Pediatric 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 Meds/ IV TherapyOrthopedicAdminister PO MedicationsCrutch WalkingAdminister NG MedicationsCast Care/Spica CastAdminister IM & SQ MedsAdminister Eye/Ear MedsCare of Patient with:Peripheral IV InsertionAmputationMix IV Infusion w/ AdditivesSkeletal TractionUse ofHeparin/ Saline LocksPost Harrington Rod InsertionNeedle-less SystemsInfusion PumpsCardiacDiscontinue Peripheral IV'sUse of Cardiac MonitorsPain Assessment/ManagementInterpretation of ArrhythmiasAssist with CodeVascularDefibrillation/Cardioversion Draw Blood for Lab StudiesCardiac Arrest/CPRA dminister Blood & Blood ProductsPreparation of Emergency MedsHyperalimentation/TPNA rterial LinesCentral Venous Lines (CVL)CVL's Dressing ChangeCare of Patient with.

2 Hickman/Broviac CathetersCongestive Heart FailureIntake and OutputCongestive Heart Defects/DiseaseAssess for Edema/Fluid OverloadPre/Post Cardiac CathPeripheral PulsesPre/Post Cardiac SurgeryUltrasonic DopplerHeart TransplantNeurologyGastrointestinalNeuro Assessment/Vital SignsAssess Bowel SoundsGlascow Coma ScaleInsertion/Monitoring NG TubesAssist with Lumbar PunctureInsertion/Monitoring OG TubeIntracranial Pressure MonitoringAssist w/ Bottle & Breast FeedingSeizure PrecautionsTube Feedings via Flexible TubesUse of AnticonvulsantsGastrostomy Tube FeedingPediatric Skills Checklist Pediatric Skills Checklist Page 2of 3 ProficiencyScale1234 ProficiencyScale1234 Care of Patient with:Care of Patient with:Open/Closed Head InjuryGastroenteritisInternal/External ShuntsGE RefluxSpinal Cord InjuryCleft Lip/PalateMeningitis/EncephalitisColosto my CareOverdose/ IngestionAbdominal Wounds & DrainsNear DrowningFailure to ThriveSpina BifidaReye's SyndromeCare of Patient with.

3 Battered Child SyndromeNephrostomy TubeShunts & FistulasHematology/OncologyRenal FailureLeukemiaRenal TransplantAIDSH emodialysisHemophiliaPeritoneal DialysisBone Marrow TransplantNephrotic SyndromeSickle Cell DiseaseChemotherapyGeneral NursingAdmit & Orient PatientsRespiratoryDischarge PatientsSuctioning & Bulb SyringeSupervise Unlicensed PersonnelAssist w/ Intubation (ETT)Vitals Sign MonitoringETT ExtubationPulse OximetryVentilate with Ambu-bagUrine DiptickApnea monitorBlood Glucose MonitoringNebulizerWound Care/DebridementDressing ChangesOxygen DeliveryWound Drains (JP/Hemovac)IsolettePositioning/Transfer ringHood/TentRestraintsNasal CannulaIsolation TechniquesFace MasksVentilatorsOtherInterpret ABG'sPre-Operative Care/PreparationChest TubesConscious SedationChest PercussionPost-Anesthesia Care:Care of Patient with:GeneralAsthmaEpiduralApiglottitis & TonsillitisMultiple Trauma Patients Pediatric Skills Checklist Page 3of 3 ProficiencyScale1234 ProficiencyScale1234 Bronchiolitis (RSV)Liver TransplantsCroupDiabetic Teaching/CarePneumoniaDepressionTracheos tomyAnorexia/BulimiaBronchopulmonary Dysplasia (BPD)Suicidal Threats/ActionsCystic FibrosisPostmortem CareTrachea-Esophageal FistulaGenitourinaryStraight/Foley Cath MaleStraight/Foley Cath FemaleAge Specific CompetencyAble to ensure a safe and caring environment for the specific age groups indicated below; able tocommunicate 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)SchoolAge (5-12 yrs)Adolescents (12-18 yrs)Young Adults (18-39 yrs)Middle Adults (39-64 yrs)Older Adults (64 yrs +)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) _____