Respiratory Therapy Competency Checklist - Procel …

1 DIRECTIONSP lease place a check mark next to each question to provide us and the1 = No Experienceinterested facilities with an assessment of your clinical experience. 2 = Some Experience One box must be checked for each skill listed. 3 = Experienced 4 = Very Experienced Print Name: _____Date: _____Last 4 Digits of Social Security Number: _____BASIC Respiratory Therapy & TREATMENTS1234 Aerosol for Medication Acom Nebulizers Hand Held Nebulizers Twin Jet NebulizersAerosol Set-up for Trach Patients Briggs T-Pierce Trach MasksChest Physical Therapy Flutter Incentive Spirometry IPV Percussion, Vibration & Postural Drainage Therapy VestIPPB Treatments AP5 Bird TV2 PNebulizers Cold Heated "Heated Aerosols" Ultrasonic NebulizersOxygen Therapy Analyze Oxygen Fi02 Calculating Remaining Time in Individualized 02 Tank Change Regulator from Empty Tank to Full Tank (any size)

2 Respiratory Therapy Skills PAGE 1 Respiratory Therapy Competency ChecklistEXPERIENCE Respiratory Therapy Self Assessment1 = No Experience2 = Some Experience 3 = Experienced 4 = Expert - Can TeachBASIC Respiratory Therapy & TREATMENTS1234 Oxygen Therapy Continued: Oxygen Set-Up Aerosol Mask Nasal Airway Nasal Cannula Oral Airway Peak Flow Regulation Trach Venturi MasksRESPIRATORY Therapy MEDICATIONSA lbuterol (Proventil, Ventolin)Anti-Asthmatics IV (aminophylline) Inhalers (Azmacort)Atropine SulfateColi-MycinCombiventCromolyn Sodium (Intal)DecadronD-NaseGentamycinIntalIsoe tharine (Bronkosol)Isoproteronol (Isuprel)Medihalers/Metered Dose InhalersMetraproterenal (Alupent)MucomystPetsmidineRacemic Epinephrine (Vaponefrin)Spacers (InsperEase, Aerochamber TM)SteroidsSurfadantTerbutaline Sulfate (Brickanyl)

3 TobramycinVancerilRespiratory Therapy Skills PAGE 2 EXPERIENCE Respiratory Therapy Self Assessment1 = No Experience2 = Some Experience 3 = Experienced 4 = Expert - Can TeachSPECIFIC SKILLS CONTINUED:1234 Complete Lab WorkFlow Volume LoopStress TestingSuction Endotrachael TubesTracheostomy SuctioningUse 02 AnalyzerVentilate Patient with Manual Resuscitator (BMV)VENTILATOR PROCEDURESA ssist ControlBlowbyBi-papCPAPF lowbyIMVI nverse Ratoio VentilationMechanics of Ventilators F/VT Negative Inspiratory Force Tidal Volume VE Vital CapacityPEEPP ressure SupportTrouble ShootingWeaning: Negative Inspiratory Force Tidal Volume Vital CapacityVENTILATORS8400 STIA dult StarBear 1000 Bear 3 BiPAP (Non-Invasive Ventilator)BirdEmmersonRespiratory Therapy Skills PAGE 3 EXPERIENCE Respiratory Therapy Self Assessment1 = No Experience2 = Some Experience 3 = Experienced 4 = Expert - Can TeachVENTILATORS CONTINUED.

4 1234 Helium/Oxygen (Heliox) Non-Ventilated VentilatedIMT (Inspiratory Muscle Trainer)Nellcor Puritan Bennet 7200 SeriesNellcor Puritan Bennet 740 Newport E 150 Newport E 200 Passy Muir Valve (Talking Valve)PB 840 PDP's (Pathways, Protocols)Servo 300 Servo 900 CNEONATAL/PEDIATRIC ICUA ssist in High Risk DeliveryECMON asal CPAPP ressure ManometerTranscutaneous MonitoringUmbilical Artery CathetersAGE SPECIFIC PRACTICE CRITERIAA. Newborn/Neonate (Birth 30 Days)F. Adolescents (12-18 years)B. Infant ( 30 days - 1 year)G. Young adults (18-39 years)C. Toddler (1-3 years)H. Middle adults (39-64 years)D. Preschooler (3-5 years)I. Older adults (64 years+)E. School age children (5-12 years)EXPERIENCE WITH AGE GROUPS:Able to adapt care to incorporate growth and developmentA B C D E F G H IAble to adapt method and terminology to patient instructionsto their age, comprehension and maturity B C D E F G H ICan ensure a safe environment reflecting specific needs of various B C D E F G H IRespiratory Therapy Skills PAGE 4 EXPERIENCEP lease circle the letter for each age group for which you have expertise in providing age-appropriate nursing care.

5 Are you BCLS Certified? YESNOExp Date: _____Are you ACLS Certified? YESNOExp Date: _____Are you PALS Certified? YESNOExp Date: _____Are you NRP Certified? YESNOExp Date: _____Additional Certifications:Certification: _____Exp Date: _____Certification: _____Exp Date: _____Have had ONE year of experience in this area within the last THREE years. YES NO_____Nurse SignatureDate_____Agency (Name/Title)DateRespiratory Therapy Skills PAGE 5 Credentialing and Expiration Dates