Proﬁciency Scale

No Experience

Some Experience (Require Assistance)

Intermittent Experience (May Require Assistance)

Experienced (Performs without Assistance)

Very Experienced (Able to Teach/Supervise)

Physiologic Monitoring

1

2

3

4

5

Monitoring/recording of LHC/RHC

Monitoring/recording of aortic/mitral valve cases

Monitoring/recording of PCI (Percutaneous Coronary Interventions)

Monitoring/recording valve cases

Monitoring/recording ASD closures

Monitoring/recording of EP/ablation cases

Monitoring/recording of permanent pacemaker insertions

National Patient Safety Goals

Accurate patient identification

Effective communication

Interpretation & communication of lab values

Medication administration

Medication reconciliation

Labeling (medications & specimens)

Anticoagulation therapy

Monitoring conscious sedation

Pain assessment & management

Infection control

Universal precautions

Isolation

Minimize risk for falls

Prevention of pressure ulcers

Use of rapid response teams

Scrubs

1

2

3

4

5

LHC/RHC

IABP insertions

Filter wires

Embolic protection devices

ASD closures

Valvuloplasty

Atherectomy

PCI

EP/ablations

Permanent pacemaker insertions

Maintain temporary pacemaker

Interventional Radiology (RN)

1

2

3

4

5

Circulates for interventional procedures

Scrubs for interventional procedures

Angiogram/aortogram

Angioplasty

Vascular stenting

Declotting

Embolization

TIPS

Port placement

Dialysis catheter placement

Retrieval of foreign body

UAE (Uterine Arterial Embolization)

EVLT (Endovascular Laser Therapy)

Vertebro/kyphoplasty

Neuroradiology

Discogram

AAA endograft repair

Carotids

Extremities

Please list any additional skills/training/equipment:

Skills:

Training

Equipment:

I certify that all the above information is correct, and that any misrepresentation or falsification of fact may be considered sufficient cause for immediate dismissal from the agency. I have filled out this skills checklist to the best of my knowledge and agree that all the information provided is correct.

Personal Information

Proﬁciency Scale

General

Physiologic Monitoring

Circulates

Scrubs

Equipment

Interventional Radiology (RN)

Age Specific Competencies

Please list any additional skills/training/equipment: