Summary ICU RN Skills Competency Checklist

Critical Care / ICU RN Skills checklist

Experience
Directions
0 Not Applicable
Please circle a value for each question to provide us
and the interested facilities with an assessment of your 1 No Experience
clinical experience. These values confirm your strengths 2 Some Experience (Require Assistance)
within your specialty and assist the facility in the 3 Intermittent Experience (May Require Assistance)
selection process of the healthcare professional.
4 Experienced (Performs without Assistance)
5 Very Experienced (Able to Teach/Supervise)


Print Name Last 4 Digits of SS# Date


General Skills Experience
Advanced directives 0 1 2 3 4 5

Patient/family teaching 0 1 2 3 4 5

Restrictive devices (restraints) 0 1 2 3 4 5

Lift/transfer devices 0 1 2 3 4 5

Specialty beds 0 1 2 3 4 5

End of life care/palliative care 0 1 2 3 4 5

Wound assessment & care 0 1 2 3 4 5

Automated Medication Dispensing System, Pyxis,Omnicell, or other 0 1 2 3 4 5

Bar coding for medication administration 0 1 2 3 4 5

Diabetic care and education 0 1 2 3 4 5

Blood Glucose Monitor (BGM) 0 1 2 3 4 5

Cardioversion/defibrillation 0 1 2 3 4 5

Electronic ICU 0 1 2 3 4 5

National Patient Safety Goals 0 1 2 3 4 5

Accurate patient identification 0 1 2 3 4 5

Effective communication 0 1 2 3 4 5

Interpretation & communication of lab values 0 1 2 3 4 5

Medication administration 0 1 2 3 4 5

Medication reconciliation 0 1 2 3 4 5

Labeling (medications and specimens) 0 1 2 3 4 5

Anticoagulation therapy 0 1 2 3 4 5

Monitoring conscious sedation 0 1 2 3 4 5

Pain assessment & management 0 1 2 3 4 5

Infection control 0 1 2 3 4 5

Universal precautions 0 1 2 3 4 5

Isolation 0 1 2 3 4 5

Minimize risk for falls 0 1 2 3 4 5

Prevention of pressure ulcers 0 1 2 3 4 5

Use of Rapid Response teams 0 1 2 3 4 5

Awareness of HCAHPS 0 1 2 3 4 5




Critical Care Competency Self Assessment 1 of 8

, Experience
0 Not Applicable
1 No Experience
2 Some Experience (Require Assistance)
3 Intermittent Experience (May Require Assistance)
Initials
4 Experienced (Performs without Assistance)
5 Very Experienced (Able to Teach/Supervise)


Cardiovascular Experience
Assessment of heart sounds 0 1 2 3 4 5

Interpretation of arrhythmias 0 1 2 3 4 5

Performing 12 lead EKG’s 0 1 2 3 4 5

Interpretation of 12 lead EKG 0 1 2 3 4 5

Interpretation of hemodynamic monitoring 0 1 2 3 4 5

Assist with Insertion & Management of:

CVC (Central Venous Catheter) 0 1 2 3 4 5

Arterial line 0 1 2 3 4 5

CVP 0 1 2 3 4 5

Swanz Ganz catheter/Pulmonary Artery Catheter 0 1 2 3 4 5

Flow trac 0 1 2 3 4 5

Vigileo 0 1 2 3 4 5

Intra-Aortic Balloon Pump (IABP) 0 1 2 3 4 5

Ventricular Assist Device (LVAD, RVAD) 0 1 2 3 4 5

Impella 0 1 2 3 4 5

Drainage devices 0 1 2 3 4 5

Maintenance & Management of:

Permanent pacemakers 0 1 2 3 4 5

Implantable Cardioverter Defibrillator (ICD) 0 1 2 3 4 5

External pacemakers -Venous or transcutaneous 0 1 2 3 4 5

Epicardial pacemaker wires 0 1 2 3 4 5

Discontinuing venous/arterial sheaths 0 1 2 3 4 5

Femostop / vasoseal 0 1 2 3 4 5

Care of Patients with:

Acute myocardial infarction 0 1 2 3 4 5

Pre/Post: cardiac catheterization 0 1 2 3 4 5

Congestive heart failure 0 1 2 3 4 5

Cardiomyopathy 0 1 2 3 4 5

Dysrhythmias / conduction disturbances 0 1 2 3 4 5

Aortic aneurysm 0 1 2 3 4 5

Thoracic / abdominal surgery 0 1 2 3 4 5

Endoluminal graft 0 1 2 3 4 5

Cardiogenic shock 0 1 2 3 4 5

Hypertensive crisis 0 1 2 3 4 5

Pericarditis / endocarditis 0 1 2 3 4 5

MAZE procedure 0 1 2 3 4 5




Critical Care Competency Self Assessment 2 of 8