Pediatric Intensive Care Unit Competency Self Assessment
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- Henry Neal
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1 Pediatric Intensive Care Unit Competency Self Assessment Directions Please circle a value for each question to provide us and the interested facilities with an assessment of your clinical experience. These values confirm your strengths within your specialty and assist the facility in the selection process of the healthcare professional. 1 No 2 Some (Require Assistance) 3 Intermittent (May Require Assistance) 4 d (Performs without Assistance) 5 Very d (Able to Teach/Supervise) Print Name Last 4 Digits of SS# Date General Skills Settings Children s hospital University healthcare facility Community hospital Family teaching Assessment of normal growth & development Recognize/report signs of child abuse/neglect Consents Specialty beds Restrictive devices (restraints) End of life care/pallative care Wound assessment & care Automated Medication Dispensing System, Pyxis, Omnicell, or other Bar coding for medication administration Diabetic care & education Blood Glucose Monitoring (BGM) Insulin administration National Patient Safety Goals Accurate patient identification Effective communication Interpretation & communication of lab values Medication administration Pediatric dosage calculations Delivery methods: eye/ear/im/iv/sq Medication reconciliation Labeling (medications & specimens) Anticoagulation therapy Pain assessment & management Steroids (inhaled/iv/po) Monitoring conscious sedation Infection control Cross Country Healthcare, Inc. Rev. 07/13 F0051 PICU 1 of 7
2 1 No 2 Some (Require Assistance) 3 Intermittent (May Require Assistance) 4 d (Performs without Assistance) 5 Very d (Able to Teach/Supervise) General Skills - cont. Universal precautions Isolation Minimize risk falls Prevention of pressure ulcers IV Therapy Starting & maintaining peripheral IVs Blood draw: venous Central line care (includes PICC/Broviac/Groshong/Hickman) Blood draw: central line Care & management of ports Care & management of nonvascular devices (epidural, intrathecal) TPN & lipids Administration of blood & blood products Infusion pumps Cardiovascular Pediatric CV assessment Assist with Insertion & Management of: Arterial line CVC (central venous catheter) Swanz-Ganz Hemodynamic monitoring Extra Corporeal Membrane Oxygenation (ECMO) Use of doppler Cardiac Monitoring & Emergency Care Administration of PALS protocols & medications Broslow system Interpretation & treatment of dysrythmias Rapid response team member Use of rapid response teams Bacterial endocarditis DIC Post cardiac cath Cardiac transplant Cardiogenic shock Cardiomyopathy Congenital heart disease/defects Cross Country Healthcare, Inc. Rev. 07/13 F0051 PICU 2 of 7
3 1 No 2 Some (Require Assistance) 3 Intermittent (May Require Assistance) 4 d (Performs without Assistance) 5 Very d (Able to Teach/Supervise) Cardiovascular - cont. Hypovolemic shock Myocarditis/pericarditis Permanent pacemaker Temporary pacemaker Medications Antidysrythmics Antihypertensives Cardiac glycoside (digoxin) Platelet inhibitors (Aggrastat/Integrilin/ReoPro) Anti-rejection immunosuppressants Vasoactive agents Pulmonary Respiratory assessment (rate & work of breathing) Equipment/Procedures Metered dose inhaler Nebulized medications Assist with & manage intubation Tracheostomy care Assist with & maintain chest tube Obtain & interpret Arterial blood gas O2 therapy (NC/oxyhood/tent) Thoracentisis Ventilator management Use of paralytics Acute Respiratory Distress Syndrome (ARDS) Respiratory Syncytial Virus (RSV) Chronic respiratory disease Croup Epiglottits Reactive Airway Disease (RAD) Status asthmaticus Pulmonary hypertension Pneumonia Near drowning Medications Bronchodilators Racemic epinephrine Cross Country Healthcare, Inc. Rev. 07/13 F0051 PICU 3 of 7
