Skills Checklist - Home Health - Origin Travel Nurses

Skills Checklist - Home Health

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GENERAL SKILLS*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Standard Precautions
Isolation Precautions.
Pediatric Respiratory/Cardiac Arrest
Adult Respiratory/Cardiac Arrest
Defibrillators
Care Planning & Discharge Planning
Patient/Family Education
Pain Management
Patient Head to Toe Assessment
Electronic Documentation

GENERAL SKILLS - TYPES OF ELECTRONIC DOCUMENTATION:
(if applicable)

CARDIOVASCULAR - Assesssment:*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Angina
Apical Pulse Rate/Rhythm
Cardiac Auscultation (Rate, Rhythm)
Clinical Identification of Arrhythmias
Fluid Overload
Peripheral Pulses/Circulation Checks

CARDIOVASCULAR - Interpretation of Lab Results:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
PT/PTT/INR
Serum Electrolytes.
CARDIOVASCULAR - Equipment & Procedures:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Holter Monitor
Pacemaker/AID

CARDIOVASCULAR - Care of Patient With:*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Hypotension
CAD/Post Myocardial Infarction (MI)
Congestive Heart Failure (CHF)
Fluid Retention
Hypertension
Pre/Post Cardiac Surgery
Pre/Post Vascular Surgery

CARDIOVASCULAR - Medication Administration:*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
ACE Inhibitors
Anti-arrhythmic
Antibiotics.
Anticoagulants
Antihypertensives
Antiplatelet Medications
Beta Blockers
Calcium Channel Blockers
Diuretics
Digoxin (Lanoxin)
Oral and Topical Nitrates
Narcotics
Potassium Supplements
Statin Medications

PULMONARY - Assessment:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Auscultation of Lung Sounds/Rate & Work of Breathing
Pulse Oximetry
ABGs

PULMONARY - Equipment & Procedures:*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Administration of O2 via Nasal Cannula
Apnea Monitor
Chest Percussion
Establishing an Airway
Incentive Spirometry
Orotracheal and Nasotracheal Suctioning
Sputum Specimen Collection
Nebulizer
CPAP
BiPAP
Ventilator Management

PULMONARY - Care of Patient With:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Asthma
Chronic Obstructive Pulmonary Disease (COPD)
Lung Cancer
Primary Pulmonary Hypertension
Pulmonary Fibrosis
Pulmonary Emboli
PULMONARY - Medication Administration:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Bronchodilators
Steroids
Expectorants
Inhalers
NEUROLOGICAL - ASSESSMENT:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Neurological Signs/Level of Consciousness (LOC)
Neuro-Motor/Sensory Functions
NEUROLOGICAL - Equipment & Procedures:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Seizure Precautions
Traction

NEUROLOGICAL - Care of Patient With:*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Alzheimer’s Disease
Dementia
Degenerative Neurological Disorders (ALS, MS, etc.)
Cerebral Tumors
Post-Cerebrovascular Accident
Guillain-Barre Syndrome
Hemiparesis
Meningitis
Parkinson’s Disease
Seizure Disorders
Paraplegia/Quadriplegia
Traumatic Brain Injury (TBI)
Transient Ischemic Attacks (TIAs)

NEUROLOGICAL - Medication Administration:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Alzheimer’s Medications
Anti-Parkinson’s Medications
Anti-Seizure Medications
Corticosteroids
Sedative/Hypnotics
ORTHOPEDICS - ASSESSMENT:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Incision Checks
Circulation/Skin Checks
Gait
Range of Motion
ORTHOPEDICS - Equipment & Procedures:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Range of Motion (Active & Passive)
Cast/Brace
Crutch/Walking
Assistive Devices
TENS Units
Wheelchairs/Lift Equipment.
Total Hip/Knee/Joint Replacement
ORTHOPEDICS - Medication Administration:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Enoxaparin (Lovenox)
GASTROINTESTINAL - Assessment:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Bowel Habits
Fluid Balance.
Nutritional Status
GASTROINTESTINAL - Equipment & Procedures:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Colostomy/Ileostomy Care
Long-Term Feeding Tube
Nasogastric (NG) Tube
PEG/Gastronomy Tube
Drainage Devices/Tubes
Tube Feeding
Feeding Pumps

