OR Skills Checklist. Frequency Scale: 1 = Never Observed 2 = Less than 6 times a year 3 = 1 or 2 Times a Month 4 = Daily or Weekly
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1 OR Skills Checklist This assessment is for determining your experience in the below outlined clinical areas. This checklist will not be used as a determining factor in accepting your application for employment with ADEX Medical Staffing, LLC. Proficency Scale: 1 = No Experience - Theory only 2 = Limited Experience - Infrequent 3 = Moderate Experience - Able to perform independently 4 = Proficient - Able to perform proficiently and instruct Frequency Scale: 1 = Never Observed 2 = Less than 6 times a year 3 = 1 or 2 Times a Month 4 = Daily or Weekly Personal Information Name: City: Country: United States State/Region: Send to: None Specified Proficiency Frequency General Skills Cardiac Arrest/ Adult CPR Cardiac Arrest/ Infant-Child CPR Care of the patient in restraints
2 Universal Precautions Care of the patient in isolation Organ Donor Protocols Lift/Transfer Devices Electronic Documentation n n n n n n n n n n n n n n n n n n n n General Surgery Abdominal Perineal Resection Adrenalectomy Bariatric Surgery (gastric bypass) Bowel Resection Cholecystectomy/Cholangiogram Colostomy/Ileostomy Gastrectomy Hemicolectomy Hepatic Resection Herniorrhaphy-Femoral/Inguinal Hiatal Herniorrhaphy-Transabdominal Pancreatectomy Organ Procurement Radical Mastectomy Saphenous Vein Ligation/Stripping Splenectomy Thyroidectomy Tracheostomy Vagotomy Familiarity with Pediatric Procedures n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n
3 Cardiovascular / Thoracic Aortic Femoral Bypass graft Femoral Popliteal Bypass Pacemaker Implantation/ Explantation Care of patients with pacemaker Cardiac Cath Lab- IABP Carotid Endoscopy Septal Defects, ASV, VSD Coronary Artery Bypass Graft Maze Procedure Valve Replacement Aortic Aneurysm Thoracotomy Lobectomy Rib Resection Endoscopic Vein Harvesting Off Pump Bypass Endoluminal AAA Angiography A-V access graft Aortic aneurysm Endarterectomy Peripheral Vascular Bypass Procedures Resection Carotid Aneurysm/ Graft Thrombectomy Embolectomy Vena Cava Ligation Arterial Switch Atrial Septectomy Bidirectional Glenn Fontan Procedure
4 Norwood Procedure Ross Procedure Tetralogy of Fallot Repair VSD Repair Valve Repair/Replacement BT Shunt PDA Ligation Repair of Coarctation of Aorta ECMO Insertion/Decannulation (Cardiac) Pacemaker Chest Exploration/Closure n n n n n n n n n n n n n n n n n n Eyes, Ears, Nose & Throat Cataract extraction IOL Implants Corneal transplant Orbital Implant Enucleation Repair Orbital Blowout Fracture Repair of Retinal Detachment Scleral Buckle Caldwell-Luc Cleft lip/palate Repair Larynegectomy Radical Neck Tonsillectomy & Adenoidectomy Mandibulectomy Mastoidectomy
5 Rhinoplasty/ Septoplasty Sinusotomy Tracheostomy n n n n n n n n n n n n n n n n n n n n Endoscopic / Laparoscopic Procedures Bronchoscopy Culdoscopy Cystoscopy Esophagoscopy Gastroscopy Hysteroscopy Appendectomy Cholecystectomy Colon Resection Hernia Repair Salpingo-oophorectomy Tubal Ligation Vaginal Hysterectomy Laryngoscopy Mediastinoscopy Pelviscopy Sigmoidoscopy Thoracoscopy Whipple Nissen Fundalplication n n n n n n n n n n n Gynecology Caesarean Section
6 Dilation & Curettage Hysterectomy-Vaginal Hysterectomy-Abdominal Laser Surgery Radium Insertion Salpingo-Oopherectomy Shirodkar Procedure Termination of Pregnancy Tubal Ligation Vaginectomy n n n n n n n n n n n n n n n Neurology Kyphoplasty A-V malformation Laparoscopic spine procedures Burr Holes for Subdural Hematoma Carotid ligation Cervical Sympathectomy Cranioplasty Craniotomy Disectomy/laminectomy Halo Traction application Insertion of nerve stimulus device Myelomeningocele repair Shunt procedure VP/ VA/LP Spinal Fusions Ventriculostomy n n n n n n n n n n n n n n n n n
7 Orthopedic Achilles Tendon Repair Amputation Arthroscopy/Arthrotomy Closed Pinning & Reduction of Extremities External Compression Devices Hip compression nails and lag screws Total Joint Replacement-knee, hip, shoulder Spica Cast ORIF- shoulder, hip, humerus Repair of Dislocation Patellectomy Tendon Implants and Reanastomosis Antegrade/Retrograde Roddings Humoral fracture Tibial fracture Femoral fracture Carpal Tunnel release n n n n n n n n n n n n n n Plastics Abdominal lipectomy Blepharoplasty Face Lift Mammoplasty Augmentation Reduction Reconstructive Liposuction Otoplasty
8 Scar Revisions Skin Grafting Craniofacial Reconstruction Repair of Cleft Lip, Nose, Palete Rhinoplasty/ Septoplasty n n n n n n n n n Transplant Bone Corneal Harvesting Heart/Lung Kidney Liver Multi Organ Pancreas Skin n n n n n n Trauma Burns Gunshot/ Stab wounds Motor Vehicle Accidents Traumatic amputations Open Fractures Hematoma: Subdural/Epidural n n n n n n n n n n n n n Urology Circumcision
9 Cystoscopy/ Ureteroscopy Cystectomy Hypospadius Repair Implants Lithotripsy Nephrectomy Orchiectomy Prostatectomy Ureterolithotomy TURP PVP- photo vaporization of prostate Vasectomy Proficiency Frequency Equipment Transfer/Lift Devices Computerized Documentation Medication Pumps Abinmed Machine Camera/Video systems Cell Saver Cidex Soak Cryo-ophthalmic unit CUSA Hypo/Hyperthermia Unit Drills and Saws Electrosurgical unit Fiber optic laminator Cavitron Autoclave
10 Fracture Tables Stapling Devices Mesh Graft/Dermatone Microscopes Nitrogen Tank Pneumatic tourniquet Steris unit Pulsevac Irrigation Autotransfusion Device Laser Equipment Care of Scopes and Fiberoptic Equipment Venodyne Proficiency Frequency Age Specific Skills Newborn birth-30 days Infant 30 days-1 year Toddler 1-3 years Preschooler 3-5 years School Age 5-12 years Adolescents years Young Adults years Middle Adults years Older Adults 64+ years Signature The information represented above is true and correct to the best of my knowledge. I authorize ADEX Medical Staffing, LLC to share this skills checklist with its clients. Initials: Copyright 2009 ADEX Medical Staffing, LLC Form Reviewed by ADEX Clinician - 11/16/2010
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