Legends

1 = No experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

PRESSURE ULCERS

1

2

3

4

Assessment

Staging

Prevention/ Risk Assessment Tools – Adult

Prevention/ Risk Assessment Tools – Pediatrics

Support Surface Selection

VENOUS STASIS ULCERS

1

2

3

4

Assessment

Management

OTHER WOUNDS

1

2

3

4

Fistulae – Pouching / Skin Care

Skin Care/ Management of Drains

DRESSINGS/ TREATMENTS

1

2

3

4

Hydrogels

Hydrocolloids

Silver Products

Foams

Alginates

Vacuum Assisted Closure

Growth Factors

Skin Substitutes

Hyperbaric Oxygen Therapy

Wound Cultures

Electrical Stimulation

Enzymatic Debriding Agents

Mist Therapy

CONTINENT ILEOSTOMY

1

2

3

4

Knock Pouch

Pelvic Pouch

CONTINENCE THERAPEUTIC DEVICES

1

2

3

4

Vaginal Cones

Penile Clamps

Male External Catheters

Internal Urethral Inserts

Catheters – Mgmt & Self Care Teaching

Magnetic Therapy

Urinary Incontinence Program

Fecal Incontinence Program

PROFESSIONAL KNOWLEDGE AND SKILLS

1

2

3

4

National Patient Safety Goals/ Core Measures

Patient Family Teaching

Age Specific/Population Based Care

Isolation Precautions

Infection Precautions

Pain Assessment & Management

Interpretation & Communication of Lab Values

EMR

EPIC

Cerner

Eclipsys

McKesson

Other Computerized System

Computerized Physician Order Entry

Bar Coding for Medication

Culture

AGE SPECIFIC CARE

1

2

3

4

Infant (Birth to 1 year)

Toddler (1-3 years)

Pre-school (3-6 years)

School Age (6-12 years)

Adolescent (12-18 years)

Young Adult (18-30 years)

Mature Adult (30-60 years)

Elderly (>60 years)

I hereby cerfy that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

I have filled out this skills checklist to the best of my knowledge and agree that all the information provided is correct.

Personal Information

Legends

WORK SETTINGS

PRESSURE ULCERS

NEUROPATHIC ULCERS

VENOUS STASIS ULCERS

PERIPHERAL ARTERIAL ULCERS

OTHER WOUNDS

WOUND DEBRIDEMENT

DRESSINGS/ TREATMENTS

COLOSTOMY / ILEOSTOMY

CONTINENT ILEOSTOMY

UROSTOMY / CONTINENT

CONTINENCE THERAPEUTIC DEVICES

BURNS

PROFESSIONAL KNOWLEDGE AND SKILLS

OTHER / MISC.

AGE SPECIFIC CARE