PCU Skills Checklist Name First Last Email Date MM slash DD slash YYYY Please check the box(es) below for each group for which you have provided safe and age appropriate care: New born / Neonatal (Birth - 30 Days) Infant (30 Days - 1 Year) Toddler (1 - 3 Years) Preschoolers (3 - 5 Years) School Age Children (5 - 12 Years) Adolescents (12 - 18 Years) Young Adults (18 - 39 Years) Middle Adults (39 - 64 Years) Older Adults (64 - 79 Years) Elderly (80+ Years) Please indicate your level of experience: 1 = Theory, No Practice 2 = Intermittent Experience 3 = One-Two Years Current Experience 4 = Two Plus Years of Experience; Can Function IndependentlyGeneral Patient CareAdmission 1 2 3 4 Advanced Directives 1 2 3 4 Charge Nurse Experience 1 2 3 4 Collect Appropriate Data 1 2 3 4 Discharge Teaching 1 2 3 4 Organ / Tissue Donation 1 2 3 4 Patient and Family Teaching 1 2 3 4 Preoperative Teaching 1 2 3 4 Computerized Documentation 1 2 3 4 CardiacAbnormal Heart Sounds/Murmurs 1 2 3 4 Apical Pulse 1 2 3 4 Auscultation (Rate/Rhythm) 1 2 3 4 Capillary Refill 1 2 3 4 Color 1 2 3 4 Pulses/Circulation Checks 1 2 3 4 Abdominal Aortic 1 2 3 4 Aneurysm 1 2 3 4 Acute MI 1 2 3 4 Angina 1 2 3 4 Cardiac Tamponade 1 2 3 4 Cardiac Teaching 1 2 3 4 Cardiomyopathy 1 2 3 4 Cardiopulmonary Arrest 1 2 3 4 Carotid Endarterectromy 1 2 3 4 Congestive Heart Failure 1 2 3 4 Endocarditis 1 2 3 4 EP Study & Ablation 1 2 3 4 Femoral Popliteal Bypass 1 2 3 4 Heart Transplant 1 2 3 4 Hypertension 1 2 3 4 Hypovolemic Shock 1 2 3 4 Multi-System Organ Failure 1 2 3 4 Myocardial Contusion 1 2 3 4 Pacemaker-External 1 2 3 4 Pacemaker-Permanent 1 2 3 4 Pacemaker-Temporary 1 2 3 4 Pacemaker-Transthoracic (Epicardial) 1 2 3 4 Pericarditis 1 2 3 4 Post AICD Insertion 1 2 3 4 Pre/Post Cardiac Cath 1 2 3 4 Pre/Post Cardiac Surgery 1 2 3 4 Pre/Post PTCA/Stents 1 2 3 4 Valve Replacement 1 2 3 4 Ventricular Assist Device (RVAD or LVAD) 1 2 3 4 Monitoring12 Lead EKG 1 2 3 4 Interpretation 1 2 3 4 Arrhythmia Interpretation 1 2 3 4 Arterial Line 1 2 3 4 CVP Monitoring 1 2 3 4 EKG Monitoring 1 2 3 4 LabsBNP 1 2 3 4 Cardiac Enzymes & Isoenzymes 1 2 3 4 Coagulation Studies 1 2 3 4 Troponin 1 2 3 4 PulmonaryAdventitious Breath Sounds 1 2 3 4 Assess Lungs Sounds 1 2 3 4 Oxygenation Status 1 2 3 4 Rate and Work of Breathing 1 2 3 4 Acute Pneumonia 1 2 3 4 ARDS 1 2 3 4 Asthma 1 2 3 4 Chest Trauma 1 2 3 4 Chest Tube 1 2 3 4 COPD 1 2 3 4 Inhalation Injuries 1 2 3 4 Lobectomy 1 2 3 Lung Transplant 1 2 3 4 Near Drowning 1 2 