The following checklist is a profile used to assess your Telemetry/Progressive Care 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 9 11% Name* First Middle Last PLEASE MARK YOUR LEVEL OF EXPERIENCE 0 - No Experience 1 - Theory/Observed Only 2 - Intermittent Experience 3 - Moderate Experience 4 – Expert General SkillsAdvanced directives01234Awareness of HCAHPS01234Patient/family teaching01234Restrictive devices (restraints)01234Lift/transfer devices01234Specialty beds01234End of life care/palliative care01234Automated Medication Dispensing System, Pyxis, Omnicell, or other01234Bar coding for medication administration01234National Patient Safety Goals01234Accurate patient identification01234Effective communication01234Interpretation & communication of lab values01234Medication administration01234Labeling01234Anticoagulation therapy01234Medication reconciliation01234Monitoring conscious sedation01234Pain assessment & management01234Use of PCA (IV, intrathecal, epidural)01234Infection control01234Universal precautions01234Isolation01234Minimize risk for falls01234Prevention of pressure ulcers01234Wound care01234Wound vac01234 Cardiac Monitoring & Emergency CareObtains 12 lead EKG01234Interpretation of rhythm strips01234Treatment of dysrythmias01234Use of rapid response teams01234Cardiac arrest/CPR01234O2 therapy & delivery01234Pulse oximetry01234Use of doppler01234IV TherapyStarting & maintaining peripheral IVs01234Blood draw: venous01234Central line care01234Blood draw: central line01234Care & management of ports01234Care & management of PICC/Groshong/Hickman01234TPN & lipids01234Administration of blood/blood products01234Administration of chemotherapy01234Monitoring chemotherapy (does not initiate)01234 OtherCare of patient with sepsis01234Diabetes mellitus01234Blood Glucose Monitoring (BGM)01234Insulin administration01234CardiovascularAssessment of heart sounds01234External & temporary pacemakers01234Management of permanent pacemaker/AICD01234Cardiovascular - Care of Patient withAngina01234CHF01234Acute MI01234Pre/post cardiac surgery (CABG & valves)01234Pre/post vascular surgery (abdominal or thoracic AA, fem-pop, carotid)01234Cardiogenic shock01234 Cardiovascular - Medication AdministrationPreparation & administration of emergency (ACLS) meds01234Inotropics (i.e. digoxin, dopamine, epinephrine)01234Antiarrythmics (beta blockers/Ca+ channel blockers)01234Antianginals (isordil/nitrates)01234Antihypertensives01234Antilipemics (“statins”)01234Diuretics01234PulmonaryAssessment of breath sounds01234Airway management/suctioning (ETT, oral, trach)01234Incentive spirometer01234Recognition & treatment of abnormal ABGS’s01234Management of chest tubes01234Heimlich valve01234Pulmonary - Care of Patient with:COPD/emphysema01234Asthma01234Tuberculosis01234Pulmonary embolism01234Pulmonary edema01234Pneumothorax01234Tracheostomy01234Pneumonia01234Thoracentesis/paracentesis01234 Pulmonary - Medication AdministrationAntihistamines01234Bronchodilators01234Expectorants & antitussives01234Use of inhalers01234Use of nebulizer treatments01234NeurologyComprehensive neuro assessment01234Glasgow coma scale01234Utilize seizure precautions/seizures01234Assist with lumbar puncture01234Neurology - Care of Patient with:TIA/CVA01234Cranial hemorrhage & hematoma01234Aspiration precautions01234Overdose/DT’s01234Spinal cord injury/trauma01234TBI (Traumatic Brain Injury)01234Pre/post neuro surgery01234Degenerative neurological disorders01234Halo traction/vest01234Neurology - Medical AdministrationAnticonvulsants (Dilantin/Neurontin/phenobarbitol)01234Antidepressants01234Antiparkinsons (Cogentin/levodopa/Sinemet)01234 GastrointestinalInsertion & management of NG tube01234Insertion & management of small bore feeding tubes (Dobhoff, Keofeed)01234Management of gastrostomy/jejunostomy tube01234Management of post surgical drains01234Gastrointestinal - Care of Patient with:GI bleed (upper/lower)01234Hepatitis01234Pre/post open abdominal surgery01234Colostomy/ileostomy01234IBS01234ERCP01234Paralytic ileus01234Gastric bypass01234Gastric banding01234Peritonitis01234Gastrointestinal - Medication AdministrationAntiulcer drugs01234Antiemetics01234Antacids01234Digestive enzymes01234 Genitourinary/RenalInsertion & maintenance of foley catheter01234Care of nephrostomy tube01234Care of suprapubic tube01234Fluid & electrolyte disturbance01234Genitourinary/Renal - Care of Patient with:UTI01234BPH01234Prostate cancer01234Nephrectomy01234Ilioconduit01234Renal Surgery01234Chronic/acute renal failure01234Hemodialysis01234Peritoneal dialysis01234GynecologyAssist with GYN exam/PAP01234GYN surgeries01234GYN malignancies01234 Progressive Care Nursing RequirementsBasic & advanced life support protocols01234Adenosine administration01234Chest tube insertion & management01234Management & D/C of arterial & venous sheaths01234Femoral hemostasis devices (femStop/vasoseal)01234Ventilator management01234Interpretation of weaning parameters01234Drug dose calculation for non-titrated IV vasoactive agents (Dobutrex/dopamine)01234Drug dose calculation for Nitrates (IV nitroglycerine)01234Drug dose calculation for Platelet inhibitors (reopro)01234Drug dose calculation for Fibrinolytics/IIb IIIa inhibitors01234Drug dose calculation for anti-arrhythmic agents (amiodarone/Cardizem/lidocaine)01234Drug dose calculation for anti-arrhythmic agents (amiodarone/Cardizem/lidocaine)01234Progressive Care Nursing Requirements - Patient Monitoring (Pre/Post Procedure)Cardioversion01234TEE01234Bronchoscopy01234EGD01234PEG placement01234Progressive Care Nursing Requirements - Patient Monitoring (During/Intra Procedure)Cardioversion01234TEE01234Bronchoscopy01234EGD01234PEG placement01234 Age 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)01234Elderly (ages 80+ years)01234CertificationsACLS Yes No Expiration Date MM DD YYYY BLS Yes No Expiration Date MM DD YYYY Other CertificationsUse the box on the right to add more rows.TypeExpiration Date Additional SkillsAdditional TrainingAdditional EquipmentAcceptanceThe information I have given is true and accurate to the best of my knowledge. In addition, I hearby authorize Fidelis Partners to release this Telemetry Profile to client institutions of Fidelis Partners in consideration of my employment with that institution.Signature
