[checklist name="Medical-Surgical / Telemetry" mailto="credentialing@teemagroup.com" templatedoc="1OUc15TbFrtOHcwpOOBIpJtsYYsEaTa73FBWLy2z9NbY" templatedrive="1LG9WAg21_L3L-ZkZEChBzrYRhBOjpmcc" savedrive="15FFQjDXxe9nC9FkAAcuxbswGy1hq4sWm" sheetid="1xJkggLvktsyYL6zuIhdO-OURJhJTkWdDKunR11agspw"] [checklistHeading title="Nurse Checklist - Medical-Surgical / Telemetry"] 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="date" default="none"]Submit Date[/checklistInput] [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="General Skills"] [checklistInput type="scale"]Restrictive Devices (Restraints)[/checklistInput] [checklistInput type="scale"]Lift/Transfer Devices[/checklistInput] [checklistInput type="scale"]Specialty Beds[/checklistInput] [checklistInput type="scale"]End of Life Care/Palliative Care[/checklistInput] [checklistInput type="scale"]Automated Medication Dispensing System, Pyxis, Omnicell, or other[/checklistInput] [checklistInput type="scale"]Barcoding for medication administration[/checklistInput] [checklistInput type="scale"]National Patient Safety Goals[/checklistInput] [checklistInput type="scale"]Accurate Patient Informaiton[/checklistInput] [checklistInput type="scale"]Interpretation & communication of lab values[/checklistInput] [checklistInput type="scale"]Medication Administration[/checklistInput] [checklistInput type="scale"]Anticoagulation therapy[/checklistInput] [checklistInput type="scale"]Monitoring conscious sedation[/checklistInput] [checklistInput type="scale"]Pain Assessment and Management[/checklistInput] [checklistInput type="scale"]Use of PCA (IV, intrathecal, epidural)[/checklistInput] [checklistInput type="scale"]Infection Control[/checklistInput] [checklistInput type="scale"]Universal Precautions[/checklistInput] [checklistInput type="scale"]Isolation[/checklistInput] [checklistInput type="scale"]Minimize Risk of Falls[/checklistInput] [checklistInput type="scale"]Prevention of pressure ulcers[/checklistInput] [checklistInput type="scale"]Wound Care[/checklistInput] [checklistInput type="scale"]Wound Vacs[/checklistInput] [checklistInput type="scale"]Awareness of HCAHPS[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Specialty Skills"] [checklistInput type="scale"]Assessing Levels of Consciousness[/checklistInput] [checklistInput type="scale"]Pupil Checks[/checklistInput] [checklistInput type="scale"]Seizure Precautions[/checklistInput] [checklistInput type="scale"]Aneurysm Precautions[/checklistInput] [checklistInput type="scale"]Assisting with Lumbar Puncture[/checklistInput] [checklistInput type="scale"]Use of Hyper/Hypothermia Blanket[/checklistInput] [checklistInput type="scale"]Cardiac Monitors[/checklistInput] [checklistInput type="scale"]Auscultation of Cardiac Sounds[/checklistInput] [checklistInput type="scale"]EKG- 12 Lead[/checklistInput] [checklistInput type="scale"]Recognizing Basic & Life-Threatening Dysrhythmias[/checklistInput] [checklistInput type="scale"]Cardioversion/ Defibrillation[/checklistInput] [checklistInput type="scale"]Pulse Checks[/checklistInput] [checklistInput type="scale"]Interpretation of Cardiac Enzymes[/checklistInput] [checklistInput type="scale"]Use of Doppler[/checklistInput] [checklistInput type="scale"]Use of Automatic BP Cuff (ie Dinamap)[/checklistInput] [checklistInput type="scale"]O2 Cannulas/Masks[/checklistInput] [checklistInput type="scale"]Nebulizer Set-up/Use[/checklistInput] [checklistInput type="scale"]Incentive Spirometry[/checklistInput] [checklistInput type="scale"]Chest PT[/checklistInput] [checklistInput type="scale"]Pulse Oximetry[/checklistInput] [checklistInput type="scale"]Oral