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
Assist with EGD’s
Assist with endoscopic ultrasound
Assist with active GI bleed
Cautery devices
Assist with manometry studies
Assist with variceal banding
Assist with esophageal dilatations
Assist with esophageal ballooning
Assist with scelrotherapy
Assist with TEE
Assist with bronchoscopy
Assist with colonoscopy
Assist with polypectomy
Assist with ERCP’s
Assist with PEG placements
Assist with liver BX
Assist with collection of hot & cold BX’s
Specimen collection & labeling
Set up of scopes & video equipment
Apply external abdominal pressure to assist with scope movement
Scope cleaning
Assist with mobile cases, ICU, ER, etc.
Radiation safety
Automated Medication Dispensing System, Pyxis, Omnicell, or other
Takes call for emergency cases
National Patient Safety Goals
Awareness of HCAHPS
Accurate patient identification
Effective communication
Interpretation & communication of lab values
Medication administration
Labeling (medications & specimens)
Anticoagulation therapy
Monitoring conscious sedation
Pain assessment & management
Infection control
Universal precautions
Isolation
Minimize risk for falls
Prevention of pressure ulcers
Use of rapid response teams
Fentanyl
Propofol
Demerol
Presedex
Versed
Reversal agents
Pre procedure phone calls
Electronic documentation
Patient assessment
Colon prep or re-prep
Pre procedure checklist/consent
IV start, med admin
Assess for air movement post colonoscopy
Assess for pain
Assess for bowel sounds
Assess for gag reflex post EGD
Assess for gag reflex post bronchoscopy
Recover from MAC
Recover from (moderate) conscious sedation
Discharge outpatients to home
Post procedure phone calls
Newborn/neonate (birth-30 days)
Infant (31 days-1 year)
Toddler (ages 2-3 years)
Preschool (ages 4-5 years)
School age (ages 6-12 years)
Adolescent (ages 13-21 years)
Young adult (ages 22-39 years)
Adult (ages 40-64 years)
Older adult (ages 65-79 years)
Elderly (ages 80+ years)
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