Skills Checklist - OR Technician - Origin Travel Nurses

Skills Checklist - Surgical Tech (CST)

Name
First Last
Phone
Email
EXPERIENCE*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Endoscopy
ENT
General Surgery -
GYN
Neuro
Opthamology
Oral
Ortho
Plastics
Thoracic/open heart
Transplant
Trauma
Urology
Vascular

EAR, NOSE, & THROAT*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Adenoidectomy
Caldswell - Luc
Cleft lip/palate repair
Closed reduction nasal fracture
Laryngectomy
Mandibulectomy
Maxillary advancement with hip graft
Myringoplasty
Myringoplasty with PE tube insertion
Open reduction facial fracture
Open reduction nasal fracture
Radical neck dissection
Rhinoplasty/septoplasty
Stapedectomy
Tonsillectomy
Tracheostomy
Tympanoplasty

ENDOSCOPIC PROCEDURE*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Bronchoscopy
Colonscopy
Cystoscopy
Esophagoscopy
Gastroscopy
Hyteroscopy
Laprascpoic Procedures
General Surgery
Hickman/Groshong/Portacatch insertion
Imperforate anus reconstruction
Lumbar sympathectomy
Omphalocele repair
Pilonidal cyctectomy
Portal caval shunt
Pyloric stenosis
Radical mastectomy
Saphenous vein ligation & stripping
Sentinel node biopsy
Splenectomy
Thyroglossal duct cyst excision
Thyroidectomy
Tracheostomy.
Vagotomy

GYNECOLOGY*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Vaginectomy/Vulvectomy

NEUROSURGERY*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
A-V malformation
Anterior cervical fusion
Anterior laparoscopic spine procedures
Anterior lumbar interbody fusion (ALIF )
Burr holes for subdural hematoma
Cervical sympathectomy
Craniectomy for decompression fracture
Insersion nerve stimulators/medication pumps
Laminectomy
Posterior lumbar interbody fusion(PLIF)
Shunt procedure/VP,VA/LP
Spine fusion
Ulnar nerve transfer

OPTHAMOLOGY*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Opthamology Proficiency
ORAL*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Oral Proficiency

ORTHOPEDICS*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Acetabular/peivic QRIF
Achilles tendon repair
Amputation - leg, arm
Anterior cruciate ligament repair
Application of halo traction
Arthrotomy
Bipolar/unipolar hips
Bunionectomy
Calcaneal reconstruction
Carpal tunnel release
Application of external fixators
Arthroscopy
Hip compression nails & leg screws
Total joint replacements / revisions
Intramedullary rods

PLASTICS*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Abdominal lipectomy
Blepharoplasty
Face lift
Scar revisions
Split thickness skin grafting
Tissue expanders
Mammoplasty
THORACIC & OPEN HEART*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Pacemaker implantation - endocardial
Pacemaker implantation - myocardial
Open heart procedures
Transplant.
TRAUMA*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Gunshot/Stab wounds
UROLOGY*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Adult circumcision
Cystectomy
Cystoscopy/ureteroscopy
Nephrectomy
Nephrolithotomy
Orchiopexy
Pyeioplasty
Radical node dissection
TURP
Vasectomy
Vasovasostomy

VASCULAR*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
A - V access graft
Aortic aneur ysm with graft replacement
Endarterectomy/carotid - femoral
Peripheral vascular bypass procedure
Thrombectomy/embolectomy
Vena cava fitter/umbrella

EQUIPMENT*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Eye Magnet
Fiber optic luminator - list types
Flash autoclave - AMSCO
Mesh graft
Microscopes, types
Nerve stimulator
Orthopedic arm board with drain
Sterad machine
Steri-vac aeration cabinet, 3M, portable
Steris unit
Suction unit, disposable
Tele-thermometer
Ultrasonic cleaner - AMSCO
Vac-pac positioner
Vacuum curettage
Washer sanitizer - AMSCO
Washer sterilizer - AMSCO
Bair Hugger
Blood/fluid warmer
Cidex soak
Electrosurgical unit
Emerson thoracic pump
Ethylene oxide sterilizer - AMSCO

MEDICATION ADMINISTRATION*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Bleomycin (Blenoxane)
Carmustine (BiCNU)
Cistplatin
Corticosteroids
Coumadin/Heparin
Cyclophosphamide (Cytoxan)
Decardron
Dilantin
Dopamine
Doxorubicin (Adriamycin)
Epogen/Neupogen
Etoposide (VP-16-213)
Fluorouracil (5-FU)
Fluxuridine (FUDR)
Hydroxyurea (Hydrea)
Melphalan (Alkeran)
Methotrexate (Amethopterin)
Mitomycin (Mutamycin)
Titrate Morphine
Usulfan (Myleran)
Vinblastine (Velban)
Vincristine (Oncovin)

PROCEDURES/SKILLS - INTRAVENOUS THERAPY*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Peripheral line insertions -
Assessment of IV site -
Care of IV Extravasation -

