GASTROENTEROLOGY / ENDOSCOPY Skills Checklist

1 GASTROENTEROLOGY / ENDOSCOPY Skills Checklist Questions? Let us know! Email: Web: Contact: (800)-292-4097. Please refer bottom for FAX numbers. Name _____. Last Middle First The following Checklist is used to assess your experience and Skills and help your Nurse Advisor place you in the proper assignment. Please provide a self-assessment of your Skills using the following guidelines: 1 - No experience 2 - Require training 3 - Have performed this task and able to perform without supervision 4 - Most experienced and able to perform independently I understand that the information provided in this application is true to the best of my knowledge. I authorize the release of the information in this document to Nurses 24/7 and facilities where I may be employed. _____ _____.

2 Signature Date General Skills 1 2 3 4 1 2 3 4. Conscious Sedation Reversal Meds Assistance or Assessment of: Informed Consent Active GIB. Interpretation of Arrhythmias Bronchoscopy IV Access / Care Collection of Hot / Cold BX's Central Lines (CVC, Hickman, Groshong) Colonoscopy Dialysis Catheter EGD. Implanted Ports Endoscopic Ultrasound Obtaining Peripheral Access ERCP. Knowledge and Practices for Radiation Esophageal Ballooning Safety Esophageal Dilatation Lift and Transfer Devices Flexible Sigmoidoscopy National Patient Safety Goals Manometry Studies Obtain and Interpret 12 Lead EKGs Patient / Family Teaching Pre / Post PEG Placements Procedure Polypectomy Performs Allen Test Rigid Proctoscopy Portable Monitors / Defibrillators Sclero Therapy Universal Precautions Sphincterotomy Use and Safety with Patient Restraints TEE.

3 Variceal Banding FAX Numbers: Broward: - 954-491-2437 | Palm Beach: - 561-684-0265 | Dade:-305-651-9297. New York: - 212-837-7945 | Long Island: - 516-222-5514 | Providence/Boston:-401-383-9710. MD:-410-337-2197 | North Jersey- 973-696-1964 | South Jersey/Philly:-800-630-6011. 2006 Nurse Staffing LLC. | Page 1 of 2. GASTROENTEROLOGY / ENDOSCOPY Skills Checklist Questions? Let us know! Email: Web: Contact: (800)-292-4097. Please refer bottom for FAX numbers. 1 2 3 4 Pediatric Procedures: 1 2 3 4. Equipment: Bicap Unit Pediatric Peg Cart Cytology Brushes Pediatric Scope Equipment Decompression Tubes Proper EGD Scopes According to Age Dilators - Balloon Dilators - Maloney Specimen Collections: Dilators - Savory 1 2 3 4. Endo Pump Biopsies Esophageal Banding Cytology Forceps Immuno Suppressed Protocol Foreign Body Equipment Gold Probe / Injector Needles Misc Skills : Jejunal Tubes 1 2 3 4.

4 Naso - Enteric Tubes Proper Scope Cleaning Polyp Snares Proper Use of Scope Washers Replacement Gastrostomy Buttons Storing Scopes Replacement Gastrostomy Tubes Use of Leak Tester Procedures: Apply External Abdominal Pressure to Assist with Scope Movement Experience: Cautery Devices 1 2 3 4. Scope Cleaning Outpatient Set Up of Scopes and Video Equipment Free Standing Clinic Specimen Collection and Labeling Community Hospital Pre - Procedures: Rural Hospital Airway Management Monitor EKG, O2 SATS, and VS using Teaching Hospital Sedation Recovery Scale Pre - Procedure Checklist Age Specific Care: Post - Procedure: 1 2 3 4. Assess GI Status Post Procedure Newborn (Birth to 30 days). Assess for Gag Reflex Post EGD. Infant (30 days to 1 year). Toddler (1 to 3 years). Young Children (3 to 6 years).

5 Manometry / Diagnostic Testing: Older Children (7 to 12 years). 1 2 3 4. Adolescents (13 to 20 years). 24 Hour PH Ambulatory Study Young Adults (21 to 39 years). Esophageal Manometry Middle Adults (40 to 60 years). Liver BX Older Adults (61+ years). Paracentesis FAX Numbers: Broward: - 954-491-2437 | Palm Beach: - 561-684-0265 | Dade:-305-651-9297. New York: - 212-837-7945 | Long Island: - 516-222-5514 | Providence/Boston:-401-383-9710. MD:-410-337-2197 | North Jersey- 973-696-1964 | South Jersey/Philly:-800-630-6011. 2006 Nurse Staffing LLC. | Page 2 of 2.