NICU / Neonatal Skills Checklist Name First Last Title Date MM slash DD slash YYYY Certification DatesBCLS MM slash DD slash YYYY ACLS MM slash DD slash YYYY Chemo MM slash DD slash YYYY PALS MM slash DD slash YYYY Level of Proficiency 1 = Knowledgeable 2 = Experienced 3 = Very Experienced Charge DutiesLEVEL I Newborn Normal Nursery 1 2 3 LEVEL II 1 2 3 LEVEL III Neonatal ICU 1 2 3 LEVEL IV Neonatal ICU 1 2 3 At Delivery to Receive Newborn 1 2 3 Admission / AssessmentMaternal History 1 2 3 Regular Preparation for Transport 1 2 3 Reverse Interfacility Emergency Transport 1 2 3 Enteric Identifying Infant 1 2 3 Gestational Age 1 2 3 Urine Output 1 2 3 Weight-Scale / Bed Scale 1 2 3 Universal Collect Cord Blood Samples 1 2 3 Skin Care / Cord Care 1 2 3 Blood Pressure 1 2 3 Temperature 1 2 3 Respiratory Monitor 1 2 3 CVP Lines and Dressing Changes Head, Chest, Length, Abdominal Measures 1 2 3 Apgar Scoring 1 2 3 FOC 1 2 3 Silverman Scoring 1 2 3 Administration Assessment of Parent-Infant attachment 1 2 3 Fontanels 1 2 3 Computer Charting / Documentation 1 2 3 SkinIdentification of Jaundice 1 2 3 Pediatric Identification of Cyanosis 1 2 3 Identification of Dehydration 1 2 3 Administration of Silver Nitrate 1 2 3 Administration of Vitamin K 1 2 3 Chemstrip / Dextrostic 1 2 3 Vital SignsTemperature (Ear) 1 2 3 Shock Management Apical Pulse 1 2 3 Blood Pressure:Locations 1 2 3 Electronic 1 2 3 Doppler 1 2 3 RespiratorySuctioning with Bulb Syringe 1 2 3 Suction with Suction Cather 1 2 3 Identification of Respiratory Distress 1 2 3 Use of Oxygen with:Mask & Bag 1 2 3 Hood 1 2 3 Ventilator (CPAP/PEEP/IMV/Jet Vent) 1 2 3 Continuous Positive Airway Pressure 1 2 3 Pulse Oximeter 1 2 3 Oxygen Analyzer 1 2 3 Knowledge of Surfactant 1 2 3 Chest Physiotherapy 1 2 3 Apnea Records 1 2 3 Assessment of Retractions & Nasal Flaring 1 2 3 Blood GassesSet Up CVP Line Peripheral Arterial Venipuncture 1 2 3 Care of CVP Line Arterialized Capillary 1 2 3 Obtaining CVP Reading Endotracheal Intubation 1 2 3 Recognize Abnormal Measurement Reinsertion of Tracheostomy Tubes 1 2 3 Discontinuing a Central Line Needle / Syringe Aspiration of Pleural Cavity to R/O Pneumothorax 1 2 3 Chest TubesCare of Tubes 1 2 3 Assist w/ Emergency Insertion 1 2 3 Medical AdministrationReconstitution of Powdered Meds 1 2 3 Calculation of Safe Dosage Range 1 2 3 Calculation of Neonatal Dosages 1 2 3 Method, Interactions, Incompatibilities and Side Effects 1 2 3 Eye Prophylaxis 1 2 3 Routine Neonatal Drugs 1 2 3 Emergency Neonatal Drugs 1 2 3 Insertion of Scalp Vein IV 1 2 3 Intramuscular Injections 1 2 3 IV Push 1 2 3 IV Piggyback 1 2 3 Intravenous Therapy 1 2 3 Peripheral Venipuncture 1 2 3 Umbilical Artery / Venous Line 1 2 3 Total Parenteral Nutrition Including Intralipids 1 2 3 Infusion Pumps 1 2 3 Blood and Blood Component Therapy 1 2 3 NutritionFresh MI Basic Requirements 1 2 3 GI Bleed Breast Feeding 1 2 3 Bottle Feeding 1 2 3 Gavage Feeding 1 2 3 Insertion of Feeding Tubes 1 2 3 Evaluation OfCardiac Monitor 1 2 3 Laboratory Values 1 2 3 Respiratory Monitor 1 2 3 X-Ray Reports 1 2 3 Use of Radiant Warmer 1 2 3 GenitourinaryDioxin Insertion of Foley Cath 1 2 3 Circumcision 1 2 3 Urostomy 1 2 3 Disorders of External Organs 1 2 3 Malformation of GU Tract / Kidney 1 2 3 GastrointestinalAssess Bowel Sounds 1 2 3 Bowel Obstruction 1 2 3 Stool Test 1 2 3 Cleft Lip / Cleft Palate 1 2 3 Respiratory / Cardiac Emergencies and Arrests 1 2 3 Post-abdominal Surgery 1 2 3 Colostomy / Ileostomy 1 2 3 GI Bleeding 1 2 3 Feeding Dysfunction 1 2 3 Major Birth Defects 1 2 3 NeurologicalManagement of Neonate w/ Seizures 1 2 3 Management of Neonate under Sedation 1 2 3 Assess Neurological Status 1 2 3 Assess Hearing 1 2 3 Assess Eyes 1 2 3 Assess Pain 1 2 3 Brain Death / Organ Procurement 1 2 3 Spina Bifida 1 2 3 Meningitis 1 2 3 OtherParent / Infant Bonding 1 2 3 Consents - Procedural / Treatment 1 2 3 Consents - Immunization 1 2 3 Preoperative Care 1 2 3 Postoperative Care 1 2 3 Discharge Training 1 2 3 Bereavement / Postmortem Care 1 2 3 Age Specific SkillsNewborn (Birth - 30 days) 1 2 3 Infant (30 days - 1 year) 1 2 3 Toddler (1 - 3 years) 1 2 3 School Age (5 - 12 years) 1 2 3 Adolescents (12 - 18 years) 1 2 3 Young Adults (18 - 39 years) 1 2 3 Middle Adults (39 - 64 years) 1 2 3 Older Adults (64 & Older) 1 2 3