PACU 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 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: Email: City: Country: United States State/Region: Send to: None Specified Post-op care of patients with 1 2 3 4 1 2 3 4 CABG Aneurysm with graft replacement Cardiac Transplantation
Cardiac Valve Replacement (MVR, AVR) Appendectomy Chest Tubes Embolectomy/Thrombectomy Endarterectomy Laryngectomy Open Heart Procedures Penetrating/Open Chest Trauma Peripheral Vascular Bypasses Pneumonectomy/Lobectomy Post Op Myocardial Infarction Radical Neck Resection Stent Placements Thorocotomy Tracheostomy Vena Cava Filter Craniotomy - Epidural Craniotomy - Subdural Aneurysm Clipping Burr Holes Evacuation of Hematoma Intracranial Tumor Excision Laminectomy Spinal Fusions Spinal Tumor Excision Subarachnoid Screw/Bolt Ventricular Peritoneal Shunt Ventriculostomy Neuromuscular Disease Abdominal Trauma
Cholecystectomy Colon Resection Colostomy/Ileostomy Esophagectomy Exploratory Laparotomy Gastrectomy Gastric Stapling Hepatic Resection Biliary Atresia Hernia Repair Pyloric Stenosis Pyloroplasty Cystectomy Ileal Conduit Vagotomy Hemorrhoidectomy AV Fistulas, Shunts & Dialysis Catheters Nephrectomy Prostatectomy Renal Transplant TURP/TURBP Ureteral Stent Insertion Amputations Open Reduction/Internal Fixation Total Joint Replacements/Arthroplasty Adenotonsillectomy (T&A) Adrenalectomy Cleft Lip/Palate Repair
Facial Fractures Sinus Surgery Thyroidectomy Transphenoidal Hypophysectomy Dilation & Curettage (D&C) Hysterectomy Lumpectomy Mastectomy Oophorectomy Orchiectomy Salpingectomy Laser Eye Surgery Myringotomy Orbital Fracture Orbital Implant Scleral Bucking (for Retinal Detachment) Dacryocystectomy TAH-BSO Cataract Extraction Cochlear Implant Keratoplasty (Corneal Transplant) Gun Shot/Stab Wound-Abdomen Gun Shot/Stab Wound-Chest Gun Shot/Stab Wound-Head Plastic Surgery Skin Flaps Skin Grafts Wound Debridement Anaphylaxis Latex Allergies
Medication Administration 1 2 3 4 1 2 3 4 Pain Management - Fentanyl Pain Management - Demerol Pain Management - Dilaudid Pain Management - Morphine Sedatives - Ativan Sedatives - Valium Sedatives - Versed H2 Receptor Antagonists - Zantac H2 Receptor Antagonists - Pepcid H2 Receptor Antagonists - Carafate Antiemetics - Droperidol Antiemetics - Phenergan Antiemetics - Zofran Anticonvulsants (Dilantin, Phenobarbital) Inotropes/Vasoactive Drips Ca++ Channel Blockers (Cardizem) Nitroglycerine Nipride Amiodarone Lidocaine Procainamide (Pronestyl) Heparin/Coumadin Diuretics Steriods (Decadron, Solumedrol) Glycoprotein IIb/IIIa Receptor Inhibitors Narcan Romazicon
Nebulizer Tx (Atrovent, Ventolin) Epinephrine Atropine IM Injections SQ Injections Continuous IV Pump Infusions Eye/Ear Instillations Monitoring - Epidural Monitoring - Intrathecal Monitoring - Spinal Anesthesia Monitoring - IV Push Procedures/Skills 1 2 3 4 1 2 3 4 Interpretation of Arrhythmias Performing 12 lead EKGs Hemodynamic Monitoring - Arterial Line Hemodynamic Monitoring - PA Catheter/Swan Ganz Catheter Hemodynamic Monitoring - CVP Line Interpretation of Lab Values - ABGs Interpretation of Lab Values - CBC Interpretation of Lab Values - Blood Chemistry Interpretation of Lab Values - Electrolytes Assessment/Management Fluid Balance Management Electrolyte Disturbances Cardiac Arrest/CPR Cardioversion Defibrillation External/Temporary Pacing Airway Management - Head Position
Airway Management - Oral/NT Airway Airway Management - Laryngeal Mask Airway (LMA) Airway Management - Endotracheal Tube Airway Management - Tracheostomy Oxygen Therapy - Nasal Cannula Oxygen Therapy - Face Mask Oxygen Therapy - Non-Rebreather Mask Oxygen Therapy - Ambu Bag Oxygen Therapy - Trach Collar CO2 Monitoring Intubation - assist with Extubation - assist with Mechanical Ventilation Obtaining ABG's - via A-Line Obtaining ABG's - via arterial stick Suctioning - Oral/NT Suctioning - ETT/Tracheostomy Chest Tubes - Care/Maintenance Seizure Precautions Cervical Spine Precautions Intracranial Pressure Monitoring (ICP) Cerebral Perfusion Pressure (CPP) Nasogastric Tube - Insertion/Care Gastric Tube - Care/Maintenance Jejunostomy Tube - Care/Maintenance Stoma Care/Maintenance Wound Drains - Self Suction (J-P, Hemovac) Wound Drains - Irrigation Drains (Axiom) Wound Drains - Tube Wound Drains - Biliary Tube
Maintenance of - Foley Catheter Maintenance of - Suprapubic Catheter Maintenance of - Nephrostomy Tube Orthopedic Traction CPM Machine Peripheral IV Insertion/Care PICC Care Blood/Blood Products - Admininstration Blood/Blood Products - Autotransfusion Blood/Blood Products - Volume Expander Administration Aldrette Scoring Malignant Hyperthermia Management Blood Glucose Monitoring Restraints Blood Specimen Collection - femoral arterial stick Blood Specimen Collection - radial arterial stick Blood Specimen Collection - arterial line Blood Specimen Collection - central line Blood Specimen Collection - venous stick Specimen Collection - Cultures Specimen Collection - Sputum Specimen Collection - Urine Assessment/Other 1 2 3 4 1 2 3 4 Assess Breath Sounds Assess Heart Sounds Admission of patients to unit Care Planning Circulation Checks
Computerized Charting Patient Teaching Neurological Assessments Vital Signs Pain Management 1 2 3 4 1 2 3 4 Pain assessment using pain scales Epidural analgesia IV conscious sedation Patient controlled analgesia (PCA) Narcotic Agents Non-narcotic agents Non-pharmacological measures Equipment 1 2 3 4 1 2 3 4 Automatic BP cuffs Cardiac Monitor Defibrillator Glucometer Hypo/Hyperthermia Blanket Infusion Pumps (Specific Brands) Age Specific Skills 1 2 3 4 1 2 3 4 Newborn (birth-30 days) Adolescents (12-18 years) Infant (30 days - 1 year) Young Adults (18-39 years) Toddler (1-3 years) Middle Adults (39-64 years)
Preschooler (3-5 years) Older Adults (64+ years) School Age (5-12 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