Telemetry Checklist


Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

Total Stars:

Obtained Stars:

Ranking: 0%

Proficiency Scale:

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

  CARDIAC         Rating Stars (Click) 1 2 3 4
  Acute Coronary Syndrome  
  Congestive Heart Failure  
  Post Open Heart (12-24 hours)  
  Carotid Endarterectomy  
  Post Vascular Surgery  
  Heart Transplant  
  Pacemaker - Temporary/Permanent  
  Pacemaker - Epicardial  
  Sheath Removal  
  Heart Sounds  
  PULMONARY         Rating Stars (Click) 1 2 3 4
  Pneumonia  
  Respiratory Distress  
  COPD  
  Breath Sounds  
  Post Thoracic Surgery  
  Chest Tube Placement & Management  
  Trach Management  
  Modes of Ventilation (AC/PC/SIMV/CPAP)  
  Intubation/Extubation  
  External CPAP/BiPAP  
  Interpretation of Arterial Blood Gases  
  NEUROLOGIC & PSYCHIATRIC         Rating Stars (Click) 1 2 3 4
  Stroke Scale Assessment  
  CVA  
  Brain Injury  
  Post Craniotomy  
  Spinal Cord Injury  
  Seizure Disorders  
  ETOH/Drug Withdrawal  
  GASTROINTESTINAL         Rating Stars (Click) 1 2 3 4
  GI Bleeding  
  GI Surgery  
  Liver Failure  
  Pancreatitis  
  Liver Transplant  
  Pancreas Transplant  
  RENAL/GENITOURINARY         Rating Stars (Click) 1 2 3 4
  Renal Failure  
  Renal Surgery  
  Renal Transplant  
  Arteriovenous Fistula/Shunt  
  Nephrostomy Tubes  
  Peritoneal Dialysis  
  ENDOCRINE METABOLIC         Rating Stars (Click) 1 2 3 4
  Diabetes - Hypo/Hyperglycemic Crisis  
  Pituitary Disorders  
  IV Insulin Protocols  
  Indwelling Insulin Pumps  
  MEDICATIONS         Rating Stars (Click) 1 2 3 4
  Diabetes - Hypo/Hyperglycemic Crisis  
  Pituitary Disorders  
  IV Insulin Protocols  
  Indwelling Insulin Pumps Anti-Arrhythmics  
  Anticoagulants (IV  
  oral  
  & injection)  
  Anti-Hypertensives  
  Anti-Psychotics  
  Anti-Seizure Medications  
  Benzodiazepines  
  Procedural Sedation  
  Diuretics  
  Emergency Medications  
  Inhaled Medications  
  Insulin  
  Titrate Vasoactive Drips  
  Manage Vasoactive Drips - No Titration  
  Narcotics/Opioid Analgesics (IV  
  oral  
  & injection)  
  Nitrates (Oral & Topical)  
  Non-Opioid Analgesics (IV  
  Oral  
  & Injection)  
  Reversal Agents  
  Steroids (IV  
  Oral  
  Inhaled)  
  Automated Medication Dispensing (i.e. Pyxis  
  Omnicell)  
  IV THERAPY         Rating Stars (Click) 1 2 3 4
  Starting Ivs  
  Central Line Blood Draws  
  Central Line/Implanted Line Care  
  Arterial Line Management  
  TPN & Lipids  
  Blood Product Administration  
  Administration of Chemotherapy  
  CARDIAC MONITORING & EMERG. RESPONSE         Rating Stars (Click) 1 2 3 4
  Dysrhythmia Interpretation  
  Dysrhythmia Management  
  Obtain 12 Lead EKG  
  Interpret 12 Lead EKG  
  Cardioversion  
  Defibrillation  
  Malignant Hyperthermia  
  PROFESSIONAL KNOWLEDGE AND SKILLS         Rating Stars (Click) 1 2 3 4
  National Patient Safety Goals/Core Measures  
  Fall Risk Assessment/Prevention  
  Pressure Ulcer Risk Assessment/Prevention  
  Restraints/Use of Least Restrictive Device  
  Patient/Family Teaching  
  Age Specific/Population-Based Care  
  Isolation Precautions  
  Infection Prevention  
  Pain Assessment & Management  
  Charge Experience  
  Interpretation and Communication of Lab Values  
  Specialty Beds  
  EMR         Rating Stars (Click) 1 2 3 4
  Epic  
  Cerner  
  Eclipsys  
  McKesson  
  Meditech  
  Other Computerized System  
  Computerized Physician Order Entry  
  Bar Coding for Medication Administration