Skill Checklists

Home Health

This checklist was electronically signed on (Today’s date)

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.

Proficiency Scale:

  • 1 = No Experience

  • 2 = Need Training

  • 3 = Able to perform with supervision

  • 4 = Able to perform independently

Cardiovascular

ACS/Post MI

Heart Failure

Post Cardiac Surgery

Cardiac Auscultation (Rate/Rhythm)

Peripheral Pulse/Circulation Checks

Pulmonary

Asthma

COPD

Pneumonia

Lung Cancer

Pulmonary Emboli

Auscultate Lung Sounds

Oxygen Administration

Oxygen Safety

Oro/Nasotracheal Suctioning

CPAP/BiPAP

Ventilator Management (Specify):

Neurological

CVA

Alzheimer's Disease/Dementia

Degenerative Neurologic Disorders (ALS, MS, etc.)

Brain Tumor

Parkinson's

Brain Injury

Para/Quadriplegia

Seizure Disorder

Level of Consciousness/Neuro Changes

Orthopedics

Joint Replacement

DVT Prophylaxis/Recognition

Incision Checks

Fractures

Cast/Brace

Amputation

Arthritis

Assistive Equipment/Lift Devices

In Home PT/INR (Specify):

Gastrointestinal

Nutritional Assessment

Colostomy/Ileostomy Management

Fecal Incontinence/Diarrhea

Bowel Obstruction

Post GI Surgery

Hepatitis Liver Failure

NG Tubes

Feeding Tubes

Feeding Pumps (Specify):

Drainage Devices

Renal/ Genitourinary

Hemodialysis

AV Fistula/Shunt

Peritoneal Dialysis

Post Bladder Surgery

Post Prostate Surgery

Urostomy

Urinary Incontinence

Bladder Catheter Insertion/Maintenance

Suprapubic Catheter Insertion/Maintenance

Endocrine / Metabolic

Diabetes

Hyper/Hypoglycemia

Diabetic Skin Assessment

Cushing's / Addison's Disease

Thyroid Disease

Insulin Pumps

Glucometers

Wound / Skin Care

Braden Scale

Pressure Ulcer Prevention

Pressure Ulcer Management

Pressure Ulcer Staging

Burns

Wound Care

Wound Cultures

Wound Vac

Oncology

Risk for Infection

Symptom Management

Side Effects of Treatment

Terminal Disease

Infectious Diseases

MRSA

VRE

C. Difficile

HIV

Tuberculosis

Isolation Precautions

Phlebotomy / IV Therapy

Peripheral Venipuncture for Labs

Start Ivs

Peripheral Ivs

PICC/CVP Lines

Venous Access Ports

Infusion Pump Set up and Management

Specify Infusion Pump Type:

Psychiatric

Cognitive Disorders

Mood Disorders

Schizophrenia/Psychotic Disorders

Medication Compliance

Women's Health / Matenal - Infant Care

Pregnancy Related Complications

Fetal Heart Tones

Contractions

Post Partum Mother/Baby Visit

Newborn Care

Phototherapy

Breast Feeding Support

Pediatrics

Growth and Development

Respiratory Distress Syndrome

Bronchopulmonary Dysplasia

Cystic Fibrosis

Muscular Dystrophy

Spina Bifida

Spinal Surgery

Sickle Cell Disease

Trach Care/Suctioning

Ventilator Management

Pain Management

Verbal/Nonverbal Pain Scales

Response to Pain Management Interventions

PCA Pump

Epidural Cath/Site Monitoring/Pump

Non-Pharmacologic Pain Measures

Palliative & End of Life Care

Palliative Symptom Management

Pain Management/Response

Family Support/Teaching

After Death Protocols

Medications

Alzheimer's Medications

Antiarrhythmics

Antibiotics/Antivirals

Anti-Depressants

Anti-Hypertensives

Anti-Psychotics

Anti-Seizure Medications

Benzodiazepines

Calculation of Pediatric Dosages

Coumadin

Diuretics

Enoxaparin

Inhaled Medications

Nebulizer Medications

Insulin

Opioid and Non-Opioid Analgesics

Oral Chemotherapy

Oral Hypoglycemics

Oral & Topics Nitrates

Rivaroxaban

Sedative/Hypnotics

Steroids

Home Health

Case Manager

Intake/Admissions

Case Load - Pts/Day(specify)

Supervise LVNs/HHAs

Medicare/Medicaid

Long/Short Term Disability

Private Insurance

Telephonic Assessments

Management of Complaints

APS Reports

OASIS

Diagnosis Coding

Document Plan of Care

Clinical Assessment Documentation

Professional Knowledge and Skills

National Patient Safety Goals/Core Measures

Safety Assessment

Fall Assessment and Prevention

Patient/Family Teaching

Age Specific/Population Based Care

EMR

Allscripts

Cerner

Epic

HomeCare Home Base

McKesson

Meditech

Other Computerized Documentation System

EMR Conversion - yes

Age Specific Competencies

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)

Certifications

ACLS

BLS

PALS

IV Certification

I hereby certify that ALL information I have provided on this skills checklist and all other documentation is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.