OBS / GYNE COMMON ANTI-MICROBIALS (Infusion or Oral) MUSCULOSKELETAL / INTEGUMENTARY COMMON NEBULIZED MEDICATIONS

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1 INDEX: SKILLS/COMPETENCIES MEDICATION ADMINISTRATION AIRWAY / BREATHING PREPARATIONS CIRCULATION MEDICATIONS IV PUSH CARDIOVASCULAR MEDICATIONS IV INFUSION NEUROLOGICAL BLOOD and BLOOD PRODUCTS EAR, EYE, NOSE AND THROAT COLLOIDAL SOLUTIONS GU/GI COMMON INFUSIONS OBS / GYNE COMMON ANTI-MICROBIALS (Infusion or Oral) MUSCULOSKELETAL / INTEGUMENTARY COMMON NEBULIZED MEDICATIONS ENVIRONMENTAL FIBRINOLYTIC / THROMBOLYTIC AGENTS TOXICOLOGY OTHER MEDICATIONS PSYCHIATRY PEDIATRICS INFECTION CONTROL 1

2 SKILLS & COMPETENCIES AIRWAY / BREATHING Perform assessment and treatments for ARDS Assessment Only Salbutamol / Atrovent Auscultation & Breath Sounds Oxygen administration using appropriate device Non-Invasive airway control Measuring and documenting pre and post intervention respiratory peak flow, utilizing a peak flow meter. No Oxygen Saturation Monitoring and Interpretation Oral Airway Insertion Nasopharyngeal Airway Insertion No Bag-Valve-Mask Use (Adult Only) Interpretation of Arterial Blood Gas results No No Chest Tube Insertion (Assist physician by preparing patient, room, equipment using sterile technique and handing equipment as required to the physician to perform the procedure) No Provide ongoing assessment of patients with chest tubes. Assessment Only (Monitor and troubleshoot) (Monitor and troubleshoot) Monitor Heimlich Valves and other pleural tubes Assessment Only Assist with Intubations (Assist physician by preparing equipment, pre-oxygenation of the patient and handing equipment to the physician or respiratory tech. ) Assist with rapid-sequence-induction (Assist physician by preparing patient, room, equipment, preoxygenation and pushing IV medications under direct request and supervision of the physician) Assist with surgical airway (cric / trach) Preparing room, patient and equipment, preparing the site, handing and securing equipment per physician order. Bagging via surgical airway adjunct. No No No No 2

3 SKILLS & COMPETENCIES CIRCULATION Assist and Intervene for Patients with Chest Pain Oxygen, Nitroglycrine, Monitor Oxygen, Nitroglycrine, Monitor Perform 12 & 15 Lead ECG (Adult) No No Perform 12 & 15 Lead ECG (Pediatric) No No Participate in Code Blue Events (Documentation, Compression) (Documentation, Compressions) (ACLS) Restocking & Daily Checking of Code Blue Carts No Attaching on bedside monitoring devices. Recognize Shock Syndromes Obtain and interpret adult /pediatric vitals signs Interpret Lab Values No No Establish Intravenous Routes No Establish fluid resuscitation with crystalloids, volume expanders, colloids blood and blood products No (Crystalloids Only) Assist with central line insertion Preparing the patient, room and equipment, utilizing sterile technique. Passing equipment and holding equipment as requested by physician. Assist with arterial line insertion Preparing the patient, room and equipment, utilizing sterile technique. Passing equipment and holding equipment as requested by physician. No No Access Central Line (Short term PICC, TIC, IVAD) No No Management and Monitoring of Arterial Lines No (Monitor Only) Hot line fluid warmer setup and use No Level 1 fluid infuser setup and use No No CARDIOVASCULAR Basic Cardiac Monitoring and Interpretation 3

