The following checklist is a profile used to assess your Surgical Assistant proficiency and assist in matching your skills with available assignments. Your employment is not dependent upon responses given on this checklist. Please rate your ability as accurately as possible by checking the appropriate option. Step 1 of 6 16% Name* First Middle Last PLEASE MARK YOUR LEVEL OF EXPERIENCE 0 - No Experience 1 - Theory/Observed Only 2 - Intermittent Experience 3 - Moderate Experience 4 - ExpertWork SettingsInpatient hospital01234Level 1 trauma center01234Outpatient setting01234General SkillsAdvanced directives01234Awareness of HCAHPS01234Patient/family teaching01234Restrictive devices (restraints)01234Lift/transfer devices01234Patient positioning01234National Patient Safety Goals01234Accurately identify patient/surgical site verification01234Effective communication01234Interpretation & timely communication of lab values01234Labeling (medications & specimens)01234Medication reconciliation01234Anticoagulant therapy01234MDRO HAI01234Hand hygiene WHO/CDC01234CLABSI infections01234CAUTI prevention01234Identify patient suicide risk01234Universal protocol01234Surg site infection control01234General SurgeryAbdominal perineal resection01234Adrenalectomy01234Bowel resection01234Cholecystectomy/cholangiogram01234 General Surgery Cont.Colostomy/ileostomy01234Gastrectomy01234Herniorrhaphy-femoral/inguinal01234Hiatal herniorrhaphy transabdominal01234Pancreatectomy01234Organ procurement01234Radical mastectomy01234Saphenous vein ligation/stripping01234Splenectomy01234Thyroidectomy01234Vagotomy01234GynecologyCaesarean section01234Dilation & curettage01234Hysterectomy - vaginal01234Hysterectomy - abdominal01234Radium insertion01234Shirodkar procedure01234Termination of pregnancy01234Tubal ligation01234Vaginectomy01234Endoscopic ProceduresBronchoscopy01234Endo/colonoscopy01234Culdoscopy01234Cystoscopy01234Esophagoscopy01234Gastroscopy01234Hysteroscopy01234Laparoscopic ProceduresAppendectomy01234Cholecystectomy01234Colon resection01234Hernia repair01234Salpingo-oophorectomy01234Tubal ligation01234 Laparoscopic Procedures Cont.Vaginal hysterectomy01234Laryngoscopy01234Mediastinoscopy01234Pelviscopy01234Sigmoidoscopy01234Thoracoscopy01234UrologyCircumcision01234Cystoscopy/ureteroscopy01234Cystectomy01234Hypospadias repair01234Implants01234Lithotripsy01234Nephrectomy01234Orchiectomy01234Prostatectomy01234Ureterolithotomy01234TURP01234Vasectomy01234OrthopedicAchilles tendon repair01234Amputation01234Arthroscopy/anthrotomy01234Closed pinning & reduction of extremities01234External compression devices01234Hip compression nails & lag screws01234Total joint replacement - knee, hip, shoulder01234Spica cast01234ORIF - shoulder, hip, humerus01234Repair of dislocation01234Patellectomy01234Tendon implants & reanastomosis01234 NeurologyA-V malformation01234Laparoscopic spine procedures01234Burr holes for subdural hematoma01234Carotid ligation01234Cervical sympathectomy01234Cranioplasty01234Craniotomy01234Disectomy/laminectomy01234Halo traction application01234Insertion of nerve stimulator devices01234Myelomeningocele repair01234Shunt procedure VP/VA/LP01234Spinal fusions01234Ventriculostomy01234PlasticsAbdominal lipectomy01234Blepharoplasty01234Face lift01234Mammoplasty01234Augmentation01234Reduction01234Reconstructive01234Liposuction01234Otoplasty01234Scar revisions01234Skin grafting01234OpthalmologyCataract extraction01234IOL implants01234Corneal transplant01234Orbital implant01234Enucleation01234Repair orbital blowout fracture01234Repair of retinal detachment01234Scleral buckle01234 Ear, Nose, & ThroatCaldwell-luc01234Cleft lip/palate repair01234Laryngectomy01234Radial neck disection/resection01234Tonsillectomy & adenoidectomy01234Mandibulectomy01234Mastoidectomy01234Rhinoplasty/septoplasty01234Sinusotomy01234Tracheostomy01234VascularAngiography01234A-V access graft01234Aortic aneurysm: abdominal01234Endarterectomy: carotid01234Peripheral vascular bypass procedures01234Thrombectomy01234Embolectomy01234Vena cava ligation01234Thoracic/CardiovascularAortic femoral bypass graft01234Femoral popliteal bypass01234Pacemaker implantation/explantation01234Care of patients with pacemakers01234Care of patients with IABP01234Septal defects, ASV, VSD01234Coronary artery bypass graft01234Valve replacement01234Aortic aneurysm: thoracic01234Thoracotomy01234Lobectomy01234Rib resection01234Endoscopic vein harvesting01234Off pump bypass01234 TransplantBone01234Bone marrow01234Corneal01234Harvesting01234Heart/lung01234Kidney01234Liver01234Multi organ01234Pancreas01234Skin01234TraumaBurns01234Gunshot/stab wound01234Motor Vehicle Accidents01234Traumatic amputations01234EquipmentCamera/video systems01234Cell saver01234Cidex soak01234Cryo ophthalmic unit01234CUSA01234Drills & saws01234Electrosurgical unit01234Fiber optic laminator01234Cavitron01234Autoclave01234Fracture tables01234Stapling devices01234Mesh graft/dermatone01234Microscopes01234Nitrogen tank01234Pneumatic tourniquet01234Steris unit01234Pulsevac irrigation01234Autotransfusion systems01234Laser equipment01234Care of scopes & fiberoptic equipment01234Venodyne robotics (Da Vinci)01234EquipmentPosition patient per surgeon's order01234Pressure point padding01234Apply tourniquest as ordered01234Protect from nerve damage01234Thermorgulation01234Use of fracture table01234Use of head stabilizer01234Use of body stabilizer01234Use of c-arm extensions01234Skin assessmnet01234Use of retractors01234Packing with sponges01234Digital manipulation of tissue01234Suctioning, irrigaiton, sponging01234Manipultaion of surgical materials (loops, tags)01234Clamping/cauterizing vessels or tissues01234Tying/ligating clamped vessles or tissues01234Apply hemostatic clips01234Place local hemostatic agents01234Direct digital pressure01234Assist in volume replacement01234Assist in autotransfusion01234Suturing all wound layers including muscle & fascia01234Wound dressing: liquid or spray occlusive01234Absorbent immobilizing dressing01234Assist to secure drainage system to tissue01234Insert/remove Foley01234Drape patient01234Electrocautery mono01234Electrocautery bipolar01234Cut tissue01234Harvest saphenous vein, including skin incision01234Dissect common femoral artery and bifurcate01234Insert drainage tubes01234Age Specific CompetenciesNewborn/neonate (birth-30 days)01234Infant (31 days-1 year)01234Toddler (ages 2-3 years)01234Preschool (ages 4-5 years)01234School age (ages 6-12 years)01234Adolescent (ages 13-21 years)01234Young adult (ages 22-39 years)01234Adult (ages 40-64 years)01234Older adult (ages 65-79 years)01234Please List Any Additional SkillsSkillsTrainingEquipmentThe information I have given is true and accurate to the best of my knowledge. In addition, I hearby authorize Fidelis Partners to release this Critical Care Profile to client institutions of Fidelis Partners in consideration of my employment with that institution.SignatureSign using your mouse or finger (if on a mobile or tablet device) to draw your signature.
