Cardiac Echo 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

  WORK SETTINGS         Rating Stars (Click) 1 2 3 4
  Adult Acute Care  
  ED/ICU  
  Adult Outpatient  
  Pediatric Acute Care  
  Pediatric Outpatient  
  ADULT ECHO         Rating Stars (Click) 1 2 3 4
  Routine  
  3-D Echo  
  Pedoff Probe  
  Transesophageal Echo  
  Stress Echo  
  Pharmacologic Stress Echo  
  Post-Cath Echo  
  Post-Surgical Echo  
  Imaging with Contrast Agents  
  Sterilization Procedures  
  SPECIAL VIEWS         Rating Stars (Click) 1 2 3 4
  Pulmonary Veins  
  Hepatic Veins  
  Suprasternal Notch  
  CALCULATIONS         Rating Stars (Click) 1 2 3 4
  Simpson\'s Rule  
  Proximal Isovelocity Surface Area  
  Distology with TDI  
  LV Strain/LV Volume  
  PEDIATRIC ECHO         Rating Stars (Click) 1 2 3 4
  Routine  
  3-D Echo  
  Pedoff Probe  
  Transesophageal Echo  
  PEDIATRIC ANOMALIES         Rating Stars (Click) 1 2 3 4
  Aortic Arch Abnormalities/Vascular Ring  
  Arch Sidedness  
  Coarctation of the Aorta  
  Coronary Artery Anomalies  
  Double Outlet Ventricle  
  Hypoplastic Heart Syndrome  
  Pulmonary Venous Return Anomalies  
  Tetralogy of Fallot  
  Transposition of the Great Vessels  
  Triscupid and Pulmonary Atresia  
  Truncus Arteriosis  
  Univentricular Heart Anomalies  
  PEDIATRIC POST-SURGICAL SCANS         Rating Stars (Click) 1 2 3 4
  Arterial Switch  
  Blalock - Taussig  
  Damus-Kaye-Stansel  
  Fontan  
  Glenn  
  Konno  
  Mustard  
  Norwood  
  Rastelli  
  Sano  
  Sennig  
  EQUIPMENT         Rating Stars (Click) 1 2 3 4
  Phillips/ATL (List Types)  
  GE (List Types)  
  Siemens (List Types)  
  Toshiba (List Types)  
  Hitachi (List Types)  
  SonoSite (List Types)  
  Other: List  
  TECHNOLOGY         Rating Stars (Click) 1 2 3 4
  McKesson  
  Epic  
  Horizon  
  SCI- Imaging  
  Online Reporting  
  EMR Conversion  
  MISCELLANEOUS         Rating Stars (Click) 1 2 3 4
  12 Lead ECG  
  Stress Testing  
  Holter Monitor  
  PROFESSIONAL KNOWLEDGE AND SKILLS         Rating Stars (Click) 1 2 3 4
  National Patient Safety Goals  
  Supervisory /Management Experience  
  Isolation/Infection Prevention  
  Procedures for Patients on Ventilators  
  Age Specific Competencies         Rating Stars (Click) 1 2 3 4
  Infant (Birth - 1 year)  
  Preschooler (ages 2-5 years)  
  Childhood (ages 6-12 years)  
  Adolescents (ages 13-21 years)  
  Young Adults (ages 22-39 years)  
  Adults (ages 40-64 years)  
  Older Adults (ages 65-79 years)  
  Elderly (ages 80+ years)