4 SKILLS & COMPETENCIES CARDIOVASCULAR (cont d) Administration and Monitoring of IV Drug Infusions No No Assist in Initiation of Thrombolytics (SK, rt-pa, TNK) No No Initiate Acute Coronary Syndrome Protocol (IIb, IIIa inhibitors) No No Assists / Performs Electrical Therapy Assist Only (Defibrillation) (Defibrillation, Cardioversion Pacing) Demonstrate Knowledge of ACLS Protocols No No Assist with Pericardiocentesis (Preparing the patient, room and equipment, utilizing sterile technique. Passing equipment and holding equipment as requested by physician.) No No NEUROLOGICAL Obtain a pertinent medical history Interpret Signs/Symptoms in relation to history Assess and initiate treatments for patients with altered LOC (BLS plus IV Initiation) Assess Glasgow Comma Scale Application of Cervical collars Management of Spinal Immobilized Patients Assess Blood Glucose Application of Non-Pharmacological therapies Initiate Thrombolytics for Stroke Patients No No Assessments and appropriate interventions for seizures (Midazolam / Lorazepam) EAR, EYE, NOSE AND THROAT Assess and initiate interventions for Epistaxis (Posterior / Anterior Nasal Packing) 4

5 SKILLS & COMPETENCIES EAR, EYE, NOSE AND THROAT Assess and initiate interventions for patients with eye injury Eye Patching Perform Basic Visual Acuity Examination Morgan Lens Treatment No No Assess and assist with post-tonsillectomy hemorrhage No No Assist with removal of foreign body No No Assist with care of displaced teeth and re-implantation No No GU/GI Assessment and Intervention of a patient with abdominal pain (Basic Life Support & Intravenous) Inspection, auscultation, palpation of the abdomen Knowledge of Abdominal Pain Standing Orders No No Insertion of Urinary Catheter (Adult) Insertion of Nasogastric / Orogastric Tubes No No Assist with peritoneal lavage No Assist with insertion of supra-pubic catheter No No OBS / GYNE Assess and initiate appropriate interventions for patients with obstetrical complications Assist with routine pelvic exam No No Estimate vaginal blood loss Auscultation of fetal heart tones No Assist with emergency childbirth 5

6 SKILLS & COMPETENCIES MUSCULOSKELETAL / INTEGUMENTARY Assess limb injury (Anke/Wrist) Neuromuscular Assessment (Pain, Pallor, Paresthesia, Pulses, Paralysis Application of splinting device and patient teaching related to injury. (Rest, Ice, Compression, Elevation) Tensor bandage application and discharge teaching Teach crutchwalking Perform minor wound care Perform complicated wound care No No Assist with reduction / immobilization of fractures and dislocations Tube gauze application Controlled nail trephination for subungual hematoma No Preservation of amputated parts Assessment and interventions for compartment syndrome (Assessment) ENVIRONMENTAL Assessment and intervention for burns (BLS and IVs) Assessment and intervention for heat stroke Assessment and intervention for near drowning Assessment and intervention for hypothermia 6

7 SKILLS & COMPETENCIES ENVIRONMENTAL (cont d) Assessment and intervention for toxic exposure (Basic Life Support & IV) Knowledge of staff and patient safety protocols Knowledge of disaster planning and emergency preparedness protocols TOXICOLOGY Assess and implement appropriate treatments for overdose patients (Basic Life Support & IV) Assess Poison Control Information Perform gastric lavage and Charcoal Administration via orogastric tube No No Knowledge of location of antidote kits PSYCHIATRY Performs psychiatric assessment using regional health authority guidelines Recognizes escalating behaviour Understands the application of the Mental Health Act PEDIATRICS Assess and initiate appropriate interventions for pediatric pyrexia Assessment Only Application of U-Bag on pediatric patients Assessment and intervention for pediatric respiratory distress (Assessment Only) (Salbutamol / Atrovent Only) Knowledge of Tylenol standing orders No 7

8 SKILLS & COMPETENCIES PEDIATRICS (cont d) Insertion of urinary catheters in pediatric patients No No Application of the Broslow tape TRAUMA Assess and apply appropriate treatment for multisystem trauma patients (ITLS Principles) (ITLS Principles) Application or management of C-Spine immobilization Assess and apply appropriate treatment for singlesystem trauma (ITLS Principles) (ITLS Principles) Assist the thoracotomy No No INFECTION CONTROL Follows precautions as outline in the facility or RHA infection control Receives and transcribes physician orders No No Specimen collection (Urine, stool, sputum) (Urine, stool, sputum) (Urine, stool, sputum, wound tissue and secretions) 8

