PCT 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

  Patient Rights         Rating Stars (Click) 1 2 3 4
  Communicates and obtains information while respecting the rights and privacy and confidentiality of information in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA)  
  Involves the patient and family and respects their role in determining the nature of care to be provided  
  including Advance Directives.  
  Complies with nursing staff responsibility included in the hospital policy related to Organ Donation.  
  Meets patient and families needs regarding communication  
  including interpreter services  
  Provides accurate information to patient and families in a timely manner.  
  Vital Signs and Weights         Rating Stars (Click) 1 2 3 4
  Placing and Removing Bed Pan  
  Clamping Catheter  
  Emptying Foley Bag  
  Placing Condom Catheter  
  Emptying and Replacing Ostomy Bag (Established Ostomy)  
  Nutrition         Rating Stars (Click) 1 2 3 4
  Estimating Intake  
  Setting up for Meals  
  Feeding Patients  
  Aspiration Precautions  
  Nourishments  
  Counting Calories  
  Fluid Restriction  
  NPO  
  Specimens         Rating Stars (Click) 1 2 3 4
  Collecting Stool  
  Collecting Sputum  
  Labeling Specimens and Preparing for Transport  
  Clean Catch  
  24 Hour  
  Hygiene /Skin         Rating Stars (Click) 1 2 3 4
  Incontinence Care  
  Shaving and Precautions  
  Reducing Pressure and Friction  
  Special Beds/Mattresses  
  Heels and Elbow Protection  
  Foot Cradles  
  Use of Shower Chair  
  Use of Bath/Shower Boat  
  Infection Control         Rating Stars (Click) 1 2 3 4
  Reverse Isolation  
  Body Substance isolation  
  TB Precautions  
  MRSA Precautions  
  Hand Washing  
  Infectious/Hazardous Waste Disposal  
  Supply/Equipment Disposal  
  Use of Disposable Therrnomete  
  Use of CPR Mask/Bag  
  Gloves  
  Gown  
  Mask / Goggles  
  Safety and Activity         Rating Stars (Click) 1 2 3 4
  Use of CaIl Light  
  Documenting Use of Restraints  
  Use of Transfer Belt  
  Use of Gait Belt for Ambulation  
  Use of Seizure Pads  
  Belt Including Seat Belt  
  Wrist/Ankle  
  Vest  
  Care Routines         Rating Stars (Click) 1 2 3 4
  Inventory andDispositionof Belongings-Useof Checklist  
  Room Orientation-Call Bell  
  Transferring into Bed  
  Call Bell  
  Assist with Turns  
  ROM Exercises  
  Replacing Mask or Nasal Caunula if Needed  
  Notifying Nurse of Problems  
  Basic Comfort Measures  
  Early Bath  
  Preparing Belongings  
  Preparingfor and Explaining Routinesto Patient  
  Post Mortem Care  
  Use ofIncentive Spirometer  
  Antiembolic Stockings  
  Sequential Stockings  
  Communication         Rating Stars (Click) 1 2 3 4
  Unusual Incidents  
  Vital Signs  
  Bathing /Hygiene  
  Turning and Repositioning  
  Ambulation and Activity  
  Diet intake-Calorie Count  
  Bowel Movements  
  Shift Volumes and Totals  
  Unit Activity         Rating Stars (Click) 1 2 3 4
  Identifying Unusual Incidents on the Unit that Require Reporting  
  Locating and Using Appropriate Reference Materials: Hospital  
  Patient Care and  
  Charging for Patient Care Items  
  Completing Risk Management Reports as Needed  
  Obtaining Needed Supplies and Equipment  
  Reporting and Following up on Faulty Equipment and Supplies  
  Using Telephone System  
  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)