GASTROINTESTINAL - Care of Patient With:*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Bowel Obstruction
Fecal Incontinence
Gastrointestinal Bleeding (G.I. Bleed)
Post-Gastrointestinal Surgery
Hepatitis
Inflammatory Bowel Disease
Liver Failure/Transplant

RENAL/GENITOURINARY - Assessment:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Arterio-Venous Fistula/Shunt
Fluid Balance
RENAL/GENITOURINARY - Interpretation of Lab Results:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Blood Urea Nitrogen (BUN)
Serum Creatinine
Serum Electrolytes

RENAL/GENITOURINARY - Equipment & Procedures:*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
3-Way Bladder Catheter
Foley Catheter Insertion/Maintenance
Straight Catheterization
Self-Catheterization
Ileostomy
Irrigations
Nephrostomy Tube
Suprapubic Catheter

RENAL/GENITOURINARY - Care of Patient With:*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Hemodialysis (Receiving in an Out Pt. Clinic Setting)
Home Hemodialysis
Peritoneal Dialysis
Post-Bladder Surgery
Post-Prostate Surgery
Shunts and Fistulas
Urinary Incontinence

ENDOCRINE/METABOLIC - Assessment:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Diabetic Skin Assessment*
Hyper- and Hypoglycemia*
ENDOCRINE/METABOLIC - Interpretation of Lab Results:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Hemoglobin A1C
Serum Glucose
ENDOCRINE/METABOLIC - Equipment & Procedures:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Glucometers
Insulin Pumps
ENDOCRINE/METABOLIC - Care of Patient With:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Diabetes
Post-Tranplantation Surgery
ENDOCRINE/METABOLIC - Medication Administration:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Insulin
Oral Hypoglycemics
WOUND/SKIN CARE MANAGEMENT - Assessment:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Wound Assessment Scale
Skin Assessment
Surgical Wound Healing
Skin Grafts.

WOUND/SKIN CARE MANAGEMENT - Equipment & Procedures:*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Burns.
Care of Pressure Ulcers
Dry and Wet to Dry Dressing Changes
Positioning of Patients
Specialty Beds
Special Mattresses and Positioning Devices
Wound Care (Sterile)
Wound Cultures
Wound Irrigations
Wound Vac

WOUND/SKIN CARE MANAGEMENT - Care of Patient With:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Burns
Pressure Ulcers
Surgical Wounds
Skin Grafts
ONCOLOGY - Assessment:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Immune Status
Symptoms Management
Signs/Symptoms of Infection.
ONCOLOGY - Interpretation of Lab Results:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
CBC with Differential
CMP
ONCOLOGY - Equipment & Procedures:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Reverse Isolation
ONCOLOGY - Care of Patient With:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Radiation Therapy
Leukemia/Lymphoma
Post-Oncology Surgery
ONCOLOGY - Medication Administration:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Oral Chemotherapy
Intravenous Chemotherapy Administration
Intravenous Chemotherapy Monitoring
Bone Marrow Stimulating Agents
INFECTIOUS DISEASE - Assessment:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Signs/Symptoms of Infection
INFECTIOUS DISEASE - Interpretation of Lab Results:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Blood Counts
Culture and Sensitivity
INFECTIOUS DISEASE - Equipment & Procedures:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Isolation Precautions
INFECTIOUS DISEASE - Care of Patient With:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
C. Diff
HIV Infection
Tuberculosis
MRSA/VRE
INFECTIOUS DISEASE - Medication Administration:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Antibiotics
Antivirals
Anti-HIV
Immunizations
PSYCHIATRY - Assessment:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Monitoring Symptoms
Compliance with Medications
PSYCHIATRY - Care of Patient With:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Cognitive Disorders
Schizophrenia/Psychotic Disorders
Substance-Related Disorders
Mood Disorders (Anxiety/Depression, etc)
WOMEN’S HEALTH/MATERNAL-INFANT CARE - Assessment:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Fetal Heart Tones
Contractions

