PACU Skills Checklist
NAME
LAST 4 OF SSN
DATE
I hereby certify that
ALL information I have provided on this skills checklist and
all other documentation, is true and accurate. I understand and acknowledge
that any misrepresentation or omission may result in disqualification from
employment and/or immediate termination.
Instructions: This checklist is
meant to serve as a general guideline for our client facilities as to the
level of your skills within your nursing specialty. Please use the scale
below to describe your experience/expertise in each area listed below.
Proficiency Scale:
1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
Rating Stars (Click)
CARDIOVASCULAR
1
2
3
4
Open Heart Recovery
AAA Repair
Vascular Surgery
Pacemaker-Permanent & Temporary
Cardioversion
AICD Insertion
Cardiac Arrest
Cardiac Tamponade
CHF/Pulmonary Edema
Abnormal Heart
Sounds/Murmurs
Pulses/Circulation Checks
Rating Stars
(Click)
PULMONARY
1
2
3
4
Ventilator Management
Fresh Tracheostomy
Thoracotomy/Lobectomy/Pneumonectomy
Pneumothorax/Hemothorax
Laryngospasm
Pulmonary Embolism
COPD
ABG Interpretation
Rating Stars
(Click)
NEUROLOGIC
1
2
3
4
Post Craniotomy
Anterior/Posterior Spinal
Fusion
Carotid Endardarectomy
Spine Surgery
CVA
Stroke Scale
Glascow Coma Scale
Spinal Precautions
Hypothermia Protocol
Hypo/Hyperthermia Blanket
Sedation Scales/Levels
Rating Stars
(Click)
GASTROINTESTINAL
1
2
3
4
Pancreas/Liver Transplant
Colon Surgery
Colostomy/Ileostomy
ERCP
G Tube/J Tube Management
T Tube Management
Rating Stars
(Click)
RENAL/GENITOURINARY
1
2
3
4
Renal Surgery
TURP
Arteriovenous
Fistula/Shunt
Nephrostomy Tubes
Rating Stars
(Click)
ENDOCRINE METABOLIC
1
2
3
4
Diabetes -
Hypo/Hyperglycemic Crisis
IV Insulin Protocols
Rating Stars
(Click)
ORTHOPEDIC
1
2
3
4
Laminectomy
Total Joint Replacement
Amputation
Open Reduction/Internal
Fixation
General Orthopedic
Surgeries
CPM/Traction
Circulation Checks
Rating Stars
(Click)
WOUND MANAGEMENT
1
2
3
4
Surgical Drains
Wound Vac
Surgical Wound Assessment
Skin Assessment for
Breakdown
Staging Decubitus Ulcers
Rating Stars
(Click)
MEDICATIONS
1
2
3
4
Procedural Sedation
Anesthesia Medications
Anti-Arrhythmics
Anticoagulants
Anti-Hypertensives
Anti-Seizure Medications
Benzodiazepines
Emergency Medications
Insulin
Narcotics/Opioid
Analgesics
Nitrates
Non-Opioid Analgesics
Reversal Agents
Steroids
Automated Medication
Dispensing (i.e. Pyxis, Omnicell)
Rating Stars
(Click)
IV THERAPY
1
2
3
4
Starting Ivs
Central Line Blood Draws
Central Line/Implanted
Line Care
Blood Product
Administration
Rating Stars
(Click)
CARDIAC MONITORING & EMERG. RESPONSE
1
2
3
4
Malignant Hyperthermia
Dysrhythmia Interpretation
Dysrhythmia Management
12 Lead EKG
Rating Stars
(Click)
PROFESSIONAL KNOWLEDGE AND
SKILLS
1
2
3
4
National Patient Safety
Goals/Core Measures
Fall Risk
Assessment/Prevention
Pressure Ulcer Risk
Assessment/Prevention
Age
Specific/Population-Based Care
Pain Assessment &
Management
Charge Experience
Interpretation and
Communication of Lab Values
Specialty Beds
Rating Stars
(Click)
EMR
1
2
3
4
Epic
Cerner
Eclipsys
McKesson
Meditech
Other Computerized System
Computerized Physician
Order Entry
Bar Coding for Medication
Administration
PULMONARY
EMR Conversion
YES
NO
CERTIFICATIONS
Expiry Date :
BLS
ACLS
PALS
Certification: CAPA or CPAN
Other: Specify
Other: Specify
Rating Stars
(Click)
Age Specific Competencies
1
2
3
4
Infant (Birth - 1 year)
Preschooler (ages 2-5
years)
Childhood (ages 6-12
years)
Adolescents (ages 13-21
years)
Young Adults (ages 22-39
years)
Adults (ages 40-64 years)
Older Adults (ages 65-79
years)
Elderly (ages 80+ years)