4 1 No 2 Some (Require Assistance) 3 Intermittent (May Require Assistance) 4 d (Performs without Assistance) 5 Very d (Able to Teach/Supervise) Neurological Neuro assessment Glascow coma scale Procedures Assisting with LP Intracranial pressure (ICP) insertion & monitoring Muscular degenerative diseases Meningitis Coma Brain death/organ procurement Encephalitis/encephalopathy External ventricular drains VP shunts/reservoirs TBI (Traumatic Brain Injury) Status epilepticus Spinal cord injury Post nuero surgery Medications Anticonvulsants Mannitol Psychostimulants (Ritalin/Adderall) Orthopedics Orthopedic assessment Traction Cervical traction Pinned fractures Post vertebral surgery Gastrointestinal GI assessment Nutritional assessment Equipment/Procedures Abdominal decompression (NG, sump tubes, intermittent & continuous suction) Colostomy/ileostomy Placement of feeding tubes (NG) G-tube/J-tube Cross Country Healthcare, Inc. Rev. 07/13 F0051 PICU 4 of 7
5 1 No 2 Some (Require Assistance) 3 Intermittent (May Require Assistance) 4 d (Performs without Assistance) 5 Very d (Able to Teach/Supervise) Gastrointestinal - cont. Feedings Assist with breastfeeding Breastmilk handling & storage Bottle Gavage Use of feeding pumps Abdominal trauma; bleeding Ascites Surgical abdomen Severe dehydration/gastroenteritis Hepatic failure Hepatitis Hyperbilirubinemia Necrotizing Entercolitios (NEC) Ruptured spleen GI bleeding GI organ transplants Renal/Genitourinary Assessment of fluid balance Equipment/Procedures Assist with suprapubic taps Insertion & care of foley catheter Acute renal failure Hemodialysis Peritoneal dialysis Hemolytic Uremic Syndrome (HUS) Post renal transplant Nephritis Ileal conduit Skin Care Skin assessment Surgical wound healing Burns Traumatic wounds Vacuum Assisted Device (VAC) Cross Country Healthcare, Inc. Rev. 07/13 F0051 PICU 5 of 7
6 1 No 2 Some (Require Assistance) 3 Intermittent (May Require Assistance) 4 d (Performs without Assistance) 5 Very d (Able to Teach/Supervise) Oncology Administration of chemotherapy Monitoring of chemotherapy (does not initiate) Assist with bone marrow aspiration Acute anemia Acute tumor lysis syndrome Bone marrow transplant Leukemia Malignant tumors Neutropenia Radiation implant Sickle cell anemia Hemophilia Graft verses host disease Inpatient hospice Autoimmune Diseases Addison s disease Cushing s disease Celiac disease/gluten intolerance Grave s disease Hypothyroidism Lupus Infectious Diseases Usual child diseases (mumps/measles/chicken pox) CMV/HIV/AIDS Tuberculosis Septic shock Fever management Medication/Administration Antiinfectives Miscellaneous Trauma Craniofacial reconstruction ENT surgery Ingestions/overdose Suicidal ideation/attempts Cross Country Healthcare, Inc. Rev. 07/13 F0051 PICU 6 of 7
7 1 No 2 Some (Require Assistance) 3 Intermittent (May Require Assistance) 4 d (Performs without Assistance) 5 Very d (Able to Teach/Supervise) Age Specific Competencies Newborn/neonate (birth-30 days) Infant (31 days-1 year) Toddler (2-3 years) Preschool (ages 4-5 years) School age (ages 6-12 years) Adolescents (ages years) Young adult (ages years) Adults (ages years) Older adult (ages years) Elderly (ages 80+ years) Please list any Additional Skills: Additional training: Additional equipment: Fax to: The information on this and all preceding pages is true and correct. Signature Date 2012 Cross Country Healthcare, Inc. Rev. 07/13 F0051 PICU 7 of 7
Experience. Initials Medical Staffing Network Rev. 06/15 F01201 NNICU 2 of 5
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