Suctioning[/checklistInput] [checklistInput type="scale"]Tracheostomy Tube Suctioning[/checklistInput] [checklistInput type="scale"]Insertion, Care & Maintenance of Nasogastric Tubes (ie Salem Pump, Levine)[/checklistInput] [checklistInput type="scale"]Nasointestinal Tubes (ie Cantor, Miller-Abbot)[/checklistInput] [checklistInput type="scale"]Jejunostomy, Gastrostomy, Cecostomy Tubes[/checklistInput] [checklistInput type="scale"]Insertion of Catheter Straight[/checklistInput] [checklistInput type="scale"]Insertion of Catheter Foley[/checklistInput] [checklistInput type="scale"]Bladder Irrigation Continuous[/checklistInput] [checklistInput type="scale"]Bladder Irrigation Intermittent[/checklistInput] [checklistInput type="scale"]Peritoneal Dialysis[/checklistInput] [checklistInput type="scale"]Automatic Cycler Machine[/checklistInput] [checklistInput type="scale"]Collection of Urine Specimens[/checklistInput] [checklistInput type="scale"]Hemodialysis[/checklistInput] [checklistInput type="scale"]A-V Fistula/Shunt Care[/checklistInput] [checklistInput type="scale"]Pre- & Post- Dialysis Care[/checklistInput] [checklistInput type="scale"]Suprapubic Catheter[/checklistInput] [checklistInput type="scale"]Nephrostomy Tube[/checklistInput] [checklistInput type="scale"]Performing Fingersticks[/checklistInput] [checklistInput type="scale"]Use of Blood Glucose Meter Device[/checklistInput] [checklistInput type="scale"]Use of Visual Blood Glucose Strips[/checklistInput] [checklistInput type="scale"]Cast Care[/checklistInput] [checklistInput type="scale"]C.M.S. Checks[/checklistInput] [checklistInput type="scale"]Traction – Skin[/checklistInput] [checklistInput type="scale"]Traction – Skeletal[/checklistInput] [checklistInput type="scale"]Range of Motion[/checklistInput] [checklistInput type="scale"]Use of Assistive Devices[/checklistInput] [checklistInput type="scale"]Applications of Splints Extremities[/checklistInput] [checklistInput type="scale"]Continuous Passive Motion Machine (CPM)[/checklistInput] [checklistInput type="scale"]Discontinue PICC[/checklistInput] [checklistInput type="scale"]Draw Blood from Arterial Line[/checklistInput] [checklistInput type="scale"]Draw Blood from Central Line[/checklistInput] [checklistInput type="scale"]Peripheral IV Insertion, Care & Maintenance[/checklistInput] [checklistInput type="scale"]Discontinue Peripheral IV[/checklistInput] [checklistInput type="scale"]IV Infusion Pumps[/checklistInput] [checklistInput type="scale"]CVP Lines – Measurement of CVP[/checklistInput] [checklistInput type="scale"]Central Line Care & Maintenance (including dressing changes)[/checklistInput] [checklistInput type="scale"]Blood/Blood Product Administration[/checklistInput] [checklistInput type="scale"]Multi-Lumen Central Catheters[/checklistInput] [checklistInput type="scale"]Port-A-Caths (Infusa-Ports)[/checklistInput] [checklistInput type="scale"]Continuous Subcutaneous Infusion Pumps[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Care of Patients With"] [checklistInput type="scale"]Aneurysm[/checklistInput] [checklistInput type="scale"]Angina[/checklistInput] [checklistInput type="scale"]Acute MI[/checklistInput] [checklistInput type="scale"]Angioplasty (pre/post)[/checklistInput] [checklistInput type="scale"]Carotid endarterectomy[/checklistInput] [checklistInput type="scale"]Chest Pain[/checklistInput] [checklistInput type="scale"]CHF[/checklistInput] [checklistInput type="scale"]Pre/post cardiac cath[/checklistInput] [checklistInput type="scale"]Post MI[/checklistInput] [checklistInput type="scale"]Pre/post cardiac surgery (CABG & valves)[/checklistInput] [checklistInput