[checklist name= "Dialysis Nursing Skills" mailto="credentialing@teemagroup.com" templatedoc="19cnTHqjwFVvB5AdQK0SFHLbpSSzO059TxJ4dQYU97XM" templatedrive="1LG9WAg21_L3L-ZkZEChBzrYRhBOjpmcc" savedrive="15FFQjDXxe9nC9FkAAcuxbswGy1hq4sWm" sheetid="1xJkggLvktsyYL6zuIhdO-OURJhJTkWdDKunR11agspw"] [checklistHeading title="Dialysis Nursing 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="Work Settings"] [checklistInput type="scale"]Acute/Inpatient Dialysis[/checklistInput] [checklistInput type="scale"]Chronic/Outpatient Dialysis[/checklistInput] [checklistInput type="scale"]Dialysis Home Care[/checklistInput] [checklistInput type="scale"]Pediatric Dialysis[/checklistInput] [checklistInput type="scale"]Apheresis[/checklistInput] [checklistInput type="scale"]Plasmapheresis[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Set up/Initiate Dialysis Treatment"] [checklistInput type="scale"]Bicarbonate Dialysate[/checklistInput] [checklistInput type="scale"]Conductivity Testing[/checklistInput] [checklistInput type="scale"]Priming Dialyzer[/checklistInput] [checklistInput type="scale"]Prep Vascular Access[/checklistInput] [checklistInput type="scale"]Fistula Gortex/Bovine Graft[/checklistInput] [checklistInput type="scale"]Anticoagulation Management[/checklistInput] [checklistInput type="scale"]Apheresis[/checklistInput] [checklistInput type="scale"]Plasmapheresis[/checklistInput] [checklistInput type="scale"]Cannulating Buttonholes[/checklistInput] [checklistInput type="scale"]Continuous Renal Replacement Therapy[/checklistInput] [checklistInput type="scale"]Peritoneal Dialysis[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Assessment During Dialysis"] [checklistInput type="scale"]Vascular Access Function[/checklistInput] [checklistInput type="scale"]Arterial and Venous Pressures[/checklistInput] [checklistInput type="scale"]Blood Flow Rate[/checklistInput] [checklistInput type="scale"]Management of Anticoagulation[/checklistInput] [checklistInput type="scale"]Conductivity[/checklistInput] [checklistInput type="scale"]Ultra Filtration Calculation[/checklistInput] [checklistInput type="scale"]Operation of Myron L. Meter[/checklistInput] [checklistInput type="scale"]Administration of Blood and Blood Products[/checklistInput] [checklistInput type="scale"]Administration of Mannitol[/checklistInput] [checklistInput type="scale"]Sequential Ultrafiltration/PUF[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Sequential Ultrafiltration/PUF"] [checklistInput type="scale"]Fluid Overload[/checklistInput] [checklistInput type="scale"]Hypotension[/checklistInput] [checklistInput type="scale"]Disequilibrium Syndrome[/checklistInput] [checklistInput type="scale"]Hyperkalemia[/checklistInput] [checklistInput type="scale"]Seizures[/checklistInput] [checklistInput type="scale"]Muscle Cramps[/checklistInput] [checklistInput type="scale"]Clotted Access/Poor Blood Flow Rate from Catheter[/checklistInput] [checklistInput type="scale"]Pyrogenic Reaction[/checklistInput] [checklistInput type="scale"]Hemolysis[/checklistInput] [checklistInput type="scale"]Air Embolus[/checklistInput] [checklistInput type="scale"]Chest Pain[/checklistInput] [checklistInput type="scale"]Anemia[/checklistInput] [checklistInput type="scale"]Neuropathy[/checklistInput] [checklistInput type="scale"]Pericarditis[/checklistInput] [checklistInput type="scale"]Filter Blood Leak[/checklistInput] [checklistInput type="scale"]Cardiopulmonary Arrest[/checklistInput] [checklistInput type="scale"]Anticoagulation Emergencies[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Dialysis Equipment"] [checklistInput type="scale"]Baxter[/checklistInput] [checklistInput type="scale"]Cobe[/checklistInput] [checklistInput type="scale"]Fresenius H/K[/checklistInput] [checklistInput type="scale"]Gambro[/checklistInput] [checklistInput type="scale"]Phoenix[/checklistInput] [checklistInput type="scale"]T Machine[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Professional Knowledge and Skills"] [checklistInput type="scale"]National Patient Safety Goals[/checklistInput] [checklistInput type="scale"]Patient Isolation/Infection Prevention[/checklistInput] [checklistInput type="scale"]Management of Dialysis Equipment Alarms[/checklistInput] [checklistInput type="scale"]Bedside Blood Glucose Monitoring[/checklistInput] [checklistInput type="scale"]Pyxis Medication Admin. System[/checklistInput] [checklistInput type="scale"]Computerized Charting[/checklistInput] [checklistInput type="scale"]Proton Charting Experience[/checklistInput] [checklistInput type="scale"]AMI Charting Experience[/checklistInput] [checklistInput type="scale"]Ecube Charting Experience[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Certifications/Licenses/Registrations"] [checklistInput type="date"]BLS (Exp. Date)[/checklistInput] [checklistInput type="date"]CHT (Exp. Date)[/checklistInput] [/checklistInputGroup] [checklistFooter] [/checklistFooter] [/checklist]