9 MEDICATION ADMINISTRATION PREPARATIONS Oral preparations all medications adult and pediatric (Only as directed by RN) Sublingual preparations all medications adult and pediatric No (Only as directed by RN) Rectal preparations all medications adult and pediatric No (Only as directed by RN) Inhalation preparations all medications adult and pediatric No (Only as directed by RN) Intramuscular preparations all medications adult and pediatric No (Only as directed by RN) Subcutaneous preparations all medications adult and pediatric No (Only as directed by RN) Eye preparations Alcaine gtts and Garamycin gtts/ungt to adult patients Eye preparations Alcaine gtts and Garamycin gtts/ungt to pediatric patients No Narcotic Control count initiation and preparation No No MEDICATIONS IV PUSH Atropine No No Amiodarone Hydrochloride No No Benadryl No No Dextrose 50% & Dextrose 25% No 9

10 Diazepam No MEDICATIONS IV PUSH (cont d) Fentanyl No No Flumazenil No No Gravol No Heparin No No Hydrocortisone No No Insulin No No Lasix No No Lorazepam No Maxeran No No Morphine No No Narcan No No Sodium Bicarbonate No No Stemetil No Versed No MEDICATIONS IV INFUSION BLOOD & BLOOD PRODUCTS Whole blood No 10

11 Fresh Frozen Plasma No MEDICATIONS IV INFUSION (cont d) Packed Red Cells No Antihemolytic Factor No Platelets No Immune Globulin No Rh Immunoglobulin (WinRHo) No Albumen No COLLOIDAL SOLUTIONS 10% Dextran 40 No No Pentaspan No COMMON INFUSIONS Acetylcysteine (Mucomyst) No No Aminophylline No No Amiodarone Hydrochloride No No Benztropine No No Calcium Chloride No No Calcium Gluconate No No Dexamethasone No No Digoxin No No 11

12 Diltiazem (Cardizem) No No MEDICATIONS IV INFUSION (cont d) Dobutamine No No Enoxaparin No No Esmolol No No Ethanol No No Flumazanil No No Folic Acid No No Heparin No No Hyocine (Buscopan) No No Insulin No Subcutaneous Only Labetalol No No Magnesium Sulphate No No Mannitol No No Meperidine (Demerol) No No Nitroglycerine No No Nitroprusside No No Norepinephrine (Levophed) No No Oxytocin No No Phenobarbital No No 12

13 Phenytoin Sodium (Dilantin) No No Physostigmine Salicylate No No MEDICATIONS IV INFUSION (cont d) Potassium Chloride No No Prednasone No No Propanolol Hydrochloride No No Propofol No No Vasopressin No No Verapamil No No COMMON ANTI-MICROBIALS (Infusion or Oral) Ampicillin No No Azithromycin (Zithromax) No No Cefazolin (Ancef) No No Cefotaxime No No Cefoxitin No No Cifixime No No Ciprofloxacin (Cipro) No No Clindamycin No No Cotrimoxazole (Bactrim) either No No Doxycycline No No 13

14 Erythromycin No No Gentamicin No No MEDICATIONS IV INFUSION (cont d) COMMON ANTI-MICROBIALS Metronidazole (Flagyl) No No Moxifloxacin No No Penicillins No No Vancomycin No No COMMON NEBULIZED MEDICATIONS Budesonide (Pulmacort) No Ipratropium Bromide (Atrovent) No Salbutamol (Ventolin) No FIBRINOLYTIC / THROMBOLYTIC AGENTS Alteplase No No Streptokinase No No Tenecteplase No No Urokinase No No OTHER MEDICATIONS Tetanus Toxid / Diptheria No EMLA Cream (Topical Anesthetic) 14