Skill Checklists

Wound Care & Ostomy

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

WORK SETTINGS

Acute Care – Adult

Clinic – Adult

SNF/LTAC/Subacute

Hospice / Palliative Care

Acute/Long Term Care – Pediatrics

Clinic – Pediatrics

PRESSURE ULCERS

Assessment

Staging

Prevention/ Risk Assessment Tools – Adult

Prevention/ Risk Assessment Tools -Pediatrics

Support Surface Selection

NEUROPATHIC ULCERS

Assessment

Management

VENOUS STASIS ULCERS

Assessment

Management

PERIPHERAL ARTERIAL ULCERS

Assessment

Ankle Brachial Index

Management

OTHER WOUNDS

Fistulae – Pouching / Skin Care

Skin Care/ Management of Drains

WOUND DEBRIDEMENT

Autolytic

Enzymatic

Mechanical

Sharp

DRESSINGS/ TREATMENTS

Hydrogels

Hydrocolloids

Silver Products

Foams

Alginates

Vacuum Assisted Closure

Growth Factors

Skin Substitutes

Hyperbaric Oxygen Therapy

Wound Cultures

Electrical Stimulation

Enzymatic Debriding Agents

Mist Therapy

COLOSTOMY / ILEOSTOMY

Ostomy Equipment Selection

Continence Skin Care Management

Loop with Rod Stoma

End Stoma

Mucous Fistula

Double Barrel Stoma

Irrigation

Ileal Lavage

CONTINENT ILEOSTOMY

Knock pouch

Pelvic Pouch

UROSTOMY / CONTINENT

Catherization for C&S

Knock Pouch

Neobladder

CONTINENCE THERAPEUTIC DEVICES

Vaginal Cones

Penile Clamps

Male External Catheters

Internal Urethral Inserts

Catheters –Mgmt & Self Care Teaching

Magnetic Therapy

Urinary Incontinence Program

Fecal Incontinence Program

BURNS

Burn Management

Professional Knowledge and Skills

National Patient Safety Goals/ Core Measures

Patient Family Teaching

Age Specific/Population Based Care

Infection Precautions

Pain assessment & Management

Interpretation & Communication of Lab Values

EMR

EPIC

Cerner

Eclipsys

McKesson

Other Computerized System

Computerized Physician Order Entry

Bar coding for Medication

Culture

OTHER / MISC.

Pain Management Assessment of Pain Levels without intervention

Pain Management Response Assessment with Intervention

Experience: Charge Duty

Experience: Preceptor

AGE SPECIFIC CARE

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)

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.