OPERATING ROOM SKILLS CHECKLIST
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1 OPERATING ROOM SKILLS CHECKLIST 1111 North 3rd Street Instructions: Please complete this checklist to enable us to match your skills and interests with available assignments. Place an "X" in the appropriate column that best describes your experience level with each skill. LEVELS OF PROFICIENCY: 1. Experienced - performs well and independently (at least 1 year experience) 2. Limited experience - some assistance or practice needed (6 months to 1 year experience) 3. Little experience - need more experience, assistance required (less than 6 months experience) 4. No experience SKILLS A. GENERAL SURGERY 1. Cholecystectomy/Cholangiogram 2. Hemorrhoidectomy 3. Imperforate Anus Reconstruction 4. Radical Mastectomy 5. Tracheostomy 6. Vagotomy 7. Saphenous Vein Ligation and Stripping 8. Lumbar Sympathectomy 9. Hepatic Resection 10. Circumcision 11. Abdominal Perineal Resection 12. Adrenalectomy 13. Colectomy 14. Herniorrhaphy, femoral, inguinal 15. Pancreatectomy/Pancreatogram 16. Splenectomy 17. Whipple Procedure 18. Bowel Resection 19. Pilonidal Cystectomy 20. Hiatal Herniorraphy, transabdominal 21. Colostomy/Ileostamy 22. Anal Fissurectomy 23. Appendectomy 24. Gastrectomy 25. Organ Procurement 26. Portal Caval Shunt 27. Thyroidectomy B. ORTHOPEDIC 1. Amputation: arm/leg 2. Insertion of McIntosh Tibial Plateau Prosthesis 3. Insertion of Swanson Finger Prosthesis 4. Tendon Transplants 5. Carpal Tunnel release 6. Putti Platt/Bankart Procedure 7. Spinal Fusion Copyright 2014 Dependable Staffing Services, LLC. All rights reserved. Page 1 of 7
2 8. Patellectomy 9. Heel Cord Lengthening 10. Bunionectomy 11. Application of Halo Traction 12. Capsularrhaphy 13. Laminectomy 14. Repair Hammer Toes 15. Application of Spica Cast 16. Excision of Olecrannon Bursa 17. Cup Arthroplasty/Insertion Prosthesis 18. Sharranrd Procedure 19. Nailing Procedures A-O Lottes Jewett K Wires Schneider Kuntscher Rod Rush C. NEURO 1. Anterior Cervical Fusion 2. Laminectomy 3. Ulna Nerve Transplant 4. Craniectomy for Decompression Fracture 5. Burrholes for Subdural Hematoma 6. Meningocele Repair 7. Vinke Tong Insertion 8. Clipping of Intracranial Aneurysm 9. Carotid Ligation 10. Shunt Procedures; VP/VA/LP 11. Ventriculography Procedures 12. Cranioplasty 13. Crutchfield Tong Insertion 14. Cervical Sympathectomy 15. Hypophysectomy 16. Craniotomy D. GYN 1. Hyserectomy, vaginal 2. Hysterectomy, abdominal 3. Termination of Pregnancy 4. Caesarean Section 5. Laser Surgery 6. Marsupialization Bartholin Cyst 7. Colpotomy 8. Radium Insertion 9. Vaginal Reconstruction 10. Dilation and Curettage 11. Vaginectomy 12. Tubal Ligation 13. Marchetti-Marshall 14. Shirodkar Operation Copyright 2014 Dependable Staffing Services, LLC. All rights reserved. Page 2 of 7
3 15. Salpingo-Oopherectomy E. UROLOGICAL 1. Vasectomy 2. Cystectomy 3. Hypospedius Repair 4. Nephrectomy 5. Circumcision 6. Prostatectomy, perineal 7. Protstectomy, suprapubic 8. Kidney Transplant 9. T.U.R. 10. Orchietomy 11. Ureterolithotomy 12. Pyeoplasty F. THORACIC/CARDIOVASCULAR 1. Closed Thoracotomy 2. Pericardiectomy 3. Tracheal Resection 4. Transthoracic Diaphragmatic Herniorrhaphy 5. Esophagectomy 6. Thoracoplasty 7. Mitral Commissurotomy 8. Closure Patent Ductus Arteriosis 9. Endocardial-Pacemaker Implantation 10. Myocaridal-Pacemaker Implantation 11. Correction Pectus Excavatum 12. Pneumonectomy/Lobectomy 13. First Rib Resection 14. Excision Cervical Rib 15. Revascularization Coronary Arteries 16. Heller Procedure 17. Resection Coarctation Aorta 18. Open Heart Procedure/CP Bypass Septal Defect Repairs Heart Valve Replacement 19. Aortic Femoral Bypass graft 20. Femoral Popliteal Bypass 21. Aortic Aneurysm w/graft replacement 22. Endoscopic Vein Harvesting 23. Cardiac Cath Lab-Intra-Aortic Balloon Pump 24. Septal Defects, ASV,VSD 25. Coronary Artery Bypass Graft 26. Off Pump Bypass G. VASCULAR 1. Shunts 2. Vena Cava Ligation 3. Embolectomy 4. Angiography 5. A -V access grafts 6. Peripheral Vascular Bypass Procedures Copyright 2014 Dependable Staffing Services, LLC. All rights reserved. Page 3 of 7