3 4 Pre/Post Thoracic Surgery 1 2 3 4 Pulmonary Edema 1 2 3 4 Pulmonary Embolism 1 2 3 4 Status Asthmaticus 1 2 3 4 Tension Pneumothorax 1 2 3 4 Tracheostomy 1 2 3 4 Tuberculosis 1 2 3 4 Pulse Oximetry Monitoring 1 2 3 4 ABGS Lab 1 2 3 4 NeurologicalGlasgow Coma Scale 1 2 3 4 Level of Conciousness 1 2 3 4 Reflex/Motor Deficits 1 2 3 4 Visual/Communication Deficits 1 2 3 4 Acute Head Injury 1 2 3 4 Alzheimer's Disease 1 2 3 4 CNS Infection 1 2 3 4 Coma 1 2 3 4 CVA 1 2 3 4 DTS 1 2 3 4 Encephalitis 1 2 3 4 Halo Traction/Cervical Tongs 1 2 3 4 Increased ICP 1 2 3 4 Intracranial Hemorrhage 1 2 3 4 Laminectomy 1 2 3 4 Meningitis 1 2 3 4 Metastatic Tumor 1 2 3 4 Multiple Sclerosis 1 2 3 4 Neuromuscular Disease 1 2 3 4 Pre/Post Neuro Surgery 1 2 3 4 Seizure Disorder 1 2 3 4 Spinal Cord Injury 1 2 3 4 TIAs 1 2 3 4 Tumor Resection 1 2 3 4 Ventriculostomy 1 2 3 4 GastrointestinalBowel Sounds 1 2 3 4 Colostomy Care 1 2 3 4 G.I. Assessment 1 2 3 4 Abdominal Wounds and Surgeries 1 2 3 4 Blunt Trauma 1 2 3 4 Bowel Obstruction 1 2 3 4 Colostomy 1 2 3 4 Esophageal Bleeding 1 2 3 4 GI Bleeding 1 2 3 4 Hepatitis 1 2 3 4 Ileostomy 1 2 3 4 Inflamatory Bowel Disease 1 2 3 4 Jejunostomy Tube 1 2 3 4 Liver Cancer 1 2 3 4 Liver Failure 1 2 3 4 Treatment Side Effects Chemo/Radiation 1 2 3 4 Pancreatic Cancer 1 2 3 4 Pancreatitis 1 2 3 4 Paralytic Ileus 1 2 3 4 LFTs Lab 1 2 3 4 Serum Ammonia Lab 1 2 3 4 Serum Amylase Lab 1 2 3 4 Nutritional Status Monitoring 1 2 3 4 Renal/GenitourinarySkin Tugor 1 2 3 4 Acute Renal Failure 1 2 3 4 End Stage Renal Disease 1 2 3 4 Hemodialysis 1 2 3 4 Nephrectomy 1 2 3 4 Nephrostomy Tube 1 2 3 4 Peritoneal Dialysis 1 2 3 4 Renal Transplant 1 2 3 4 Suprapubic Cath 1 2 3 4 V Fistula/Shunt 1 2 3 4 Fluid Balance Monitoring 1 2 3 4 Measurement I & O Monitoring 1 2 3 4 Bun & Creatinine Lab 1 2 3 4 Serum Electrolytes Lab 1 2 3 4 Endocrine/MetabolicDiabetic 1 2 3 4 Diabetic Ketoacidosis 1 2 3 4 Drug Overdose 1 2 3 4 Insulin Shock 1 2 3 4 Blood Glucose Lab 1 2 3 4 Thyroid Studies Lab 1 2 3 4 MusculoskeletalCast Care 1 2 3 4 Circulation/Pulse Checks 1 2 3 4 Amputation 1 2 3 4 External Fixation 1 2 3 4 Joint Replacements 1 2 3 4 Multiple Trauma 1 2 3 4 Paraplegia 1 2 3 4 Rheumatoid Arthritic Disease 1 2 3 4 Immunology/Hematology/OncologyBlood Transfusions 1 2 3 4 Acute Leukemia 1 2 3 4 Cancer 1 2 3 4 Disseminated Intravascular Coagulation 1 2 3 4 HIV/AIDS 1 2 3 4 Treatment Side Effects Chemo/Radiation 1 2 3 4 Sepsis 1 2 3 4 Hematology Lab 1 2 3 4 Wounds/IntegumentS/S