Wound Care 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
Acute Care – Adult
Clinic – Adult
SNF/LTAC/Subacute
Hospice / Palliative Care
Acute/Long Term Care – Pediatrics
Clinic – Pediatrics
Rating Stars (Click)
PRESSURE ULCERS 1
2
3
4
Assessment
Staging
Prevention/ Risk Assessment Tools –Adult
Prevention/ Risk Assessment Tools -Pediatrics
Support Surface Selection
Rating Stars (Click)
NEUROPATHIC ULCERS 1
2
3
4
Assessment
Management
Rating Stars (Click)
VENOUS STASIS ULCERS 1
2
3
4
Assessment
Management
Rating Stars (Click)
PERIPHERAL ARTERIAL ULCERS 1
2
3
4
Assessment
Ankle Brachial Index
Management
Rating Stars (Click)
OTHER WOUNDS 1
2
3
4
Fistulae – Pouching / Skin Care
Skin Care/ Management of Drains
Rating Stars (Click)
WOUND DEBRIDEMENT 1
2
3
4
Autolytic
Enzymatic
Mechanical
Sharp
Rating Stars (Click)
DRESSINGS/ TREATMENTS 1
2
3
4
Hydrogels
Hydrocolloids
Silver Products
Foams
Alginates
Vacuum Assisted Closure
Growth Factors
Skin Substitutes
Hyperbaric Oxygen Therapy
Wound Cultures
Electrical Stimulation
Enzymatic Debriding Agents
Mist Therapy
Rating Stars (Click)
COLOSTOMY / ILEOSTOMY 1
2
3
4
Ostomy Equipment Selection
Continence Skin Care Management
Loop with Rod Stoma
End Stoma
Mucous Fistula
Double Barrel Stoma
Irrigation
Ileal Lavage
Rating Stars (Click)
CONTINENT ILEOSTOMY 1
2
3
4
Knock pouch
Pelvic Pouch
Rating Stars (Click)
UROSTOMY / CONTINENT 1
2
3
4
Catherization for C&S
Knock Pouch
Neobladder
Rating Stars (Click)
CONTINENCE THERAPEUTIC DEVICES 1
2
3
4
Vaginal Cones
Penile Clamps
Male External Catheters
Internal Urethral Inserts
Catheters –Mgmt & Self Care Teaching
Magnetic Therapy
Urinary Incontinence Program
Fecal Incontinence Program
Rating Stars (Click)
BURNS 1
2
3
4
Burn Management
Rating Stars (Click)
PROFESSIONAL KNOWLEDGE AND SKILLS 1
2
3
4
National Patient Safety Goals/ Core Measures
Patient Family Teaching
Age Specific/Population Based Care
Isolation Precautions
Infection Precautions
Pain assessment & Management
Interpretation & Communication of Lab Values
EMR
EPIC
Cerner
Eclipsys
McKesson
Other Computerized System
Computerized Physician Order Entry
Bar coding for Medication
Culture
Rating Stars (Click)
OTHER / MISC. 1
2
3
4
Pain Management Assessment of Pain Levels without intervention
Pain Management Response Assessment with Intervention
Experience: Charge Duty
Experience: Preceptor
Rating Stars (Click)
AGE SPECIFIC CARE 1
2
3
4
Infant (Birth to 1 year)
Toddler (1-3 years)
Pre-school (3-6 years)
School Age (6-12 years)
Adolescent (12-18 years)
Young Adult (18-30 years)
Mature Adult (30-60 years)
Elderly (>60 years)