Med Surg Skills Checklist Please enable JavaScript in your browser to complete this form.Personal InformationName *FirstLastPlease enter your full legal name as it appears on your Social Security Card.Email *Phone No experience: requires education, training and supervision Intermittent experience: may need support or supervise Proficient: consistent experience, independent Expert level: can teach/supervise others. Work settingsLTAC1234MS/Tele1234Med/Surg1234Short Stay- 23 hour Stay Unit1234Telemetry1234Cardiac Monitoring and Emergency responseCPR/ Cardiac Arrest1234Interpretation of dysrhythmias1234Management of dysrhythmias1234Telemetry –on the unit monitoring1234Telemetry- remote monitoring1234Use of Rapid Response Teams1234CardiovascularAAA1234Angina1234Carotid Endarterectomy1234Congestive Heart Failure1234Femoral Popliteal Bypass1234Pacemakers1234Post Angiogram1234Post Cardiac Surgery1234Post MI1234Endocrine /MetabolicBlood Glucose Monitoring1234Hyperthyroidism1234Hypothyroidism1234IV insulin protocols1234Management of Hyperglycemia1234Management of Hypoglycemia1234Thyroidectomy1234GastrointestinalBariatric surgery1234Bowel obstruction1234Cholecystectomy1234Colon resection1234Colostomy care1234Feeding tube care and management1234Gastrostomy tube1234GI bleed1234GI Surgery1234Hernia repair1234Ileostomy1234Liver disease1234NG tube insertion1234Pancreatitis1234Genitourinary/RenalBladder suspension1234Continuous Bladder Irrigation1234Foley catheter insertion female1234Foley catheter insertion male1234Hysterectomy1234Interstim therapy1234Nephrectomy1234Peritoneal Dialysis1234Pre/Post Hemodialysis Management1234Pubovaginal sling procedure1234Renal failure1234Shunts and Fistula Care1234Suprapubic tube care1234TURP patients1234Urogenics1234GynecologyAnterior/Posterior Repair (Colporrhaphy)1234Myomectomy1234Oophorectomy1234Salpingectomy1234Salpingo-oophorectomy1234Total abdominal Hysterectomy1234TVT - Tension Free Vaginal Tape1234TVTO- Trans-Obturator Tape- both procedures for stress urinary incontinence1234Vaginal Hysterectomy1234Vulvectomy1234IV therapy/PhlebotomyAccessing Ports1234Blood product administration1234Central line blood draw1234Phlebotomy1234PICC line management1234Starting IVs1234TPN/Lipids1234MedicationsAnticoagulants1234Anti-Depressants1234Anti-Hypertensives1234Anti-Psychotics1234Benzodiazepines1234Emergency Medications1234Epidural analgesia1234Heparin1234Insulin1234Narcotics1234Non Narcotic analgesics1234Oral hypoglycemics1234PCA1234Automated Medication Dispensing SystemsOmnicell1234Pyxis1234Accudose1234Bar Code Medication Administration1234Neurological/PsychiatricAneurysms and repair1234CVA1234EED grid/electrode placements1234Intracranial bleeds1234Mood Disorders1234Neuromuscular disorders1234Post TPA care1234Seizure disorders1234Spinal cord injuries1234Stroke scale assessment1234Substance Withdrawal1234Traumatic Brain injury1234Pre/Post Neuro Surgery1234Laminectomy1234OncologyChemotherapy Administration1234Medical Oncology1234Monitoring Chemotherapy1234Radiation Implants1234Surgical Oncology1234OrthopedicsAmputations1234Assessment of peripheral pulses1234Cast Care1234Continuous Passive Motion Devices1234Hip Fracture1234Laminectomy1234Ortho trauma1234Peripheral nerve block catheters1234Prosthetics1234Shoulder surgery1234Total Joint Replacements1234Traction1234PlasticsAbdominoplasty1234Breast augmentation1234Breast reconstruction with implants1234Breast reconstruction with tram flap1234Breast reduction1234Skin grafts1234Surgical drains1234RespiratoryAssessment of Breath Sounds1234Chest tubes-Emerson/Pleuravac1234COPD1234CPAP/BiPAP1234Incentive Spirometry1234Interpretation of ABGs1234Nasotracheal Suctioning1234Non-invasive airway management1234Oral Suctioning1234Pneumonia1234Pneumothorax1234Pre/Post Thoracic Surgery1234Pulmonary Edema1234Pulse Oximetry1234Trachesotomy Management1234Ventilator Management1234Professional Knowledge and SkillsNational Patient Safety Goals/Core Measures1234Fall Risk assessment1234Pressure Ulcer Assessment/Prevention1234Restraint Use1234Isolation Precautions1234Infection Prevention1234Pain Assessment Management1234Wound Care/Wound Vac1234SBAR1234COMPUTERIZED CHARTINGAllscripts1234Cerner1234EPIC1234McKesson1234Meditech1234Other:1234If other, please specifyAge specific competencyNeonate1234Infant1234Child1234Adolescent1234Young Adult1234Middle Adult1234Older Adult1234Submit