Pediatric Emergency Department Skills Checklist Date:* Name: (First, MI, Last)* Email Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledCARDIOVASCULARAssessment:* 0 1 2 3 Auscultation:* 0 1 2 3 Heart Sounds/Murmurs:* 0 1 2 3 Assist with Set up/Insertion/Monitoring:* 0 1 2 3 A Line:* 0 1 2 3 CVP Line:* 0 1 2 3 PA Catheter/Swan Ganz:* 0 1 2 3 Cardioversion:* 0 1 2 3 Equipment & Procedures:* 0 1 2 3 Arrhythmia Interpretation:* 0 1 2 3 Basic 12 Lead Interpretation:* 0 1 2 3 Defibrillation:* 0 1 2 3 Care of the Patient with:* 0 1 2 3 Cardiac Anomalies:* 0 1 2 3 CHF:* 0 1 2 3 Cardiogenic Shock:* 0 1 2 3 Cardiac Arrest:* 0 1 2 3 Medications:* 0 1 2 3 Anti-Arrhythmics (Amiodarone, Lidocaine, Procainamide):* 0 1 2 3 Atropine:* 0 1 2 3 Beta Blockers:* 0 1 2 3 Calcium Channel Blockers:* 0 1 2 3 Digoxin (Lanoxin):* 0 1 2 3 Dopamine (Intropin):* 0 1 2 3 Epinephrine (Adrenalin):* 0 1 2 3 Heparin:* 0 1 2 3 Nitroprusside (Nipride):* 0 1 2 3 Sodium Bicarbonate:* 0 1 2 3 Vasopressin:* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledPULMONARYAssess Breath Sounds:* 0 1 2 3 Assess Rate & Work of Breathing:* 0 1 2 3 Obtain ABGs:* 0 1 2 3 Interpretation of ABGs:* 0 1 2 3 Sputum Specimen Collection:* 0 1 2 3 Assist with Thoracentesis:* 0 1 2 3 Assist with Set up/Insertion of Chest Tubes:* 0 1 2 3 Management of Chest Tubes:* 0 1 2 3 Assist with Intubation/Extubation:* 0 1 2 3 Management of the Patient on a Ventilator:* 0 1 2 3 Oxygen Therapy & Medication Delivery Systems* 0 1 2 3 Bag & Mask:* 0 1 2 3 External CPAP/BIPAP:* 0 1 2 3 Face Mask/Nasal Cannula:* 0 1 2 3 Inhalers/Nebulizer:* 0 1 2 3 Pulse Oximetry:* 0 1 2 3 Manage Secretions:* 0 1 2 3 Care of the Patient with* 0 1 2 3 Aspiration:* 0 1 2 3 Reactive Airway Disease (Asthma):* 0 1 2 3 Airway Obstruction (Medical):* 0 1 2 3 Airway Obstruction (Traumatic):* 0 1 2 3 Croup:* 0 1 2 3 Pneumonia:* 0 1 2 3 Pneumothorax/Hemothorax/Tension Pneumothorax:* 0 1 2 3 Epiglottitis:* 0 1 2 3 Pulmonary Edema:* 0 1 2 3 Medication* 0 1 2 3 Inhaled Bronchodilators:* 0 1 2 3 Inhaled Steroids:* 0 1 2 3 IV/Oral Steroids:* 0 1 2 3 Racemic Epinephrine:* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledNEUROLOGICALAssessment* 0 1 2 3 Glasgow Coma Scale:* 0 1 2 3 Reflex/Motor Deficits:* 0 1 2 3 Head Circumference:* 0 1 2 3 Care of the Patient with* 0 1 2 3 Basal Skull Fracture:* 0 1 2 3 Head Injury:* 0 1 2 3 Encephalitis:* 0 1 2 3 Increased ICP/ICP Monitoring:* 0 1 2 3 Lumbar Puncture:* 0 1 2 3 Meningitis:* 0 1 2 3 Migraine:* 0 1 2 3 Neuromuscular Disease:* 0 1 2 3 Status Epilepticus:* 0 1 2 3 Seizures - Febrile:* 0 1 2 3 Intraventricular Shunts:* 0 1 2 3 Neurogenic Shock:* 0 1 2 3 Medications* 0 1 2 