Mother/Baby Skills Checklist - Freedom Staffing

1 Page 1of 3 This assessment is for determining your experience in the below outlined clinical areas. This Checklist will not be used as a determining factor in accepting your application to become an employee of Freedom SCALE1. No Experience 2. Need Training 3. Able to perform with supervision 4. Able to perform independentlyProficiencyScale1234 ProficiencyScale1234 Care of the NewbornMeds/IV Therapy(Mother)Ballard ScaleAdministerIM & SQ MedsBlood Glucose MonitoringAdminister IV MedicationsBulb SuctionAdminister PO MedicationsCircumcision CareAdminister RhoGAMC ircumferencesMix IV Infusion w/ AdditivesCollect Heelstick Blood SamplesNeedle-Less SystemsCord CareNeonatal InjectionsCPR -NeonatePeripheral IV InsertionCulture Suspect Infectious NeonateUse of Heparin/Saline LocksDischarge ProceduresDubowitz ScaleAdminister/MonitorIV Infusions.

2 Eye ProphylaxisAdminister Blood/PRBC'sIdentifying InfantAdminister Plasma/AlbuminIncubator/IsolettesAntibio ticsJaundice/Phototherapy TreatmentAssess Pain LevelLengthCare of Central LineMother/Baby Skills Self EvaluationDiscontinue Peripheral IV'sNewborn Assessment:Draw Blood From Central LineReflexesDraw Perip. Blood for LabsSkin Care -BatheHeparinTest Stool for BloodOxytocin induction/augmentationThermoNeutral EnvironmentUrine Output/Collect SpecimensCare of Patient with:Vital SignsConscious SedationWeightEpidural AnesthesiaPatient Controlled Anesthesia (PCA)Postpartum Assessment:Bladder DistentionPostpartum CareBreast EngorgementMaternal HistoryDeep Vein ThrombosisMaternal Vital SignsEdemaFundus Consistency/Location: Mother/Baby Skills ChecklistMother/Baby Skills ChecklistPage 2of 3 ProficiencyScale1234 ProficiencyScale1234 LochiaCare of the Patient withManage Postpartum PainAssist/Instruct BottlefeedingPerineumAssist/Instruct BreastfeedingAssist/Instruct Use of Breast PumpsInitiate Post-Anesthesia Care.

3 AsthmaAdult CPR / Assist with CodeCardiac DiseaseApply Ice to PerineumContraceptive CounselingBlood Glucose MonitoringDiabetesC-Section Incision CareDischarge TeachingEpiduralFamily-Centered Maternity CareEpisiotomy CareInfant Safety / Car SeatsGeneralInfectious DiseaseInsert Straight/Foley CatheterKnown Substance AbuseIntake and OutputMultiple Births Provide/Instruct Perineal CareParent/Infant BondPulse Oximetry Setup/MonitoringPost-Tubal LigationSitz BathsPregnancy Induced HTN/PreeclampsiaSpinalUrine DipstickVital Sign MonitoringAge Specific CompetencyAble to ensure a safe and caring environment for the specific age groups indicated below; able to communicate and instruct patients from various age groups; able to evaluate age-appropriate behavior and SCALE1234 Newborn (birth-30 days)Infant (30 days-1 yrs)Toddler (1-3 yrs)Preschooler (3-5 yrs)School Age (5-12 yrs)Adolescents (12-18 yrs)Young Adults (18-39 yrs)Middle Adults (39-64 yrs)Older Adults (64 yrs +) Mother/Baby Skills ChecklistPage 3of 3 The information represented above is true and correct to the best of my knowledge.

4 I also authorize FreedomHealthcare Staffing to share the above Skills Checklist with its hospital _____Date_____Name (Printed) _____