periodic competency skills checklist 2015. hydrocephalus$ $ ()$ ()$ $ $...
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Chesapeake Home Health Care
JAN 2015 (Revised)
1
ANNUAL/PERIODIC COMPETENCY SKILLS CHECKLIST FOR PEDIATRIC NURSING NAME: TITLE: Evaluation: Clinician ability to demonstrate to the provider’s Nurse Supervisor or designee, on a continuing basis, the ability to carry out competently specified nursing services. This document meets COMAR Regulations 10.09.53.03 – D 2, 4, and 5
PROCEDURE Date Satisfactory Need further Training
RN Initials COMMENTS
MEDICATION ADMINISTRATION P.O. ( ) ( ) Parenteral ( ) ( ) IV Therapy ( ) ( ) Central Line Care/Dressing ( ) ( ) Venous Access Devices ( ) ( ) IV TPN/Intra Lipids ( ) ( )
CARDIOVASCULAR PROBLEMS Apnea/Bradycardia monitor ( ) ( ) Cardiopulmonary resuscitation of an infant ( ) ( ) Cardiopulmonary resuscitation of a child ( ) ( ) Cardiovascular Assessment ( ) ( ) Blood pressure: a. Doppler ( ) ( ) b. Palpation ( ) ( )
c. Sphygmomanometer ( ) ( ) RESPIRATORY PROBLEMS Assessment of breath sounds ( ) ( ) Change tracheotomy tube ( ) ( ) Care of infant/child on ventilator ( ) ( ) Chest physiotherapy (CPT) ( ) ( ) Tracheotomy care ( ) ( ) Suctioning: a. Tracheal ( ) ( ) b. Nasal ( ) ( ) c. Oral ( ) ( )
CARE OF THE INFANT/CHILD WITH: a. Respiratory Disease ( ) ( ) b. Pneumonia ( ) ( ) c. Brain Injury ( ) ( )
Transcutaneous oxygen monitor (Pulse Oximeter) ( ) ( ) Oxygen saturation monitor ( ) ( ) Ventilation with ambu bag ( ) ( ) Use of respiratory assistance equipment a. Nasal cannula ( ) ( ) b. Oxygen analyzer ( ) ( ) c. Ventilators ( ) ( ) d. C. Pap ( ) ( ) e. Bi Pap ( ) ( ) f. Chest Phisiotherapy Vest ( ) ( )
Weaning of an infant/child from a respirator ( ) ( ) PROCEDURE Date Satisfactory Need RN Initials COMMENTS
Chesapeake Home Health Care
JAN 2015 (Revised)
2
further Training
Assessment of level of consciousness ( ) ( ) Assessment of pupil size and response ( ) ( ) Care of the child with: a. Seizures ( ) ( ) b. A V-‐P Shunt ( ) ( ) c. Hydrocephalus ( ) ( )
Administration of anticonvulsive medications ( ) ( ) GASTROINTESTINAL PROBLEMS Assessment of GI status: a. Abdominal Girth ( ) ( ) b. Bowel Sounds ( ) ( )
Nasogastric Tube – Placement/Feeding ( ) ( ) Gastrostomy Tube – Placement/Feeding ( ) ( ) G Tube Site Care ( ) ( )
Checking Residual ( ) ( ) Feeding Pumps ( ) ( )
a. Bolus Feeding ( ) ( ) WOUNDS AND SKIN PROBLEMS Assessment of wound/Staging of Wound ( ) ( ) Sterile dressing changes ( ) ( ) Assessment of skin color changes: a. Jaundice ( ) ( ) b. Cyanosis ( ) ( ) c. Mottling ( ) ( ) d. Petechiae ( ) ( )
Care of burned patient ( ) ( ) OTHER PROBLEMS Care of child abuse ( ) ( ) Care of failure to thrive ( ) ( ) Grief counseling for parents whose children are: a. Dying/Have Died ( ) ( )
GENERAL DUTIES a. Transcribe Orders ( ) ( ) b. Develop Care Plan ( ) ( ) c. Teach Caregivers ( ) ( )
INFECTION CONTROL (UNIVERSAL PRECAUTIONS a. Aspiration ( ) ( ) b. Respiratory ( ) ( )
The Clinician meets requirements for: (year) SKILL LEVEL:
(Circle One) FIRST QUARTER SECOND QUARTER THIRD QUARTER FORTH QUARTER RN Supervisor/Designee Nurse Signature & Title