Endoscopy 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

  Procedures         Rating Stars (Click) 1 2 3 4
  Assist with EGD�s  
  Assist with endoscopic ultrasound  
  Assist with active GI bleed  
  Cautery devices  
  Assist with manometry studies  
  Assist with variceal banding  
  Assist with esophageal dilatations  
  Assist with esophageal ballooning  
  Assist with scelrotherapy  
  Assist with TEE  
  Assist with bronchoscopy  
  Assist with colonoscopy  
  Assist with polypectomy  
  Assist with ERCP�s  
  Assist with PEG placements  
  Assist with liver BX  
  Assist with collection of hot & cold BX�s  
  Specimen collection & labeling  
  Set up of scopes & video equipment  
  Apply external abdominal pressure to assist with scope movement  
  Scope cleaning  
  Assist with mobile cases  
  ICU  
  ER  
  etc.  
  Radiation safety  
  Automated Medication Dispensing System  
  Pyxis  
  Omnicell  
  or other  
  Takes call for emergency cases  
  National Patient Safety Goals  
  Awareness of HCAHPS  
  Accurate patient identification  
  Effective communication  
  Interpretation & communication of lab values  
  Medication administration  
  Anticoagulation therapy  
  Monitoring conscious sedation  
  Pain assessment & management  
  Infection control  
  Universal precautions  
  Isolation  
  Minimize risk for falls  
  Prevention of pressure ulcers  
  Use of rapid response teams  
  Fentanyl  
  Propofol  
  Demerol  
  Presedex  
  Versed  
  Reversal agents  
  Pre procedure phone calls  
  Electronic documentation  
  Patient assessment  
  Colon prep or re-prep  
  Pre procedure checklist/consent  
  IV start  
  med admin  
  Assess for air movement post colonoscopy  
  Assess for pain  
  Assess for bowel sounds  
  Assess for gag reflex post EGD  
  Assess for gag reflex post bronchoscopy  
  Recover from MAC  
  Recover from (moderate) conscious sedation  
  Discharge outpatients to home  
  Post procedure phone calls  
  Age Specific Competencies         Rating Stars (Click) 1 2 3 4
  Newborn/neonate (birth-30 days)  
  Infant (31 days-1 year)  
  Toddler (ages 2-3 years)  
  Preschool (ages 4-5 years)  
  School age (ages 6-12 years)  
  Adolescent (ages 13-21 years)  
  Young adult (ages 22-39 years)  
  Adult (ages 40-64 years)  
  Older adult (ages 65-79 years)  
  Elderly (ages 80+ years)