Telemetry 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)
CARDIAC 1
2
3
4
Acute Coronary Syndrome
Congestive Heart Failure
Post Open Heart (12-24 hours)
Carotid Endarterectomy
Post Vascular Surgery
Heart Transplant
Pacemaker - Temporary/Permanent
Pacemaker - Epicardial
Sheath Removal
Heart Sounds
Rating Stars (Click)
PULMONARY 1
2
3
4
Pneumonia
Respiratory Distress
COPD
Breath Sounds
Post Thoracic Surgery
Chest Tube Placement & Management
Trach Management
Modes of Ventilation (AC/PC/SIMV/CPAP)
Intubation/Extubation
External CPAP/BiPAP
Interpretation of Arterial Blood Gases
Rating Stars (Click)
NEUROLOGIC & PSYCHIATRIC 1
2
3
4
Stroke Scale Assessment
CVA
Brain Injury
Post Craniotomy
Spinal Cord Injury
Seizure Disorders
ETOH/Drug Withdrawal
Rating Stars (Click)
GASTROINTESTINAL 1
2
3
4
GI Bleeding
GI Surgery
Liver Failure
Pancreatitis
Liver Transplant
Pancreas Transplant
Rating Stars (Click)
RENAL/GENITOURINARY 1
2
3
4
Renal Failure
Renal Surgery
Renal Transplant
Arteriovenous Fistula/Shunt
Nephrostomy Tubes
Peritoneal Dialysis
Rating Stars (Click)
ENDOCRINE METABOLIC 1
2
3
4
Diabetes - Hypo/Hyperglycemic Crisis
Pituitary Disorders
IV Insulin Protocols
Indwelling Insulin Pumps
Rating Stars (Click)
MEDICATIONS 1
2
3
4
Anti-Arrhythmics
Anticoagulants (IV, oral, & injection)
Anti-Hypertensives
Anti-Psychotics
Anti-Seizure Medications
Benzodiazepines
Procedural Sedation
Diuretics
Emergency Medications
Inhaled Medications
Insulin
Titrate Vasoactive Drips
Manage Vasoactive Drips - No Titration
Narcotics/Opioid Analgesics (IV, oral, & injection)
Nitrates (Oral & Topical)
Non-Opioid Analgesics (IV, Oral, & Injection)
Reversal Agents
Steroids (IV, Oral, Inhaled)
Automated Medication Dispensing (i.e. Pyxis, Omnicell)
Rating Stars (Click)
IV THERAPY 1
2
3
4
Starting Ivs
Central Line Blood Draws
Central Line/Implanted Line Care
Arterial Line Management
TPN & Lipids
Blood Product Administration
Administration of Chemotherapy
Rating Stars (Click)
CARDIAC MONITORING & EMERG. RESPONSE 1
2
3
4
Dysrhythmia Interpretation
Dysrhythmia Management
Obtain 12 Lead EKG
Interpret 12 Lead EKG
Cardioversion
Defibrillation
Malignant Hyperthermia
Rating Stars (Click)
PROFESSIONAL KNOWLEDGE AND SKILLS 1
2
3
4
National Patient Safety Goals/Core Measures
Fall Risk Assessment/Prevention
Pressure Ulcer Risk Assessment/Prevention
Restraints/Use of Least Restrictive Device
Patient/Family Teaching
Age Specific/Population-Based Care
Isolation Precautions
Infection Prevention
Pain Assessment & Management
Charge Experience
Interpretation and Communication of Lab Values
Specialty Beds
Rating Stars (Click)
EMR 1
2
3
4
Epic
Cerner
Eclipsys
McKesson
Meditech
Other Computerized System
Computerized Physician Order Entry
Bar Coding for Medication Administration