type="scale"]Pre/post vascular surgery (abdominal or thoracic AA, fem-pop, carotid)[/checklistInput] [checklistInput type="scale"]Cardiogenic shock[/checklistInput] [checklistInput type="scale"]COPD[/checklistInput] [checklistInput type="scale"]Tracheostomy[/checklistInput] [checklistInput type="scale"]Thyroidectomy[/checklistInput] [checklistInput type="scale"]Pulmonary embolism[/checklistInput] [checklistInput type="scale"]Pulmonary edema[/checklistInput] [checklistInput type="scale"]Pneumothorax[/checklistInput] [checklistInput type="scale"]Pneumonia[/checklistInput] [checklistInput type="scale"]Inhalation injuries[/checklistInput] [checklistInput type="scale"]Tuberculosis[/checklistInput] [checklistInput type="scale"]Emphysema[/checklistInput] [checklistInput type="scale"]Asthma[/checklistInput] [checklistInput type="scale"]Thoracentesis/paracentesis[/checklistInput] [checklistInput type="scale"]Lung Transplant[/checklistInput] [checklistInput type="scale"]Stroke[/checklistInput] [checklistInput type="scale"]Spinal Cord Injury - Acute[/checklistInput] [checklistInput type="scale"]Spinal Cord Injury – Long Term[/checklistInput] [checklistInput type="scale"]Neuromuscular Disease[/checklistInput] [checklistInput type="scale"]Alzheimer's Disease[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Alzheimer's Disease"] [checklistInput type="scale"]Anticoagulants[/checklistInput] [checklistInput type="scale"]Narcotics[/checklistInput] [checklistInput type="scale"]PCA for Pain Control[/checklistInput] [checklistInput type="scale"]Epidural for Pain Control[/checklistInput] [checklistInput type="scale"]Non-narcotic Analgesics[/checklistInput] [checklistInput type="scale"]Topical Medications[/checklistInput] [checklistInput type="scale"]IM Medications[/checklistInput] [checklistInput type="scale"]SQ Medications[/checklistInput] [checklistInput type="scale"]Oral Medications[/checklistInput] [checklistInput type="scale"]IV Push Medications[/checklistInput] [checklistInput type="scale"]IV Drip Medications[/checklistInput] [checklistInput type="scale"]Antibiotics[/checklistInput] [checklistInput type="scale"]Chemotherapy[/checklistInput] [checklistInput type="scale"]Anticonvulsants[/checklistInput] [checklistInput type="scale"]IV Drip Steroids[/checklistInput] [checklistInput type="scale"]Nitrates (Oral, Topical)[/checklistInput] [checklistInput type="scale"]Antiarrhythmics (Oral)[/checklistInput] [checklistInput type="scale"]Antihypertensives (Oral) [/checklistInput] [checklistInput type="scale"]Heparin Drip[/checklistInput] [checklistInput type="scale"]O2 Therapy[/checklistInput] [checklistInput type="scale"]Bronchodilators[/checklistInput] [checklistInput type="scale"]Oral Steroids[/checklistInput] [checklistInput type="scale"]IV Steroids[/checklistInput] [checklistInput type="scale"]Inhaler[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Age-Appropriate Care of"] [checklistInput type="scale"]Newborn (birth - 30 days)[/checklistInput] [checklistInput type="scale"]Infant (31 days - 1 year)[/checklistInput] [checklistInput type="scale"]Toddler (1 - 3 years)[/checklistInput] [checklistInput type="scale"]Preschooler (3 - 5 years)[/checklistInput] [checklistInput type="scale"]School Age (5 - 12 years)[/checklistInput] [checklistInput type="scale"]Adolescents (12 - 18 years)[/checklistInput] [checklistInput type="scale"]Young Adults (18 - 39 years)[/checklistInput] [checklistInput type="scale"]Middle Adults (39 - 64 years)[/checklistInput] [checklistInput type="scale"]Older Adults (64+ years)[/checklistInput] [/checklistInputGroup] [checklistFooter] [/checklistFooter] [/checklist]