4 7. Thrombectomy 8. Endarterectomy; carotid/femoral 9. Resection Carotid Aneurysm with Graft H. EAR, NOSE & THROAT 1. Luc-Caldwell 2. Maxillary Advancement with Hip Graft 3. Selective Osteotomy of Maxilla/Mandible 4. Cammendo Procedure 5. Open Reduction Facial Fractures 6. Submuccus Resection 7. Fenestration Procedure 8. Parotidectomy 9. Tympanoplasty 10. Laryngectomy 11. Radial Neck Dissection 12. Cleft Lip-Palate Repair 13. Myringotomy 14. Sinusotomy 15. Ethymoidectomy 16. Open Reduction Nasal Fracture 17. Tonsillectomy 18. Frontal Flap Sinus Procedure 19. PE Tube Insertion 20. Myringoplasty 21. Mastoidectomy 22. Ranulectomy 23. Closed Reduction Nasal Fracture 24. Nasal Ploypectomy 25. Stapedectomy 26. Excision Salivary Gland Tumor 27. Open Reduction Tripod Fracture 28. Tracheostomy 29. Glossectomy 30. Pharyngeal Flap Procedure I. EYE 1. Pterygium Repair 2. Corneal Transplant 3. Ocutome 4. Dacryocystorlfinostomy 5. Microscope 6. Enucleation 7. Repair of Retinal Detachment 8. Orbital Implant 9. Phacoemulsifier 10. Repair Orbital Blowout Fracture 11. Dacryocystectomy 12. Cataract Extraction 13. Recession Resection 14. Diathermy Operation 15. Iridectomy Copyright 2014 Dependable Staffing Services, LLC. All rights reserved. Page 4 of 7
5 J. ORAL 1. Closed reduction facial fractures/wiring 2. Extraction of Impacted Molars 3. Extraction of Deciduous Teeth 4. Excision Odontoma K. CARDIOVASCULAR RESUSCITATION 1. Rhinoplasty 2. Mentoplasty 3. Blepheroplasty 4. Reduction Mammoplasty 5. Reconstructive 6. Augmentation Mammoplasty 7. Otoplasty 8. Cleft-Lip Palate Repair 9. Split Thickness Skin Grafting 10. Dermabrasion 11. Scar Revisions 12. Skin Grafting 13.Liposuction L. ENDOSCOPIC 1. Gastroscopy 2. Sigmoidoscopy 3. Bronchoscopy 4. Laryngoscopy 5. Culdoscopy 6. Mediastinoscopy 7. Laparoscopy 8. Esophagoscopy 9. Cystoscopy M. CARDIOVASCULAR RESUSCITATION 1. Intubation 2. Mouth to Mouth Resuscitation 3. Ambu 4. Cardiac Compression N. TRAUMA 1. Motor Vehicle Accidents 2. Amputations 3. Gunshot/Stab wounds 4. Burns O. INTRAVENOUS THERAPY 1. Medicut 2. Jelco 3. Intracath 4. Regular Intravenous Set 5. Scalp Vein Copyright 2014 Dependable Staffing Services, LLC. All rights reserved. Page 5 of 7
6 P. MISCELLANEOUS EQUIPMENT 1. Disposable Bovie Plates 2. K-Pad Unit 3. Pneumatic Tube System 4. Washer Sterilizer--AMSCO 5. Ultrasonic Cleanser--AMSCO 6. Washer Sanitizer--AMSCO 7. Flash Autoclave--AMSCO 8. Ethylene Oxide Sterilizer--AMSCO 9. Defibrillator-Datascope 680 Resuscitation 10. Aquamatic K Thermia Unit 11. Kiddie Pneumatic Tourniquet 12. Portable Light 13. Vaccum Curettage 14. Hemokinetitherm-Blood Warmer 15. Eye Magnet 16. Nitrous Oxide Bank 17. Auto Suture, TA 30, Stapling Instrument 18. Auto Suture, TA 55, Stapling Instrument 19. Auto Suture, TA 90, Stapling Instrument 20. Auto Suture, GIA, Stapling Instrument 21. Pleur-e-vac Units (Disp. Chest Drainage) 22. Vac-pac Positioner 23. Blood Bank Refrigerator 24. Emerson-Thoracic Pump 25. Nerve Stimulator 26. Portable Cardiac Monitor, Datascope Cry-Opthalmic Unit 28. AOMI, Fiber Optic Luminator 29. PILLING, Fiber Optic Luminator 30. Orthopedic Arm Board with Drain 31. Bovie Electrosurgical Unit 32. Dual Tract Lights (bulb changing; handles) 33. Kreiselman Resuscitator 34. Steri-vac-neration Cabinet, 3-M, portable 35. Electrodyne-Cardiac Montior & Pacemaker 36. Conductometer 37. Operating Microscope 38. Cell Saver 39. Laser 40. Defibrillator-Electrodyne 41. Hall Neurotome 42. Nesq Graft 43. Operating Room Table, Castle 5 Section 44. Ohio Suction Units 45. Suction Unit, Disposable 46. Tele-thermometer 47. Compression Set, Zimmer 48. Drills Smith Cranial Hall Air Driver Hall Dental Chayes Copyright 2014 Dependable Staffing Services, LLC. All rights reserved. Page 6 of 7
7 Jordan Day A-O 49. Dermatome Cordless Davol Unit Brown Padgett Castroviejo Electro-Kerotome Age Specific Experience Circle each of the following age groups you have experience providing age specific care to: Neonatal Infant-Children(0-11) Adolescent (12-18) Adult Geriatric Employee Signature Date Copyright 2014 Dependable Staffing Services, LLC. All rights reserved. Page 7 of 7
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