NAME:

Proficiency assessment sheet for nurses wishing to work in CCU

1 = Perform well. At least 1 year of current experience. Very comfortable performing with out supervision.

2 = Limited experience 6 to 12 months within the last 2 years. Would require some assistance.

3. Perform infrequently – less than 3 months experience. Need more experience.

Assistance required.

4 = No experience. Have never preformed this task. Willing to learn.

1 / 2 / 3 / 4 / Comments (if any)

MEDICATION ADMINISTRATION

Oral
Intramuscular
Intravenous Infusions
Piggyback
IV Push
Infusion
Central Lines
Subcutaneous
Intradermal
Rectal-medication
-enemas
Vaginal
Topical
Eye,Ear,Nose
Inhalation Therapy
Cognitive and Applied Skills in special drug administration ;
Crash Cart Drugs
Thrombolytic Agents
Anti-hypertensives
Insulin
Heparin
Narcotics/Controlled Drugs
Inotropes
Digoxin
Verpamil
Adenosine
Nitroglycerine
PERFORMS;
Age specific competencies(peads)
Age specific competencies(adult)
Systems Assessments :
Respiratory
Cardiovascular
Gastrointestinal
Integumentary
Neurological/GCS
Demonstrates skill performing tasks associated with;

Ambu Techniques

CXR Interpretation
Cardio-Pulmonary Resuscitation
Defibrillation/Cardioversion
Pulse Oximetry
Central Line Set-Up
Central Line Management
Perform EKG:3 and 12 lead application
Interpretation: basic
advanced
Arterial Line/Transducer Set Up
IV line insertion
Interpretation of ABGs
Incentive Spirometer
Phlebotomy
Bladder Irrigation
Glucometer
Pleural Drains
Chest tube set-up and insertion
(Assistance with)
Maintenance(trouble shooting)
SPECIMAN COLLECTION
Wound Cultures
Sputum trap collection
Oropharyngeal
Urine
Stool

Performs Nursing Care of Patients with

Neurological Problems
Cardiovascular Accident
Seizures
Cardiac Problems
Aneurysms
Acute Myocardial Infarction
Unstable Angina
Congestive Health Failure
Pulmonary Oedema
Cardiogenic/Hypovolemic Shock
PTCA
Stents
Pre/Post Cardiac Surgery
Aorta-Femoral Bypass
Respiratory Problems:

ARDS

Chronic Obstructive Pulmonary Disease
Pulmonary Embolism
Pneumonia
Pneumothorax/Haemothorax
Asthma
Gastrointestinal Problems:
GI bleed
Bowel Obstructions
Cirrhosis
Renal Problems:
Acute/Chronic Renal Failure
Orthopaedic Problems
Amputation

Osteomyelitis

Performed General Post-Anaesthesia Nursing
Post-Op Recovery-Intubated
-extubated
Airway Management-neonate/infant
- -toddler
-child
-adolescent

-adult

-elder adult
Pain Management
-PCA Pump
-Morphine
-Epidural
ASSIST WITH:
Chest tube Insertion and Removal
Subclavian line insertion and removal
Arterial line insertion and removal
Pacemaker insertion and removal
FAMILIARITY WITH EQUIPMENT
Buretrols
Feeding Pumps
Infusion Pumps
Syringe Pumps
Pleurovacs
Glucometer
Central Lines

Oxygen Equipment

Defibrillators
Monitors :
Hewlett Packard
Space Lab.
Siemens
Marquette
Mennen
Nikon-Khodon

Responsibilities

Charge Nurse
Preceptor
Inservice Presentation:Nursing
Patient/Family Education
CSF
Blood (Peripherally)
Blood (Central Venous Catheter)
Cultures viral bacterial
Sputum
Stool
Urine
24 Hour Urine
Pre-Post OP Care of Liver, Kidney, Transplant Patient
Care of HIV Patient
Hypoglycaemic Hyperglycmic Reaction

NEUROLOGICAL

Glasgow Coma Scale
Pre-post Craniotomy Care
Subarachnoid Haemorrhage
Identify S & S of Increased Intracranial Pressure

ENT/HEAD & NECK

Tracheostomy Care:
Fenestrated –Cuffed
Non-cuffed
SKILL / 1 / 2 / 3 / 4 / Comments (if any)
Shiley Plastic-cuffed
Non-cuffed
Metal
T-Tude
Tracheosromy Suctioning Peds/Adults
Skin Grafts/Flaps/Bone Grafts
Radical Next Surgeries
Laryngectomy Patients with Airlon Tubes
Nasal and Oral Suction
Myingotomy
Tonsillectomy/adenoidectomy
Septoplasty:
a) packing
b) splint
c) moustache dressing
Tympanomastoidectomy
Ophthalmology/Dilating Drugs:
a)pre-cataract
b)intra-occular lens implant surgery (IOL)
c) with and after cochlear implant surgery

BMT/HEMATOLOLGY PATIENTS

Care of patients Receiving BMT
Care of Patients Receiving Peripheral Stem Cells Transfusions
Neutropenic Isolation
Psychological Care
Lab Values:

Renal/Hepatic Profile

Hepatitis Profile
Full Blood Count
Coagulation Studies
Cyclosporin Administration/FK 50

Administration

Bone Marrow
Amphpotericin B
Immunoglobulins ALG/ATG
Cyclosporin A
Electrolyte Boluses
GCSF/CGCSF
SKILLS / 1 / 2 / 3 / 4 / Comments (if any)

MANAGEMENT EXPERIENCE

Precepting New Employees
Charge Nurse Responsibilities
Type of Nursing Care Experienced in:
Team Nursing
Total Patient Care
Primary Nursing

COMPUTER EXPERIENCE

Laboratory
Radiology
Nursing Documentation
Other (Specific)

Signature of the Application:

Date: