ADEX Medical Staffing - PACU Skills Checklist

PACU Skills Checklist

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 for employment with ADEX Medical Staffing, LLC.

Proficency Scale:

1 = No Experience - Theory only

2 = Limited Experience - Infrequent

3 = Moderate Experience - Able to perform independently

4 = Proficient - Able to perform proficiently and instruct

Frequency Scale:

1 = Never Observed

2 = Less than 6 times a year

3 = 1 or 2 Times a Month

4 = Daily or Weekly

Personal Information
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	Proficiency				Frequency
Post-op care of patients with	1	2	3	4	1	2	3	4
CABG
Aneurysm with graft replacement
Cardiac Transplantation
Cardiac Valve Replacement (MVR, AVR)
Chest Tubes
Embolectomy/Thrombectomy
Endarterectomy
Laryngectomy
Open Heart Procedures
Penetrating/Open Chest Trauma
Peripheral Vascular Bypasses
Pneumonectomy/Lobectomy
Post Op Myocardial Infarction
Radical Neck Resection
Stent Placements
Thorocotomy
Tracheostomy
Vena Cava Filter
Craniotomy - Epidural
Craniotomy - Subdural
Aneurysm Clipping
Burr Holes
Evacuation of Hematoma
Intracranial Tumor Excision
Laminectomy
Spinal Fusions
Spinal Tumor Excision
Subarachnoid Screw/Bolt
Ventricular Peritoneal Shunt
Ventriculostomy
Neuromuscular Disease
Abdominal Trauma
Appendectomy
Cholecystectomy
Colon Resection
Colostomy/Ileostomy
Esophagectomy
Exploratory Laparotomy
Gastrectomy
Gastric Stapling
Hepatic Resection
Biliary Atresia
Hernia Repair
Pyloric Stenosis
Pyloroplasty
Cystectomy
Ileal Conduit
Vagotomy
Hemorrhoidectomy
AV Fistulas, Shunts & Dialysis Catheters
Nephrectomy
Prostatectomy
Renal Transplant
TURP/TURBP
Ureteral Stent Insertion
Amputations
Open Reduction/Internal Fixation
Total Joint Replacements/Arthroplasty
Adenotonsillectomy (T&A)
Adrenalectomy
Cleft Lip/Palate Repair
Facial Fractures
Sinus Surgery
Thyroidectomy
Transphenoidal Hypophysectomy
Dilation & Curettage (D&C)
Hysterectomy
Lumpectomy
Mastectomy
Oophorectomy
Orchiectomy
Salpingectomy
Laser Eye Surgery
Myringotomy
Orbital Fracture
Orbital Implant
Scleral Bucking (for Retinal Detachment)
Dacryocystectomy
TAH-BSO
Cataract Extraction
Cochlear Implant
Keratoplasty (Corneal Transplant)
Gun Shot/Stab Wound-Abdomen
Gun Shot/Stab Wound-Chest
Gun Shot/Stab Wound-Head
Plastic Surgery
Skin Flaps
Skin Grafts
Wound Debridement
Anaphylaxis
Latex Allergies

	Proficiency				Frequency
Medication Administration	1	2	3	4	1	2	3	4
Pain Management - Fentanyl
Pain Management - Demerol
Pain Management - Dilaudid
Pain Management - Morphine
Sedatives - Ativan
Sedatives - Valium
Sedatives - Versed
H2 Receptor Antagonists - Zantac
H2 Receptor Antagonists - Pepcid
H2 Receptor Antagonists - Carafate
Antiemetics - Droperidol
Antiemetics - Phenergan
Antiemetics - Zofran
Anticonvulsants (Dilantin, Phenobarbital)
Inotropes/Vasoactive Drips
Ca++ Channel Blockers (Cardizem)
Nitroglycerine
Nipride
Amiodarone
Lidocaine
Procainamide (Pronestyl)
Heparin/Coumadin
Diuretics
Steriods (Decadron, Solumedrol)
Glycoprotein IIb/IIIa Receptor Inhibitors
Narcan
Romazicon
Nebulizer Tx (Atrovent, Ventolin)
Epinephrine
Atropine
IM Injections
SQ Injections
Continuous IV Pump Infusions
Eye/Ear Instillations
Monitoring - Epidural
Monitoring - Intrathecal
Monitoring - Spinal Anesthesia
Monitoring - IV Push

	Proficiency				Frequency
Procedures/Skills	1	2	3	4	1	2	3	4
Interpretation of Arrhythmias
Performing 12 lead EKGs
Hemodynamic Monitoring - Arterial Line
Hemodynamic Monitoring - PA Catheter/Swan Ganz Catheter
Hemodynamic Monitoring - CVP Line
Interpretation of Lab Values - ABGs
Interpretation of Lab Values - CBC
Interpretation of Lab Values - Blood Chemistry
Interpretation of Lab Values - Electrolytes
Assessment/Management Fluid Balance
Management Electrolyte Disturbances
Cardiac Arrest/CPR
Cardioversion
Defibrillation
External/Temporary Pacing
Airway Management - Head Position
Airway Management - Oral/NT Airway
Airway Management - Laryngeal Mask Airway (LMA)
Airway Management - Endotracheal Tube
Airway Management - Tracheostomy
Oxygen Therapy - Nasal Cannula
Oxygen Therapy - Face Mask
Oxygen Therapy - Non-Rebreather Mask
Oxygen Therapy - Ambu Bag
Oxygen Therapy - Trach Collar
CO2 Monitoring
Intubation - assist with
Extubation - assist with
Mechanical Ventilation
Obtaining ABG's - via A-Line
Obtaining ABG's - via arterial stick
Suctioning - Oral/NT
Suctioning - ETT/Tracheostomy
Chest Tubes - Care/Maintenance
Seizure Precautions
Cervical Spine Precautions
Intracranial Pressure Monitoring (ICP)
Cerebral Perfusion Pressure (CPP)
Nasogastric Tube - Insertion/Care
Gastric Tube - Care/Maintenance
Jejunostomy Tube - Care/Maintenance
Stoma Care/Maintenance
Wound Drains - Self Suction (J-P, Hemovac)
Wound Drains - Irrigation Drains (Axiom)
Wound Drains - Tube
Wound Drains - Biliary Tube
Maintenance of - Foley Catheter
Maintenance of - Suprapubic Catheter
Maintenance of - Nephrostomy Tube
Orthopedic Traction
CPM Machine
Peripheral IV Insertion/Care
PICC Care
Blood/Blood Products - Admininstration
Blood/Blood Products - Autotransfusion
Blood/Blood Products - Volume Expander Administration
Aldrette Scoring
Malignant Hyperthermia Management
Blood Glucose Monitoring
Restraints
Blood Specimen Collection - femoral arterial stick
Blood Specimen Collection - radial arterial stick
Blood Specimen Collection - arterial line
Blood Specimen Collection - central line
Blood Specimen Collection - venous stick
Specimen Collection - Cultures
Specimen Collection - Sputum
Specimen Collection - Urine

	Proficiency				Frequency
Assessment/Other	1	2	3	4	1	2	3	4
Assess Breath Sounds
Assess Heart Sounds
Admission of patients to unit
Care Planning
Circulation Checks
Computerized Charting
Patient Teaching
Neurological Assessments
Vital Signs

	Proficiency				Frequency
Pain Management	1	2	3	4	1	2	3	4
Pain assessment using pain scales
Epidural analgesia
IV conscious sedation
Patient controlled analgesia (PCA)
Narcotic Agents
Non-narcotic agents
Non-pharmacological measures

	Proficiency				Frequency
Equipment	1	2	3	4	1	2	3	4
Automatic BP cuffs
Cardiac Monitor
Defibrillator
Glucometer
Hypo/Hyperthermia Blanket
Infusion Pumps (Specific Brands)

	Proficiency				Frequency
Age Specific Skills	1	2	3	4	1	2	3	4
Newborn (birth-30 days)
Adolescents (12 - 18 years)
Infant (30 days - 1 year)
Young Adults (18 - 39 years)
Toddler (1 - 3 years)
Middle Adults (39 - 64 years)
Preschooler (3 - 5 years)
Older Adults (64+ years)
School Age (5 - 12 years)

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The information represented above is true and correct to the best of my knowledge. I authorize ADEX Medical Staffing, LLC to share this skills checklist with its clients.
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Form Reviewed by ADEX Clinician - 11/16/2010