Telemetry Skills Checklist Name First Last Date MM slash DD slash YYYY Proficiency 1 = None 2 = Intermittent 3 = Experienced 1. Assessment / Patient CareGeneralAdmission 1 2 3 Advance Directives 1 2 3 Discharge Teaching 1 2 3 Organ / Tissue Donation 1 2 3 Patient / Family Teaching 1 2 3 Preoperative Teaching 1 2 3 CardiovascularGeneralAbnormal Heart 1 2 3 Auscultation (Rate / Rhythm) 1 2 3 Pulses / Circulation Checks 1 2 3 Patient ExperienceAbdominal Aortic 1 2 3 Angina 1 2 3 Cardiac Teaching 1 2 3 Cardiomyopathy 1 2 3 Cardiopulmonary Arrest 1 2 3 Carotid Endarterectomy 1 2 3 Congestive Heart Failure 1 2 3 EP Study / Ablation 1 2 3 Femoral Popliteal Bypass 1 2 3 Pacemaker Transthoracic 1 2 3 Pacemaker Permanent 1 2 3 Pericarditis 1 2 3 Cardioverter / Defibrillator Implanted 1 2 3 Post Arthrectomy (DCA) 1 2 3 Pre / Post Cardiac Cath 1 2 3 Pre / Post Cardiac Surgery 1 2 3 Pre / Post PTCA 1 2 3 Valve Replacement 1 2 3 MonitoringArrhythmia Interpretation 1 2 3 Vital Sign Monitoring 1 2 3 12 Lead EKG Interpretation 1 2 3 EKG Monitoring 1 2 3 LabsCardiac Enzymes & Isoenzymes 1 2 3 Coagulation Studies 1 2 3 BNP (Brain Natriuretic Peptide) 1 2 3 PulmonaryGeneralBreath Sounds (Adventitious) 1 2 3 Oxygenation Status 1 2 3 Rate / Work of Breathing 1 2 3 Patient ExperienceAsthma 1 2 3 Chest Tubes 1 2 3 COPD 1 2 3 Pneumonia 1 2 3 Pre / Post Thoracic Surgery 1 2 3 Pulmonary Embolism 1 2 3 Tracheostomy 1 2 3 Tuberculosis 1 2 3 MonitoringPulse Oximetry 1 2 3 LabABGs Interpretation 1 2 3 NeurologyGeneralConsciousness Level 1 2 3 Neurological Assessment 1 2 3 Reflex / Motor Functions 1 2 3 Visual / Communications Functions 1 2 3 Patient ExperienceAcute Head Injury 1 2 3 Alzheimer's Disease 1 2 3 Coma 1 2 3 CVA 1 2 3 Externalized VP Shunts 1 2 3 Halo Traction / Cervical Tongs 1 2 3 Intracranial Hemorrhage 1 2 3 Neuromuscular Disease 1 2 3 Pre / Post Neuro Surgery 1 2 3 Seizure Disorder 1 2 3 Spinal Cord Injury 1 2 3 Ventriculostomy 1 2 3 Signs / Symptoms of Increasing ICP 1 2 3 GastrointestinalGeneralG. I. Assessment 1 2 3 Assess Nutritional Status 1 2 3 Colostomy Care 1 2 3 Patient ExperienceEsophageal Bleeding 1 2 3 GI Surgery 1 2 3 Bowel Obstruction 1 2 3 GI Bleeding 1 2 3 Hepatitis 1 2 3 Liver Failure 1 2 3 Pancreatitis 1 2 3 Pancreatic Cancer 1 2 3 Liver Cancer 1 2 3 LabsLiver Function Test 1 2 3 Serum Ammonia 1 2 3 Serum Amylase 1 2 3 Renal / GenitourinaryPatient ExperienceAcute Renal Failure 1 2 3 End Stage Renal Disease 1 2 3 Hemodialysis 1 2 3 Peritoneal Dialysis 1 2 3 Pre / Post Urinary Tract Infection 1 2 3 Suprapubic Cath 1 2 3 Fistula / Shunt 1 2 3 MonitoringMeasurement of In / Out 1 2 3 