Wound Care 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
  Acute Care � Adult  
  Clinic � Adult  
  SNF/LTAC/Subacute  
  Hospice / Palliative Care  
  Acute/Long Term Care � Pediatrics  
  Clinic � Pediatrics  
  PRESSURE ULCERS         Rating Stars (Click) 1 2 3 4
  Assessment  
  Staging  
  Prevention/ Risk Assessment Tools � Adult  
  Prevention/ Risk Assessment Tools -Pediatrics  
  Support Surface Selection  
  NEUROPATHIC ULCERS         Rating Stars (Click) 1 2 3 4
  Assessment  
  Management  
  VENOUS STASIS ULCERS         Rating Stars (Click) 1 2 3 4
  Assessment  
  Management  
  PERIPHERAL ARTERIAL ULCERS         Rating Stars (Click) 1 2 3 4
  Assessment  
  Ankle Brachial Index  
  Management  
  OTHER WOUNDS         Rating Stars (Click) 1 2 3 4
  Fistulae � Pouching / Skin Care  
  Skin Care/ Management of Drains  
  WOUND DEBRIDEMENT         Rating Stars (Click) 1 2 3 4
  Autolytic  
  Enzymatic  
  Mechanical  
  Sharp  
  DRESSINGS/ TREATMENTS         Rating Stars (Click) 1 2 3 4
  Hydrogels  
  Hydrocolloids  
  Silver Products  
  Foams  
  Alginates  
  Vacuum Assisted Closure  
  Growth Factors  
  Skin Substitutes  
  Hyperbaric Oxygen Therapy  
  Wound Cultures  
  COLOSTOMY / ILEOSTOMY         Rating Stars (Click) 1 2 3 4
  Ostomy Equipment Selection  
  Continence Skin Care Management  
  Loop with Rod Stoma  
  End Stoma  
  Mucous Fistula  
  Double Barrel Stoma  
  Irrigation  
  Ileal Lavage  
  CONTINENT ILEOSTOMY         Rating Stars (Click) 1 2 3 4
  Knock pouch  
  Pelvic Pouch  
  UROSTOMY / CONTINENT         Rating Stars (Click) 1 2 3 4
  Catherization for C&S  
  Knock Pouch  
  Neobladder  
  CONTINENCE THERAPEUTIC DEVICES         Rating Stars (Click) 1 2 3 4
  Vaginal Cones  
  Penile Clamps  
  Male External Catheters  
  Internal Urethral Inserts  
  Catheters �Mgmt & Self Care Teaching  
  Magnetic Therapy  
  Urinary Incontinence Program  
  Fecal Incontinence Program  
  BURNS         Rating Stars (Click) 1 2 3 4
  Burn Management  
  PROFESSIONAL KNOWLEDGE AND SKILLS         Rating Stars (Click) 1 2 3 4
  National Patient Safety Goals/ Core Measures  
  Patient Family Teaching  
  Age Specific/Population Based Care  
  Isolation Precautions  
  Infection Precautions  
  Pain assessment & Management  
  Interpretation & Communication of Lab Values  
  EMR  
  EPIC  
  Cerner  
  Eclipsys  
  McKesson  
  Other Computerized System  
  OTHER / MISC.         Rating Stars (Click) 1 2 3 4
  Pain Management Assessment of Pain Levels without intervention  
  Pain Management Response Assessment with Intervention  
  Experience: Charge Duty  
  Experience: Preceptor  
  AGE SPECIFIC CARE         Rating Stars (Click) 1 2 3 4
  Infant (Birth to 1 year)  
  Toddler (1-3 years)  
  Pre-school (3-6 years)  
  School Age (6-12 years)  
  Adolescent (12-18 years)  
  Young Adult (18-30 years)  
  Mature Adult (30-60 years)  
  Elderly (>60 years)