[checklist name="Telemetry" mailto="credentialing@teemagroup.com" templatedoc="1t1jFIALLmEZQIVTVyyXWofhRBMIAZVO_IhaTqI2EdKA" templatedrive="1LG9WAg21_L3L-ZkZEChBzrYRhBOjpmcc" savedrive="15FFQjDXxe9nC9FkAAcuxbswGy1hq4sWm" sheetid="1xJkggLvktsyYL6zuIhdO-OURJhJTkWdDKunR11agspw"] [checklistHeading title="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="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="Pulmonary"] [checklistInput type="scale"]Pneumonia[/checklistInput] [checklistInput type="scale"]Respiratory Distress[/checklistInput] [checklistInput type="scale"]COPD[/checklistInput] [checklistInput type="scale"]Breath Sounds[/checklistInput] [checklistInput type="scale"]Post Thoracic Surgery[/checklistInput] [checklistInput type="scale"]Chest Tube Placement & Management[/checklistInput] [checklistInput type="scale"]Trach Management[/checklistInput] [checklistInput type="scale"]Modes of Ventilation (AC/PC/SIMV/CPAP)[/checklistInput] [checklistInput type="scale"]Intubation/Extubation[/checklistInput] [checklistInput type="scale"]External CPAP/BiPAP[/checklistInput] [checklistInput type="scale"]Interpretation of Arterial Blood Gases[/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="Neurologic & 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"]ETOH/Drug Withdrawal[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="RENAL/GENITOURINARY"] [checklistInput type="scale"]Renal Failure[/checklistInput] [checklistInput type="scale"]Renal Surgery[/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] [/checklistInputGroup] [checklistInputGroup name="ENDOCRINE METABOLIC"] [checklistInput type="scale"]Diabetes - Hypo/Hyperglycemic Crisis[/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, & 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"]Procedural Sedation[/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"]Titrate Vasoactive Drips[/checklistInput] [checklistInput type="scale"]Manage Vasoactive Drips - No Titration[/checklistInput] [checklistInput type="scale"]Narcotics/Opioid Analgesics (IV, oral, & injection)[/checklistInput] [checklistInput type="scale"]Nitrates (Oral & Topical)[/checklistInput] [checklistInput type="scale"]Non-Opioid Analgesics (IV, Oral, & 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="CARDIAC MONITORING & 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"]Cardioversion[/checklistInput] [checklistInput type="scale"]Defibrillation[/checklistInput] [checklistInput type="scale"]Malignant Hyperthermia[/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"]Arterial Line Management[/checklistInput] [checklistInput type="scale"]TPN & Lipids[/checklistInput] [checklistInput type="scale"]Blood Product Administration[/checklistInput] [checklistInput type="scale"]Administration of Chemotherapy[/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"]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 & 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] [checklistFooter] [/checklistFooter] [/checklist]