Fluid Balance 1 2 3 Endocrine / MetabolicAdrenal Gland Disorders 1 2 3 Diabetics 1 2 3 Diabetic Ketoacidosis 1 2 3 Drug Overdose 1 2 3 Insulin Shock 1 2 3 Pituitary Gland Disorder 1 2 3 Thyroid Gland Disorder 1 2 3 LabsBlood Glucose 1 2 3 Thyroid 1 2 3 MusculoskeletalGeneralPulse / Circulation 1 2 3 Patient ExperienceAmputation 1 2 3 Multiple Trauma 1 2 3 Paraplegia / Quadriplegia 1 2 3 Rheumatic Arthritic Disease 1 2 3 Joint Replacement 1 2 3 Skin / Skeletal Traction 1 2 3 Immunology / Hematology / OncologyGeneralBlood Transfusion 1 2 3 Patient ExperienceAcute Leukemia 1 2 3 Anaphylactic Shock 1 2 3 Cancer 1 2 3 HIV / AIDS 1 2 3 Sepsis 1 2 3 Sickle Cell Anemia 1 2 3 Treatment Side Effects 1 2 3 Chemo / Radiation 1 2 3 LabsHematology 1 2 3 Procedures / EquipmentChest Tube Drainage 1 2 3 Doppler 1 2 3 Dressing Changes 1 2 3 Airway - Protect / Establish 1 2 3 Sheath Removal - Femoral Artery 1 2 3 Foley - 3 Way / Male - Female 1 2 3 JP - Hemovac - Penrose Drains 1 2 3 Hyper / Hypothermia Blanket 1 2 3 Oral / Naso / Pharynx Suctioning 1 2 3 Isolation 1 2 3 Tracheotomy Care / Suctioning 1 2 3 Wound Vac 1 2 3 Wound Care / Irrigation 1 2 3 Specimen CollectionsCentral Line Draw 1 2 3 Venipuncture 1 2 3 Finger Stick 1 2 3 Butterfly Stick 1 2 3 Stool 1 2 3 Sputum 1 2 3 Swab - Throat 1 2 3 Urine 1 2 3 Blood Cultures 1 2 3 Dipstick 1 2 3 AssistBedside Invasive Procedures 1 2 3 Bronchoscopy 1 2 3 Cardioversion / Defibrillation 1 2 3 Central Line Insertion 1 2 3 Chest Tube Insertion 1 2 3 Tracheotomy Emergency 1 2 3 Lumbar Puncture 1 2 3 Chest Tube Removal 1 2 3 Emergency Intubation 1 2 3 MedicationsAminophylline 1 2 3 Atopine 1 2 3 Amiodarone 1 2 3 Diltiazem (Cardizem) 1 2 3 Dobutamine (Dobutrex) 1 2 3 Dopamine (Intropin) 1 2 3 Epidural Administration 1 2 3 Epinephrine (Adrenalin) 1 2 3 Inderal 1 2 3 Lidocaine 1 2 3 Insulin Drip 1 2 3 Administration of MedicationPO Medications 1 2 3 Bladder Irrigation / Instillation 1 2 3 Needleless Systems 1 2 3 IV TherapyAdverse Reactions 1 2 3 A-Line Assist with Insertion and Maintenance 1 2 3 Heparin Locks 1 2 3 Infusion Pumps 1 2 3 Insertion Peripheral IV 1 2 3 PCA Pumps 1 2 3 IV Drips and Medications Administer 1 2 3 IV Solution / Mixing 1 2 3 BloodAdminister Blood / Blood Products 1 2 3 Albumin 1 2 3 NutritionalEnteral Administration 1 2 3 TPN 1 2 3 Procalamine 1 2 3 Tube Feeding Pumps 1 2 3 NGT Insertion 1 2 3 Oxygen AdministrationAmbu-Bag 1 2 3 Cannula - Nasal 1 2 3 Mask - Non-rebreather 1 2 3 Venti Mask 1 2 3 Portable Oxygen 1 2 3 Tracheostomy 1 2 3 Pain ManagementAssess Pain Level / Tolerance 1 2 3 Patient Controlled Anaglesia 1 2 3 Moderate Sedation 1 2 3
