NICU 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 1 2 3 4 A. CARDIOVASCULAR Auscultation (Rate, Rhythm, Volume) Blood Pressure/ Invasive (Arterial line) Blood Pressure/ Non-Invasive Heart Sounds/ Murmurs Perfusion Pulses EKG Interpretation Defibrillation/ Cardioversion Invasive Hemodynamic Monitoring Central Venous Pressure 3. Care of the Neonate with Cardiac Arrest Cardiac Transplant Cardiomyopathy Congenital Heart Disease/ Defects Hemodynamic Instability Hypovolemic Shock Post Cardiac Surgery Post Interventional Cardiac Cath 4. Medications Dobutamine Dopamine Epinephrine Nipride Sodium Bicarbonate B. PULMONARY Breath Sounds Rate and Work of Breathing 2. Interpretation of Lab Results Blood Gases Interpretation of x-ray reports Copyright 2014 Dependable Staffing Services, LLC. All rights reserved. Page 1 of 6
3. Equipment & Procedures Airway Management Assist with Intubation Bulb Syringe CPAP (Nasal Prongs) Endotracheal Tube Stabilization Endotracheal Tube Suctioning Apnea Monitor Cardiac Resuscitation Apnea Monitor Insertion Removal Set-up ECMO (Extracorporeal Membrane Oxygenation) O2Therapy Delivery Systems Bag (Anesthesia) & Mask Bag (Self-inflating) & Mask Nasal Cannula Nebulizer Oxyhood Tent Trach Collar Obtaining Blood Gases Arterial Heelstick Peripheral Umbilical Line Thoracentesis Use of Artificial Surfactant Ventilator Care CPAP/PEEP High Frequency Jet Ventilator Home Ventilator IMV Oscillating Pressure Ventilator Volume Ventilator Weaning 4. Care of the Neonate with Bronchopulmonary Dysplasia (BPD) Cardiogenic/Hypovolemic Shock Diaphragmatic hernia Fresh Tracheostomy Meconium Aspiration Persistent Pulmonary Hypertention (PPHN) Pneumothorax Respiratory Distress Syndrome (RDS) Respiratory Failure 5. Medications Aminophylline Prostaglandin Copyright 2014 Dependable Staffing Services, LLC. All rights reserved. Page 2 of 6
C. NEUROLOGICAL Intracranial Pressure Monitoring Neurological Status 2. Care of Neonate with Brain Death/ Organ Procurement Externalized VP Shunt/ Reservoirs Increased Intracranial Pressure Meningitis Seizures 3. Medications Anticonvulsant Medication D. GASTROINTESTINAL Abdominal Girth Bowel Sounds Palate Suck/Swallow Abdominal Girth Feeding Assist with Breast Feeding Bottle Breast Milk Handling/ Storage Gavage Hospital Grade Electric Breast Pump Placement of Intestinal Tubes Jejunal Gastro Nasogastric/Orogastric Test for Occult Blood 3. Care of the Neonate with Cleft Palate Colostomy/Ileostomy Gastroschisis/Omphalocele GI Bleeding Inguinal Hernia Necrotizing Enterocolitis (NEC) Post Abdominal Surgery Reflux Precautions Tracheoesophageal Fistula (TEF) E. ENDOCRINE/METABOLIC Finnegan Fluid & Electrolyte Balance 2. Interpretation of Lab Results Bilirubin Test Urine and Interpret Glucose Labstix Copyright 2014 Dependable Staffing Services, LLC. All rights reserved. Page 3 of 6
Occult Blood ph Specific Gravity 3. Equipment & Procedures Collection of Urine Specimens Assist with Supra Pubic Tap Catheter Diaper/Bag Phototherapy for Jaundice Post Circumcision Care 4. Care of the Neonate with Acute Renal Failure DIC (Disseminated Intravascular Coagulation Disorders of Internal/External Organs Drug Addiction/Withdrawal Hypo/Hyperkalemia Hypo/Hypernatremia IDM (Infant of a Diabetic Mother) Malformation of the GU Tract, Kidney Peritoneal Dialysis F. INFECTIOUS DISEASES 1. Interpretation of Lab Results CBC/Differential Culture Reports Maternal Lab Results Assist with Lumbar Puncture Maternal Lab Results Isolation Techniques Standard (Universal) Precautions 3. Care of the Neonate with Hepatitis Surface Antigen+ Mother HIV Positive Mother Neonatal Sepsis 4. Medications - Immunizations HBIG HBV HIV Polio DPT RespiGam/Synergis Prophylaxis G. PHLEBOTOMY/IV THERAPY 1. Equipment & Procedures Administration of Blood/ Blood Products Cryoprecipitate Packed Red Blood Cells Plasma/Albumin Whole Blood Delivery Systems Copyright 2014 Dependable Staffing Services, LLC. All rights reserved. Page 4 of 6
IV Pump Syringe Pump Drawing Blood from Central Line Drawing Venous Blood Hyperlimentation/TPN Intralipid Managing IV Therapy Discontinuing Dressing & Tubing Change Rate Calculation Site & Patency Assessment Starting IVs Angiocath Butterfly Heparin Lock 2. Care of Neonate with Central Line/Catheter/Dressing Products Broviac Groshong Hickman Portacath Quinton Percutanious Arterial Line Percutanious Venous Line Peripheral Line/Dressing PICC (Peripherally Inserted Central Catheter) Umbilical Artery Line Umbilical Venous Line H. PAIN MANAGEMENT of Pain Level 2. Care of the Neonate with Sedation, i.e. Morphine I. MISCELLANEOUS Apgar Scoring Eye Exam (r/o Retinopathy) Gestational Age Ballard Dubowitz Other (Specify) Maternal History Screen for Hearing Loss Bereavement/Postmortem Care Consents Immunization Procedural Treatment Cord Care Neonatal Skin Care Copyright 2014 Dependable Staffing Services, LLC. All rights reserved. Page 5 of 6
Positioning Devices Preparation for Transport/Transfer Thermoregulation Isolette with Humidity Radiant Warmer Temperature (Axillary, rectal, skin) Weaning to Open Crib/Bassinet Weights Bed Scale Scale 3. Medications Calculation of Dosage Emergency Drug Action and Reaction Eye Prophylaxis - Vitamin K Neonatal Drug Action and Reaction 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 6 of 6