Emergency Department Skills Checklist Personal InformationName(Required) First Middle Last Last 4 Digits of Social Security NumberEmail(Required) Date MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyWork SettingsLevel I Trauma Center 1 2 3 4 Level II Trauma Center 1 2 3 4 Non-Trauma Center Emergency Department 1 2 3 4 Pediatric Emergency Department 1 2 3 4 Emergency Department - Combined Adult/Pediatric 1 2 3 4 Critical Care Transport 1 2 3 4 CardiacAcute Coronary Syndrome 1 2 3 4 Congestive Heart Failure/Pulmonary Edema 1 2 3 4 Aneurysm 1 2 3 4 Cardioversion 1 2 3 4 Transcutaneous Pacemaker 1 2 3 4 Heart Sound 1 2 3 4 PulmonaryRespiratory Failure 1 2 3 4 COPD/Asthma 1 2 3 4 Aspiration 1 2 3 4 Pneumonia 1 2 3 4 Pneumo/Hemothorax 1 2 3 4 Chest Tube Insertion/Management 1 2 3 4 Pulmonary Embolism 1 2 3 4 Tuberculosis 1 2 3 4 External CPAP/BiPAP 1 2 3 4 Intubation 1 2 3 4 Ventilated Patients 1 2 3 4 ABG Interpretation 1 2 3 4 NeurologicalCVA 1 2 3 4 Stroke Scale 1 2 3 4 Brain Injury 1 2 3 4 Glascow Coma Scale 1 2 3 4 Spinal Cord Injury 1 2 3 4 Meningitis 1 2 3 4 Seizures 1 2 3 4 OrthopedicsFractures/Casting 1 2 3 4 Open/Complex Fractures 1 2 3 4 Apply/Manage Splints 1 2 3 4 Circulation Checks 1 2 3 4 GastrointestinalGI Bleeding 1 2 3 4 Liver Disease 1 2 3 4 GI Obstruction 1 2 3 4 Abdominal Pain/Distress 1 2 3 4 Gastric Tubes 1 2 3 4 Renal/GUAcute Renal Failure 1 2 3 4 Renal Calculi 1 2 3 4 Renal Trauma 1 2 3 4 Testicular Torsion 1 2 3 4 EndocrineHypoglycemia 1 2 3 4 Hyperglycemia 1 2 3 4 DKA 1 2 3 4 Wound ManagementSkin Integrity Assessment 1 2 3 4 Wound Repair 1 2 3 4 Shock/TraumaInjury Severity Score 1 2 3 4 Trauma Code 1 2 3 4 Trauma Team Member 1 2 3 4 Major Trauma 1 2 3 4 Traumatic Amputation 1 2 3 4 Peritoneal Lavage 1 2 3 4 Hypovolemic Shock 1 2 3 4 Neurogenic Shock 1 2 3 4 Anaphylactic Shock 1 2 3 4 Septic Shock 1 2 3 4 Cardiogenic Shock 1 2 3 4 Burns - 2nd Degree 1 2 3 4 Burns - 3rd Degree 1 2 3 4 Infectious Disease/Immunosuppressed PatientsContagious/Infectious Patients 1 2 3 4 Isolation 1 2 3 4 Neutropenia/Reverse Isolation 1 2 3 4 Women's HealthPlacenta Abruptio/Previa 1 2 3 4 Precipitous Delivery 1 2 3 4 Pregnancy Induced Hypertension 1 2 3 4 Fetal Heart Tones 1 2 3 4 Sexual Assault 1 2 3 4 Reporting Acts of Violence 1 2 3 4 PediatricsManagement of Pediatric Emergency Patients 1 2 3 4 Identification/Reporting Abuse 1 2 3 4 Abdominal Pain 1 2 3 4 Epiglottitis 1 2 3 4 Asthma/Reactive Airway Disease 1 2 3 4 Fractures 1 2 3 4 Head/Spinal Injury 1 2 3 4 Poison Ingestion 1 2 3 4 Seizures 1 2 3 4 Sickle Cell Crisis 1 2 3 4 PsychiatricAcute Psychotic Patient 1 2 3 4 Managing Violent Behavior 1 2 3 4 Drug /ETOH Overdose/Withdrawal 1 2 3 4 Psychiatric Hold 1 2 3 4 Suicidal Patient 1 2 3 4 MiscellaneousBites- Animal/Snake/Human 1 2 3 4 Hazardous Material Exposure 1 2 3 4 Heat Exhaustion/Stroke 1 2 3 4 Drowning 1 2 3 4 IV TherapyStarting IVs 1 2 3 4 