Telemetry/Stepdown 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

  CARDIOVASCULAR Care of Patient with         Rating Stars (Click) 1 2 3 4
  Acute MI  
  CHF  
  Angina Hypertension  
  Cardiomyopathy Cardiopulmonary Arrest  
  Abdominal Aortic Aneurysm  
  Carotid Endarterectomy  
  Femoral Popliteal Bypass  
  Pre & Post Cardiac Surgery  
  Pre & Post Cardiac Cath  
  Pre & Post PTCA  
  Permanent Pacemaker Temporary PacemakerExternal Pacemaker  
  Cardiac Lab Interpretation  
  Cardiac Patient/Family Teaching  
  RESPIRATORY         Rating Stars (Click) 1 2 3 4
  Respiratory assessment  
  Assess Lung sounds  
  Chest percussion  
  Establish/Protect Airway  
  Chest tubes/Pleurevac  
  Oxygen therapy  
  Drawing ABGs  
  Interpretation of ABGs  
  Incentive Spirometry  
  Suctioning: oral nasotracheal endotracheal tube tracheostomy tube  
  Oxygen Equipment Set Up and Maintenance: nasal canula non-rebreather mask venti-mask ET  
  Inturbation/extubationambu bag pulse oximetry  
  Care of patient with: COPD tracheostomy pulmonary edema ARDS ventilator (A/C  
  IMV  
  PEEP) pre/post-op thoracis surgery pneumonia chest tubes asthma emphysema  
  NEUROLOGY         Rating Stars (Click) 1 2 3 4
  Neurological assessment  
  Seizure precautions  
  Assessment and Management of Seizure Activity  
  Assisting with lumbar puncture  
  Signs/Symptoms of increasing ICP  
  Glascow Coma Scale  
  Crutchfield tongs  
  Circo-electric bed Halo traction  
  Stryker frame  
  Care of patient with: seizures CNS infection overdose DTs spinal cord injury acute head injury CVA/TIA neuromuscular disease pre/post neuro surgery  
  GASTROINTESTINAL         Rating Stars (Click) 1 2 3 4
  G.I. assessment  
  Bowel sounds  
  Inserting N-G tubes  
  Colostomy care  
  Measurement of I & O  
  Administration of tube feedings  
  Care of patients with: GI bleed NG tube G-tube J-tube abdominal wounds/surgeries inflammatory bowel disease bowel obstruction  
  RENAL/GENITOURINARY         Rating Stars (Click) 1 2 3 4
  Insertion and care of: straight cath Indwelling urinary cath: male female 3-way  
  Care of Patient with: Bladder Irrigation Suprapubic Tube Nephrostomy Tube Renal Transplant Nephrectomy Renal Transplant BPH Pre/post Turp  
  ORTHOPEDIC         Rating Stars (Click) 1 2 3 4
  Total Knee Replacement  
  Bucks Extension  
  Cast Care  
  Crutch Walking  
  K-Wires  
  Spica Casts  
  Balanced Suspension Traction  
  Circulation Checks  
  Care of Patient with: Amputation Rheumatic/Arthritic Disease Multiple Trauma Paraplegia External Fixation Post Arthroplasty  
  GENERAL         Rating Stars (Click) 1 2 3 4
  Blood Glucose Monitoring  
  Dressing Changes  
  Universal Precautions  
  Isolation  
  Discharge Planning  
  Care of Patient with: Diabetes Pressure Sores Sickle Cell Anemia Cancer Alzheimer\'s Disease HIV/AIDS  
  MEDICATIONS         Rating Stars (Click) 1 2 3 4
  Unit Dose  
  Dosage Calculation  
  Pouring from stock medication  
  Administration of Code Cart Emergency Drugs  
  Aminophylline  
  Ativan  
  Atropine  
  Chemotherapy Agents  
  Corticosteroids  
  Decadron  
  Digoxin  
  Dilantin  
  Dobutamine  
  Dopamine  
  Heparin Inhalers  
  Lidocaine  
  Lopressor  
  Magenesium Sulfate  
  Nipride Nitroglycerin  
  Phenobarbital  
  Thrombolytic Agents  
  Valium  
  Verapamil  
  IV THERAPY         Rating Stars (Click) 1 2 3 4
  Inserting IVs Mixing IV solutions  
  Heparin locks  
  TPN/Hyperalimentation  
  IV push IV drip Infusion pumps Syringe pumps  
  Continuous Subcutaneous Infusion Pumps  
  PCA Pumps  
  Ultrasonic Doppler  
  CVP lines/measurement of CVP  
  Central line dressing change  
  Blood/Blood products administration ordering/obtaining from blood bank identification/intercession for adverse reaction  
  Multi-lumen central venous catheters Implanted CVC (port-a-cath)  
  Assessment of IV insertion site  
  Assist with insertion of central line  
  X-ray/assessment after insertion  
  Care of patient with Central Line  
  Charge Nurse Experience?  
  CPR certified?  
  BCLS certified?  
  ACLS certified?  
  Knowledge of normal values?  
  Have you had a dysrhythmia course?  
  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)