PROCEDURES/SKILLS - INTRAVENOUS THERAPY*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Peripheral line insertions
Assessment of IV site
Care of IV Extravasation
TPN
Antibiotics
Antifungals/Antivirals
IV Push
Oral Chemotherapy
IM Injections
SQ Injections
Intrathecal
Continuous Narcotic Infusion
Suctioning - Oral
Suctioning - Nasotracheal
Tube Feeding
NG Tube Insertion
GastrostomyJejunostomy Tube Care
Colostomy/Enterostomal Care
Ileostomy Care
Platelet Precautions

PROCEDURES/SKILLS - INTRAVENOUS THERAPY (BLOOD/BLOOD PRODUCTS)*
Rarely Some Experience Proficient Trainer / Preceptor N/A
PRBCs
Platelets
FFP
Leukocytes/WBC
PROCEDURES/SKILLS - FOLEY CATHETER*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Insertion/Care
Irrigations
Suprapubic Catheter Care

PROCEDURES/SKILLS - CHEST TUBE & DRAINAGE SYSTEM*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Set up
Assist with insertion
Care & maintenance
Troubleshooting
Removal
Thoracentesis - assist
Paracentesis - assist
Liver Biopsy - assist
Bone Marrow Biopsy - assist
Central Line Placement - assist
Skin Care
Immunosuppression/Laminar Airflow

PROCEDURES/SKILLS - VENOUS ACCESS DEVICES*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Hickman/Broviac/Groshong
PICC lines
Site Care/Dressing Changes
Assist with Insertion
Declot Occluded Ports/Catheters
Temporary Repair of Catheters
Flush Lumens
Change Caps
Obtain Blood Specimens

PROCEDURES/SKILLS - VASCULAR ACCESS PORTS*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Port-a-Cath
Opti-Port
S.E.A. Port
Omega Port
Chemo Port
Access the Catheter Port
Flush Catheter
Troubleshooting/Maintain Patency
Obtain Blood Specimens.
Patient/Family Teaching

RADIATION THERAPY*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
External Radiotherapy
Total Body Irradiation
Intraoperative Radiation Therapy
IORT Implants
Brachytherapy
Radiation Safety Procedures
Patient/Family Teaching.
Management of Side Effects

BONE MARROW TRANSPLANT*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Peripheral Blood Stem Cells
Autologous BMT
Allogeneic BMT
Patient/Donor Education
Infection
Graft Rejection
GVHD Graft vs. Host Disease
Venocclusive Disease
Pneumonitis

EQUIPMENT - AMBULATORY INFUSION PUMPS*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Cormed
Auto Syringe
Pharmacia
Pancretec
Synchromed
Patient/Family Teaching of
Automated Med. Dispensing Systems
Automatic BP cuffs
Computer Charting Systems

EQUIPMENT - IMPLANTABLE INFUSION PUMPS*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Infusaid Implantable Pump
Medtronic
Glucometer/Accucheck
Isolation
PCA Pumps
Pressure Relief Devices
Pulse Oximetry
Reverse Isolation

PSYCHOSOCIAL CARE/SUPPORT*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Identify/Refer to Resources Available
Participation in Support Groups
Palliative Care
Advanced Directives
Death & Dying Counseling
Hospice Care
Support During Ethical Decision Making
Family Support

PAIN MANAGEMENT*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Pain assessment using pain scales
Epidural analgesia
IV conscious sedation
Patient controlled analgesia (PCA)
Narcotic Agents
Non-narcotic agents
Non-pharmacological measures

ASSESSMENT/OTHER*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Admission of patients to unit
Assess Breath Sounds
Assess Heart Sounds
Care Planning
Charge Nurse responsibilities
Circulation Checks
Computerized Charting
Manage Cytotoxic Spills
Neurological Assessments
Patient Teaching - General re: Oncology
Universal Precautions
Vital Signs

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)

YEARS EXPERIENCE IN CLINICAL
Specialty
Most recent facility worked at
Do you speak any languages other than English?*
- No
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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
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Skills Checklist – OR Technician

Skills Checklist - Surgical Tech (CST)

YEARS EXPERIENCE IN CLINICAL

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	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Endoscopy
ENT
General Surgery -
GYN
Neuro
Opthamology
Oral
Ortho
Plastics
Thoracic/open heart
Transplant
Trauma
Urology
Vascular

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Abdominal lipectomy
Blepharoplasty
Face lift
Scar revisions
Split thickness skin grafting
Tissue expanders
Mammoplasty

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Adult circumcision
Cystectomy
Cystoscopy/ureteroscopy
Nephrectomy
Nephrolithotomy
Orchiopexy
Pyeioplasty
Radical node dissection
TURP
Vasectomy
Vasovasostomy

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Infusaid Implantable Pump
Medtronic
Glucometer/Accucheck
Isolation
PCA Pumps
Pressure Relief Devices
Pulse Oximetry
Reverse Isolation