[checklist name= "Critical Care/ICU Skills" mailto="credentialing@teemagroup.com" templatedoc="13S4nyrwQmnjwJOA8w7Snp5rmvWsvz8JH1UfCRBsRgno" templatedrive="1LG9WAg21_L3L-ZkZEChBzrYRhBOjpmcc" savedrive="15FFQjDXxe9nC9FkAAcuxbswGy1hq4sWm" sheetid="1xJkggLvktsyYL6zuIhdO-OURJhJTkWdDKunR11agspw"] [checklistHeading title="Critical Care/ICU Skills"] Please rate your experience / frequency (within the last year) using the scale (check the appropriate boxes below) 0 = No theory and/or experience 1 = Limited experience/need supervision and/or support 2 = Experienced/minimal support needed to perform) 3 = Proficient/can perform independently 4 = Expert/very experienced in the field [/checklistHeading] [checklistInputGroup name="Recruiter Information"] [checklistInput type="text"]Recruiter TEEMA email[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Personal Information"] [checklistInput type="text"]Full Name[/checklistInput] [checklistInput type="email"]Your Email[/checklistInput] [checklistInput type="text"]Your phone number[/checklistInput] [checklistInput type="text"]Last 4 of Social Security Number[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Cardiac"] [checklistInput type="scale"]Acute Coronary Syndrome[/checklistInput] [checklistInput type="scale"]Congestive Heart Failure[/checklistInput] [checklistInput type="scale"]Cardiogenic Shock[/checklistInput] [checklistInput type="scale"]Cardiac Tamponade[/checklistInput] [checklistInput type="scale"]Heart Sounds[/checklistInput] [checklistInput type="scale"]Immediate Post-Op Open Heart (directly from OR)[/checklistInput] [checklistInput type="scale"]Immediate Post-Op Open Heart (NOT directly from OR)[/checklistInput] [checklistInput type="scale"]Heart Transplant[/checklistInput] [checklistInput type="scale"]Open Chest Emergency[/checklistInput] [checklistInput type="scale"]Sheath Removal[/checklistInput] [checklistInput type="scale"]Pacemaker - Temporary/Permanent[/checklistInput] [checklistInput type="scale"]Pacemaker - Epicardial[/checklistInput] [checklistInput type="scale"]Hemodynamic Monitoring[/checklistInput] [checklistInput type="scale"]SVO2 Monitoring[/checklistInput] [checklistInput type="scale"]Intra-Aortic Balloon Pump[/checklistInput] [checklistInput type="scale"]Ventricular Assist Device[/checklistInput] [checklistInput type="scale"]ECMO[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Pulmonary"] [checklistInput type="scale"]Respiratory Failure[/checklistInput] [checklistInput type="scale"]ARDS[/checklistInput] [checklistInput type="scale"]Pneumothorax[/checklistInput] [checklistInput type="scale"]Pulmonary Embolism[/checklistInput] [checklistInput type="scale"]Pulmonary Edema[/checklistInput] [checklistInput type="scale"]Fresh Tracheostomy[/checklistInput] [checklistInput type="scale"]Chest Trauma[/checklistInput] [checklistInput type="scale"]Post Thoracic Surgery[/checklistInput] [checklistInput type="scale"]Lung Transplant[/checklistInput] [checklistInput type="scale"]Intubation/Extubation[/checklistInput] [checklistInput type="scale"]Modes of Ventilation (AC/PC/SIMV/CPAP)[/checklistInput] [checklistInput type="scale"]Nitric Oxide[/checklistInput] [checklistInput type="scale"]Interpretation of Arterial Blood Gases[/checklistInput] [checklistInput type="scale"]Chest Tube Placement And Management[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Neurological And Psychiatric"] [checklistInput type="scale"]Stroke Scale Assessment[/checklistInput] [checklistInput type="scale"]CVA[/checklistInput] [checklistInput type="scale"]Brain Injury[/checklistInput] [checklistInput type="scale"]Post Craniotomy[/checklistInput] [checklistInput type="scale"]Spinal Cord Injury[/checklistInput] [checklistInput type="scale"]Seizure Disorders[/checklistInput] [checklistInput type="scale"]ICP Monitoring[/checklistInput] [checklistInput type="scale"]Hypothermia Protocol[/checklistInput] [checklistInput type="scale"]Substance Withdrawal[/checklistInput] [checklistInput type="scale"]Suicide Precautions[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Gastrointestinal"] [checklistInput type="scale"]GI Bleeding[/checklistInput] [checklistInput type="scale"]GI Surgery[/checklistInput] [checklistInput type="scale"]Liver Failure[/checklistInput] [checklistInput type="scale"]Pancreatitis[/checklistInput] [checklistInput type="scale"]Liver Transplant[/checklistInput] [checklistInput type="scale"]Pancreas Transplant[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Renal/Genitourinary"] [checklistInput type="scale"]Renal Failure[/checklistInput] [checklistInput type="scale"]Renal Surgery[/checklistInput] [checklistInput type="scale"]TURP[/checklistInput] [checklistInput type="scale"]Renal Transplant[/checklistInput] [checklistInput type="scale"]Arteriovenous Fistula/Shunt[/checklistInput] [checklistInput type="scale"]Nephrostomy Tubes[/checklistInput] [checklistInput type="scale"]Peritoneal Dialysis[/checklistInput] [checklistInput type="scale"]Continuous Renal Replacement Therapy[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Endocrine Metabolic"] [checklistInput type="scale"]Diabetes - Hypo/Hyperglycemic Crisis[/checklistInput] [checklistInput type="scale"]Diabetic Ketoacidosis[/checklistInput] [checklistInput type="scale"]Pituitary Disorders[/checklistInput] [checklistInput type="scale"]IV Insulin Protocols[/checklistInput] [checklistInput type="scale"]Indwelling Insulin Pumps[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Medications"] [checklistInput type="scale"]Anti-Arrhythmics[/checklistInput] [checklistInput type="scale"]Anticoagulants (IV, oral, and injection)[/checklistInput] [checklistInput type="scale"]Anti-Hypertensives[/checklistInput] [checklistInput type="scale"]Anti-Psychotics[/checklistInput] [checklistInput type="scale"]Anti-Seizure Medications[/checklistInput] [checklistInput type="scale"]Benzodiazepines[/checklistInput] [checklistInput type="scale"]Continuous IV Paralytics[/checklistInput] [checklistInput type="scale"]Continuous IV Sedation[/checklistInput] [checklistInput type="scale"]Procedural Sedation - Administration[/checklistInput] [checklistInput type="scale"]Diuretics[/checklistInput] [checklistInput type="scale"]Emergency Medications[/checklistInput] [checklistInput type="scale"]Inhaled Medications[/checklistInput] [checklistInput type="scale"]Insulin[/checklistInput] [checklistInput type="scale"]IV Vasopressors[/checklistInput] [checklistInput type="scale"]Narcotics/Opioid Analgesics (IV, oral, and injection)[/checklistInput] [checklistInput type="scale"]Nitrates (Oral and Topical)[/checklistInput] [checklistInput type="scale"]Non-Opioid Analgesics (IV, Oral, and Injection)[/checklistInput] [checklistInput type="scale"]Reversal Agents[/checklistInput] [checklistInput type="scale"]Steroids (IV, Oral, Inhaled)[/checklistInput] [checklistInput type="scale"]Automated Medication Dispensing (i.e. Pyxis, Omnicell)[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="IV Therapy"] [checklistInput type="scale"]Starting IVs[/checklistInput] [checklistInput type="scale"]Central Line Blood Draws[/checklistInput] [checklistInput type="scale"]Central Line/Implanted Line Care[/checklistInput] [checklistInput type="scale"]TPN And Lipids[/checklistInput] [checklistInput type="scale"]Blood Product Administration[/checklistInput] [checklistInput type="scale"]Administration of Chemotherapy[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Cardiac Monitoring And Emerg. Response"] [checklistInput type="scale"]Dysrhythmia Interpretation[/checklistInput] [checklistInput type="scale"]Dysrhythmia Management[/checklistInput] [checklistInput type="scale"]Obtain 12 Lead EKG[/checklistInput] [checklistInput type="scale"]Interpret 12 Lead EKG[/checklistInput] [checklistInput type="scale"]Management of Cardiac Arrest[/checklistInput] [checklistInput type="scale"]Shock Management[/checklistInput] [checklistInput type="scale"]Malignant Hyperthermia[/checklistInput] [checklistInput type="scale"]Multisystem Organ Failure[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Professional Knowledge And Skills"] [checklistInput type="scale"]National Patient Safety Goals/Core Measures[/checklistInput] [checklistInput type="scale"]Fall Risk Assessment/Prevention[/checklistInput] [checklistInput type="scale"]Pressure Ulcer Risk Assessment/Prevention[/checklistInput] [checklistInput type="scale"]Restraints/Use of Least Restrictive Device[/checklistInput] [checklistInput type="scale"]Patient/Family Teaching[/checklistInput] [checklistInput type="scale"]Age Specific/Population-Based Care[/checklistInput] [checklistInput type="scale"]Isolation Precautions[/checklistInput] [checklistInput type="scale"]Infection Prevention[/checklistInput] [checklistInput type="scale"]Pain Assessment and Management[/checklistInput] [checklistInput type="scale"]Charge Experience[/checklistInput] [checklistInput type="scale"]Interpretation and Communication of Lab Values[/checklistInput] [checklistInput type="scale"]Specialty Beds[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="EMR"] [checklistInput type="scale"]Epic[/checklistInput] [checklistInput type="scale"]Cerner[/checklistInput] [checklistInput type="scale"]Eclipsys[/checklistInput] [checklistInput type="scale"]McKesson[/checklistInput] [checklistInput type="scale"]Meditech[/checklistInput] [checklistInput type="scale"]Other Computerized System[/checklistInput] [checklistInput type="scale"]Computerized Physician Order Entry[/checklistInput] [checklistInput type="scale"]Bar Coding for Medication Administration[/checklistInput] [checklistInput type="scale"]EMR Conversion[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Certifications"] [checklistInput type="date"]BLS (Exp. Date)[/checklistInput] [checklistInput type="date"]ACLS (Exp. Date)[/checklistInput] [checklistInput type="date"]PALS (Exp. Date)[/checklistInput] [checklistInput type="date"]TNCC (Exp. Date)[/checklistInput] [checklistInput type="date"]CCRN (Exp. Date)[/checklistInput] [checklistInput type="date"]Telemetry Certificate/Course (Date taken)[/checklistInput] [checklistInput type="date"]Critical Care Course (Date taken)[/checklistInput] [/checklistInputGroup] [checklistFooter] [/checklistFooter] [/checklist]