3 Dexamethasone (Decadron):* 0 1 2 3 Mannitol:* 0 1 2 3 Paralytics:* 0 1 2 3 Phenobarbitol:* 0 1 2 3 Phenytoin (Dilantin):* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledORTHOPEDICSAssessment* 0 1 2 3 Circulation Checks:* 0 1 2 3 Range of Motion:* 0 1 2 3 Nursemaid's Elbow:* 0 1 2 3 Compartment Syndrome:* 0 1 2 3 Equipment & Procedures* 0 1 2 3 Fracture Reduction:* 0 1 2 3 Spinal Precautions:* 0 1 2 3 Transfer Boards:* 0 1 2 3 Apply Splints:* 0 1 2 3 Care of the Patient* 0 1 2 3 Splints & Casts:* 0 1 2 3 Moderate Sedation:* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledGASTROINTESTINALAssessment* 0 1 2 3 Abdominal/Bowel Sounds:* 0 1 2 3 Fluid Balance:* 0 1 2 3 Nutritional Status:* 0 1 2 3 Blood Chemistries:* 0 1 2 3 Abdominal Girth:* 0 1 2 3 Equipment & Procedures:* 0 1 2 3 Management of NG Tubes:* 0 1 2 3 Management of G-tubes:* 0 1 2 3 Care of the Patient with:* 0 1 2 3 Assist with Breast Feeding/Storage & Handling of Breast Milk:* 0 1 2 3 Bottle Feeding:* 0 1 2 3 Gavage Feedings:* 0 1 2 3 Placement & Management of GI Tubes:* 0 1 2 3 Abdominal Trauma/Peritoneal Lavage:* 0 1 2 3 Abdominal Pain/RO Appendicitis:* 0 1 2 3 GI Bleeding:* 0 1 2 3 Hepatitis:* 0 1 2 3 Liver Failure:* 0 1 2 3 Medications:* 0 1 2 3 Antiemetics:* 0 1 2 3 Antispasmodics:* 0 1 2 3 Ipecac/Charcoal:* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledENDOCRINE/METABOLICEquipment & Procedures:* 0 1 2 3 Bedside Blood Glucose Monitoring:* 0 1 2 3 Care of the Patient with:* 0 1 2 3 Hyperglycemia/DKA:* 0 1 2 3 Hypoglycemia/Insulin Shock:* 0 1 2 3 Medications:* 0 1 2 3 Dextrose:* 0 1 2 3 Insulin:* 0 1 2 3 Insulin Drip:* 0 1 2 3 Oral Hypoglycemics:* 0 1 2 3 Pyelonephritis/UTI:* 0 1 2 3 Renal Calculi:* 0 1 2 3 Renal Trauma:* 0 1 2 3 STD:* 0 1 2 3 Testicular Torsion:* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledWOUND MANAGEMENTAssessment:* 0 1 2 3 Skin for Impending Breakdown:* 0 1 2 3 Surgical Wound Healing:* 0 1 2 3 Equipment & Procedures:* 0 1 2 3 Specialty Beds:* 0 1 2 3 Sterile Dressing Changes:* 0 1 2 3 Care of the Patient with:* 0 1 2 3 Burns:* 0 1 2 3 Decubitus Ulcers:* 0 1 2 3 Staged Decubitus Ulcers:* 0 1 2 3 Surgical Wounds with Drains:* 0 1 2 3 Vacuum Assisted Devices (VAD):* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledOB/GYNAssessment:* 0 1 2 3 Ultrasound:* 0 1 2 3 Fetal Heart Tones:* 0 1 2 3 Equipment & Procedures:* 0 1 2 3 Obtain Cultures:* 0 1 2 3 Pelvic Exam:* 0 1 2 3 Sexual Assault/Evidence Collection:* 0 1 2 3 Education about Birth Control/Protection from STD:* 0 1 2 3 Care of the Patient with:* 0 1 2 3 Vaginal Bleeding/Hemorrhage:* 0 1 2 3 Pelvic Inflammatory Disease:* 0 1 2 3 Precipitous Delivery:* 