Central Line Placement 1 2 3 4 Intraosseous Infusion 1 2 3 4 Blood Product Administration 1 2 3 4 MedicationsAnti-Arrhythmics 1 2 3 4 Anticoagulants (IV, oral, & injection) 1 2 3 4 Anti-Hypertensives 1 2 3 4 Anti-Psychotics 1 2 3 4 Anti-Seizure Medications 1 2 3 4 Benzodiazepines 1 2 3 4 Continuous IV Paralytics 1 2 3 4 Continuous IV Sedation 1 2 3 4 Procedural Sedation - Administration 1 2 3 4 Emergency Medications 1 2 3 4 Inhaled Medications 1 2 3 4 Insulin 1 2 3 4 IV Vasopressors 1 2 3 4 Narcotics/Opioid Analgesics (IV, oral, & injection) 1 2 3 4 Nitrates (Oral & Topical) 1 2 3 4 Non-Opioid Analgesics (IV, Oral, & Injection) 1 2 3 4 Reversal Agents 1 2 3 4 Thrombolytic Therapy 1 2 3 4 Steroids (IV, Oral, Inhaled) 1 2 3 4 Automated Medication Dispensing (i.e. Pyxis, Omnicell) 1 2 3 4 Cardiac Monitoring & Emergency ResponseDysrhythmia Interpretation 1 2 3 4 Dysrhythmia Management 1 2 3 4 Obtain 12 Lead EKG 1 2 3 4 Interpret 12 Lead EKG 1 2 3 4 Management of Cardiac Arrest 1 2 3 4 Professional Knowledge & SkillsTriage 1 2 3 4 Ambulance/Paramedic Radio 1 2 3 4 Charge Experience 1 2 3 4 AMA Procedures 1 2 3 4 EMTALA 1 2 3 4 National Patient Safety Goals/Core Measures 1 2 3 4 Fall Risk Assessment/Prevention 1 2 3 4 Pressure Ulcer Risk Assessment/Prevention 1 2 3 4 Restraints/Use of Least Restrictive Device 1 2 3 4 Patient/Family Teaching 1 2 3 4 Age Specific/Population-Based Care 1 2 3 4 Isolation Precautions 1 2 3 4 Infection Prevention 1 2 3 4 Pain Assessment & Management 1 2 3 4 Interpretation and Communication of Lab Values 1 2 3 4 Age Specific CompetenciesInfant (Birth - 1 year) 1 2 3 4 Preschooler (ages 2-5 years) 1 2 3 4 Childhood (ages 6-12 years) 1 2 3 4 Adolescents (ages 13-21 years) 1 2 3 4 Young Adults (ages 22-39 years) 1 2 3 4 Adults (ages 40-64 years) 1 2 3 4 Older Adults (ages 65-79 years) 1 2 3 4 Elderly (ages 80+ years) 1 2 3 4 EMREpic 1 2 3 4 Cerner 1 2 3 4 Eclipsys 1 2 3 4 McKesson 1 2 3 4 Meditech 1 2 3 4 Allscripts 1 2 3 4 Other Computerized System 1 2 3 4 Computerized Physician Order Entry 1 2 3 4 Bar Coding for Medication Administration 1 2 3 4 EMR ConversionYesNoCertificationsBLS Yes BLS Expiry Date MM slash DD slash YYYY ACLS Yes ACLS Expiry Date MM slash DD slash YYYY PALS Yes PALS Expiry Date MM slash DD slash YYYY PEARS Yes PEARS Expiry Date MM slash DD slash YYYY TNCC Yes TNCC Expiry Date MM slash DD slash YYYY ENPC Yes ENPC Expiry Date MM slash DD slash YYYY CEN Yes CEN Expiry Date MM slash DD slash YYYY Other Certification Other Expiration MM slash DD slash YYYY Other Certification 2 Other 2 Expiration MM slash DD slash YYYY AuthorizationsSignature(Required)The information I have given is true and accurate to the best of my knowledge. I hereby authorize Hired by Matrix, Inc. to release this Emergency Room RN Skills Checklist to Client facilities of Hired by Matrix, Inc. in consideration of my assignment to work at those facilities.