Infection Assessment 1 2 3 4 Skin Assessment 1 2 3 4 Burns 1 2 3 4 Staged Decubitus Ulcers 1 2 3 4 Stasis Ulcers 1 2 3 4 Surgical Wounds w/ Drains 1 2 3 4 Skin Breakdown Monitoring 1 2 3 4 Medications AdministrationAdminister IM and SQ Meds 1 2 3 4 Administer PO Medications 1 2 3 4 Bladder Irrigation and Instillation 1 2 3 4 Needleless Systems 1 2 3 4 IV TherapyAssess/Maintain IV Insertion Site 1 2 3 4 PICCs 1 2 3 4 Inserting IVs 1 2 3 4 Multi-Lumen Central Venous Catheters 1 2 3 4 BloodAdminister Blood/Blood Products 1 2 3 4 Albumin 1 2 3 4 Nutritional TherapyDobhoff Insertion 1 2 3 4 Enteral Administration 1 2 3 4 Gravity/Bolus Tube Feedings 1 2 3 4 J-Tube 1 2 3 4 NGT Insertion 1 2 3 4 PEG 1 2 3 4 TPN and Hyperalimentation 1 2 3 4 Oxygen AdministrationAmbu-bag 1 2 3 4 Nasal Cannula 1 2 3 4 Nebulizer Treatments 1 2 3 4 Non-Rebreather Mask 1 2 3 4 Portable Oxygen 1 2 3 4 Tracheostomy Tube 1 2 3 4 Venti Mask 1 2 3 4 Pain ManagementAssess Pain Level/Tolerance 1 2 3 4 Epidural Anesthesia/Analgesia 1 2 3 4 Moderate Sedation 1 2 3 4 Patient Controlled Analgesia 1 2 3 4 Ramsey Scale 1 2 3 4 Procedures/EquipmentChest Tube Drainage Systems 1 2 3 4 Doppler 1 2 3 4 Drains (JP-Hemovac-Penrose) 1 2 3 4 Dressing Changes 1 2 3 4 Establish/Protect Airway 1 2 3 4 Femoral Artery Sheath Removal 1 2 3 4 Foley 1 2 3 4 Hyper/Hypothermia Blanket 1 2 3 4 Incentive Spirometry 1 2 3 4 Isolation 1 2 3 4 Specialty Beds 1 2 3 4 Sterile Dressing Changes 1 2 3 4 Suction (ET-Oral-Trach-Nasal) 1 2 3 4 Universal Precautions 1 2 3 4 Wound Care/Irrigations 1 2 3 4 Wound Vac 1 2 3 4 Specimen CollectionArterial Line Draw 1 2 3 4 Butterfly Stick 1 2 3 4 Central Line Draw 1 2 3 4 Clean Catch Urine 1 2 3 4 Cultures-Blood 1 2 3 4 Dip Stick 1 2 3 4 Finger Stick 1 2 3 4 Stool 1 2 3 4 Sputum 1 2 3 4 Sterile Urine 1 2 3 4 Throat Swabs 1 2 3 4 Venipuncture 1 2 3 4 Assisting withBedside Invasive Procedures 1 2 3 4 Bronchoscopy 1 2 3 4 Cardioversion/Defibrillation 1 2 3 4 Central Line Insertion 1 2 3 4 Chest Tube Insertion 1 2 3 4 Chest Tube Removal 1 2 3 4 Emergency Tracheostomy 1 2 3 4 ET Intubation and Extubation 1 2 3 4 Lumbar Puncture 1 2 3 4 Open Chest Emergency 1 2 3 4 Pericardiocentesis 1 2 3 4 Paracentesis 1 2 3 4 Temporary Pacemaker Insertion 1 2 3 4 Thoracentesis 1 2 3 4 Transesophogeal Echocardiogram 1 2 3 4 Critical Care SettingsInterventional Unit 1 2 3 4 PCU 1 2 3 4 Stepdown 1 2 3 4 Tele 1 2 3 4 Joint CommissionNational Safety Goals 1 2 3 4 "Do Not Use" Abbreviations and Terms 1 2 3 4