WOMEN’S HEALTH/MATERNAL-INFANT CARE - Care of Patient With:*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Breast Feeding
Pregnancy-Related Complications
Post-Mastectomy
Post-Partum Mother/Baby Visit
Newborn Care
Bulb Suctioning
Cord and Circumcision Care
Phototherapy

PEDIATRICS - Assessment:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Growth
Development Stages
Nutrition.
Family/Caregiver Interaction
PEDIATRICS - Equipment & Procedures:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Calculations of Pediatric Dosages
Croup Tent
Ventilator
Trach
Pediatric Ambu
Near Drowning
Pre- and Post-Cardiac Surgery

PEDIATRICS - Care of Patient With:*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Broncho Pulmonary Dysplasia
Cystic Fibrosis
Respiratory Distress Syndrome (RDS)
Reye’s Syndrome
Pre- and Post-Spinal Surgery
Sickle Cell Disease
Spina Bifida

PAIN MANAGEMENT - Assessment:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Pain Scale
Response to Pain Management Interventions
PAIN MANAGEMENT - Equipment & Procedures:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Pharmacologic Pain Relief
Non-pharmacologic Pain Relief Measures
PCA Pump
PAIN MANAGEMENT - Care of Patient With:*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Epidural Catheter/Site Monitoring/Pump
Patient Controlled Analgesia
PALLIATIVE AND END-OF-LIFE CARE*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Family Support and Teaching
Medication Protocols
Symptom Management
After Death Protocol and Management
PATIENT AND FAMILY TEACHING*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Diabetic
Pre- and Post-Procedure
Post-partum/Infant Care
Medications
Monitoring
Nutrition
Safety
Self-care
Equipment
Resources

MISCELLANEOUS*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
APS/ CPS Reporting
Fall Assessment and Prevention
National Patient Safety Goals
Safety Assessment
Recognizing Failure to Thrive Across the Lifespan
Advanced Directives
Wheelchairs/Lift Equipment

CASE MANAGEMENT*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Experience as a Case Manager
Case Load
Supervision of Home Health Aides

EXPERIENCE WITH*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Long-term/Short-term Disability
Management of Complaints
Medicare/Medicaid
Pre-certifications
Private Insurance
Telephone Assessments
Utilization Review
Workman’s Compensation

DOCUMENTATION*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Diagnosis Coding (ICD Coding)
Document Plan of Care (Form 485)
OASIS Documentation

Age Group Experience*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Newborn (birth - 30 days)
Infant (30 days - 1 year)
Toddler (1 - 3 years)
Preschooler (3 - 5 years)
School Age (5 - 12 years)
Adolescents (12 - 18 years)
Young Adults (18 - 39 years)
Middle Adults (39-64 years)
Older Adults (64+ years)

Do you speak any languages other than English?*
- No
If yes, enter languages above, separated by commas.
Confirmation*
- I attest that the information I have given is both true and, to the best of my knowledge, represents an accurate self assessment of my professional skills and/or education.
Signature
Date
MM slash DD slash YYYY

Skills Checklist - Home Health

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	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Range of Motion (Active & Passive)
Cast/Brace
Crutch/Walking
Assistive Devices
TENS Units
Wheelchairs/Lift Equipment.
Total Hip/Knee/Joint Replacement

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Blood Urea Nitrogen (BUN)
Serum Creatinine
Serum Electrolytes

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Oral Chemotherapy
Intravenous Chemotherapy Administration
Intravenous Chemotherapy Monitoring
Bone Marrow Stimulating Agents