventilators
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)