0 1 2 3 Ectopic Pregnancy:* 0 1 2 3 Spontaneous Abortion:* 0 1 2 3 Medication:* 0 1 2 3 RhoGAM/Immune Globulin:* 0 1 2 3 Oxytocin (Pitocin):* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledEENTSet Up Slit Lamp:* 0 1 2 3 Test for Visual Acuity:* 0 1 2 3 Ear Irrigation/Remove Foreign Body:* 0 1 2 3 Eye Irrigation/Remove Foreign Body:* 0 1 2 3 145:* 0 1 2 3 Nasal - Remove Foreign Body:* 0 1 2 3 Set up for Cautery:* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledTRAUMA/SHOCKAssessment:* 0 1 2 3 Champion Trauma Score:* 0 1 2 3 Equipment & Procedures:* 0 1 2 3 Transport of Trauma Patient:* 0 1 2 3 Care of the Patient with:* 0 1 2 3 Facial Trauma:* 0 1 2 3 Dental Trauma:* 0 1 2 3 Penetrating Trauma:* 0 1 2 3 Blunt Trauma:* 0 1 2 3 Major Trauma:* 0 1 2 3 Minor Trauma:* 0 1 2 3 Traumatic Amputation:* 0 1 2 3 Spinal Cord Injury:* 0 1 2 3 Shock - Hypovolemic:* 0 1 2 3 Burns:* 0 1 2 3 Rule of Nines:* 0 1 2 3 First/Second Degree:* 0 1 2 3 Third Degree:* 0 1 2 3 Fluid Management:* 0 1 2 3 Electrocution:* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledINFECTIOUS DISEASEInterpretation of Lab Results:* 0 1 2 3 Culture Results:* 0 1 2 3 CBC:* 0 1 2 3 Equipment & Procedures:* 0 1 2 3 Obtain Cultures:* 0 1 2 3 Fever Management:* 0 1 2 3 Isolation:* 0 1 2 3 Care of the Patient with:* 0 1 2 3 Infectious Disease:* 0 1 2 3 Immunosuppression/Neutropenia:* 0 1 2 3 Septic Shock:* 0 1 2 3 Medications:* 0 1 2 3 Antibiotic Therapy:* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledPHLEBOTOMY/IV THERAPY/INVASIVE PROCEDURESEquipment & Procedures:* 0 1 2 3 Administration of Blood/Blood Products:* 0 1 2 3 Autotransfusion:* 0 1 2 3 Assist with Cutdown:* 0 1 2 3 Starting IVs:* 0 1 2 3 Arterial Stick:* 0 1 2 3 Venous Blood Draw:* 0 1 2 3 Intraosseous Infusion:* 0 1 2 3 Injections:* 0 1 2 3 Care of the Patient with:* 0 1 2 3 Long Term Lines:* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledPAIN MANAGEMENTAssessment of Pain Level/Use of Pain Scale:* 0 1 2 3 Assessment of Response to Pain Management Interventions:* 0 1 2 3 Care of the Patient with:* 0 1 2 3 IV Sedation:* 0 1 2 3 Ketamine:* 0 1 2 3 Analgesia:* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledPSYCHIATRICEquipment & Procedures:* 0 1 2 3 Psychiatric Hold:* 0 1 2 3 Managing Threatening/Violent Behavior:* 0 1 2 3 Care of the Patient with:* 0 1 2 3 Drug Overdose:* 0 1 2 3 ETOH Overdose:* 0 1 2 3 Restraints/Seclusion:* 0 1 2 3 Eating Disorders:* 0 1 2 3 Suicidal Patient:* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledWOUND MANAGEMENT/SURGICALWound Repair (Staples/Sutures, etc.):* 0 1 2 3 Bites - Human:* 0 1 2 3 Bites - Animal:* 0 1 2 3 Bites - Snake/Spider/Other:* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledMISCELLANEOUSNational Patient Safety Goals:* 0 1 2 3 Child Abuse Recognition/Reporting:* 0 1 2 3 Patient/Family Education:* 0 1 2 3 Care of the Patient with:* 0 1 2 3 Hypo/Hyperthermia:* 0 1 2 3 Heat Stroke/Exhaustion:* 0 1 2 3 Near Drowning:* 0 1 2 3 Overdose/Poison Ingestion:* 0 1 2 3 Anaphylactic Shock:* 0 1 2 3 Sickle Cell Crisis:* 0 1 2 3 Failure to Thrive:* 0 1 2 3 Hazardous Material Exposure:* 0 1 2 3 Equipment & Procedures:* 0 1 2 3 Papoose Board:* 0 1 2 3 Obtaining Consent to Treat:* 0 1 2 3 AMA Procedure:* 0 1 2 3 Triage:* 0 1 2 3 Disaster Management:* 0 1 2 3 Charge Experience:* 0 1 2 3 Preceptor Experience:* 0 1 2 3 Pyxis Medication Delivery System:* 0 1 2 3 Other Medication Delivery System:* 0 1 2 3 Computerized Charting* 0 1 2 3 Cerner:* 0 1 2 3 Eclipsys:* 0 1 2 3 Epic:* 0 1 2 3 GE:* 0 1 2 3 McKesson:* 0 1 2 3 Meditech:* 0 1 2 3 Other:* 0 1 2 3 Please Use The Following Key: A = Newborn/Neonate (Birth - 30 days) B = Infant (31 days - 1 year) C = Toddler (1 - 2 years) D = Preschooler (3 - 4 years) E = School Age Children (5 - 12 years) F = Adolescents (13 - 18 years) G = Young Adults (19 - 39 years) H = Middle Adults (40 - 64 years) I = Older Adults (65+)Experience with age groupsAble to adapt care to incorporate normal growth and development: A B C D E F G H I Able to adapt method and terminology of patient instructions to their age, comprehension, and maturity: A B C D E F G H I Can ensure a safe environment reflecting specific needs of various age groups: A B C D E F G H I My experience is primarily in the following settingsPediatric Trauma Center: Years Pediatric Trauma Center: ED Beds Pediatric General ED: Years Pediatric General ED: Ed Beds Pediatric/Adult ED: Years Pediatric/Adult ED: Ed Beds Certifications/Licensures/RegistrationsBLS: MM slash DD slash YYYY PALS: MM slash DD slash YYYY ACLS: MM slash DD slash YYYY CEN: MM slash DD slash YYYY TNCC: MM slash DD slash YYYY ENPC: MM slash DD slash YYYY NALS: MM slash DD slash YYYY NRP: MM slash DD slash YYYY PEARS: MM slash DD slash YYYY Advanced Trauma Nursing Certificate (CATN): MM slash DD slash YYYY ACLS Instructor: MM slash DD slash YYYY BLS Instructor: MM slash DD slash YYYY Other MM slash DD slash YYYY Managing Assaultive Behavior: MM slash DD slash YYYY CPI Certificate: MM slash DD slash YYYY Disaster Management/Bioterrorism Training: MM slash DD slash YYYY Computerized Charting* 0 1 2 3 Areas of ExpertiseConsent* By submitting this form, I agree to all terms and conditions and agree to authorize consent PhoneThis field is for validation purposes and should be left unchanged.
