Oncology RN 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 independentlyRadiation TherapySkin Assessment 1 2 3 4 Total Body Irradiation 1 2 3 4 Side Effect Management 1 2 3 4 External Radiotherapy 1 2 3 4 Brachytherapy 1 2 3 4 Radiation Safety Precautions 1 2 3 4 Intraoperative Radiation 1 2 3 4 Oncology Patient CareRenal Failure 1 2 3 4 Fever 1 2 3 4 Pneumonia 1 2 3 4 Cardiac Arrhythmias 1 2 3 4 Hypercalcemia 1 2 3 4 Hyperkalemia 1 2 3 4 Pancreatitis 1 2 3 4 Pulmonary Embolism 1 2 3 4 Bowel Obstruction 1 2 3 4 Diabetes 1 2 3 4 Pneumothorax 1 2 3 4 Stress Fractures 1 2 3 4 Respiratory Distress 1 2 3 4 Spinal Cord Compression 1 2 3 4 GI Bleed 1 2 3 4 Pleural Effusion 1 2 3 4 Infection 1 2 3 4 Hypokalemia 1 2 3 4 DIC 1 2 3 4 Atlelectasis 1 2 3 4 Lymphedema 1 2 3 4 Vascular DevicesFlush Catheter 1 2 3 4 Punctured Catheter 1 2 3 4 Chemo Port 1 2 3 4 Omega-Port 1 2 3 4 S.E.A. Port 1 2 3 4 Port-A-Cath 1 2 3 4 Opti-Port 1 2 3 4 PICC Lines 1 2 3 4 Obtain Blood Specimens 1 2 3 4 Line Insertion Assistance 1 2 3 4 De-Clotting Ports 1 2 3 4 Groshong Catheters 1 2 3 4 Catheter Port 1 2 3 4 Site Care 1 2 3 4 Broviac Catheters 1 2 3 4 Patient/Teaching 1 2 3 4 Hickan Catheters 1 2 3 4 Care of Patients WithFoley Catheter Irrigations 1 2 3 4 CVP Line Insertion 1 2 3 4 Circumcision 1 2 3 4 Jejunostomy Tubes 1 2 3 4 Wound Care 1 2 3 4 Colostomy Care 1 2 3 4 TURP 1 2 3 4 Reverse Isolation 1 2 3 4 Liver Biopsy 1 2 3 4 Platelet Precautions 1 2 3 4 Accucheck 1 2 3 4 NG Tube Insertion 1 2 3 4 Suprapubic Catheter 1 2 3 4 Ileostomy 1 2 3 4 Thoracentesis 1 2 3 4 Isolation 1 2 3 4 Foley Catheter Irrigations 1 2 3 4 Bone Marrow Biopsy 1 2 3 4 Enterostomal Care 1 2 3 4 Chest Tube Care 1 2 3 4 Paracentesis 1 2 3 4 Gastrostomy Tube 1 2 3 4 Narcotic Infusion 1 2 3 4 Hemodialysis 1 2 3 4 Nephrostomy Tube 1 2 3 4 Pain Management 1 2 3 4 Pulse Oximetry 1 2 3 4 Fistulas/Shunts 1 2 3 4 Seizure Precautions 1 2 3 4 Peritoneal Dialysis 1 2 3 4 Nasotracheal Suctioning 1 2 3 4 PCA Pumps 1 2 3 4 CardiovascularHyperalimentation 1 2 3 4 Peripheral Blood Stem Cells 1 2 3 4 Packed RBC’s 1 2 3 4 IV Fluid Hydration 1 2 3 4 Venoclusive Disease 1 2 3 4 Fresh Frozen Plasma 1 2 3 4 Infections 1 2 3 4 Pneumonitis 1 2 3 4 Graft Rejection 1 2 3 4 Platelets 1 2 3 4 WBC/Lukocytes 1 2 3 4 Blood/Byproducts 1 2 3 4 Antivirals 1 2 3 4 Donor Education 1 2 3 4 Allogeneic BMT 1 2 3 4 GVHD Graft 1 2 3 4 Autologous BMT 1 2 3 4 Antifungals 1 2 3 4 Implantable Infusion Pumps 1 2 3 4 Medtronic 1 2 3 4 Infusaid 1 2 3 4 Ambulatory Infusion Pumps 1 2 3 4 Synchormed 1 2 3 4 Cormed 1 2 3 4 Pharmacia 1 2 3 4 Auto Syringe 1 2 3 4 Pancretec 1 2 3 4 Patency Maintenance 1 2 3 4 Patient Teaching 1 2 3 4 Psycho & Social CarePalliative Care 1 2 3 4 Hospice Care 1 2 3 4 Family Support 1 2 3 4 Counseling/Death/Dying 1 2 3 4 Identifying Support Groups 1 2 3 4 Advance Directives 1 2 3 4 Identifying Resources 1 2 3 4 Health Care Proxy 1 2 3 4 PharmacologyFloxuridine/FUDR 1 2 3 4 Doxorubicin/Adrianycin 1 2 3 4 Heparin/Coumadin 1 2 3 4 Carmustine/BiCNU 1 2 3 4 Dopamine 1 2 3 4 Cistplatin 1 2 3 4 Mitonycin/Mutanycin 1 2 3 4 Dilantin 1 2 3 4 Fluorouracil/-FU 1 2 3 4 Usulfan/Myleran 1 2 3 4 Neupogen/Epogen 1 2 3 4 Hydroxyurea/Hydrea 1 2 3 4 Corticosteroids 1 2 3 4 Vincristine/Oncovin 1 2 3 4 Methotrexate/Amethopterin 1 2 3 4 Morphine 1 2 3 4 Etoposide/VP-6- 1 2 3 4 Cyclophosphamide/Cytoxan 1 2 3 4 Decadron 1 2 3 4 Belomycin/Blenoxane 1 2 3 4 Vinblastine/Velban 1 2 3 4 Melphalan/Alkeran 1 2 3 4 IV Care/Skills 1 2 3 4 Chemotherapy Adm 1 2 3 4 IM/SQ 1 2 3 4 IVPB 1 2 3 4 IV Push/Intrathecal 1 2 3 4 Oncology & General CareThrombocytopenia 1 2 3 4 Stomatitis 1 2 3 4 Hemorrhabe 1 2 3 4 Oncology PCU 1 2 3 4 Neuropathy 1 2 3 4 Bone Marrow Transplant 1 2 3 4 Death /Dying 1 2 3 4 Venous Access Devices 1 2 3 4 Electrolyte Imbalance 1 2 3 4 Palliative/Hospice Care 1 2 3 4 Neutropenia 1 2 3 4 Pain Management 1 2 3 4 Telemetry 1 2 3 4 Nutritional Needs 1 2 3 4 Immunosuppression 1 2 3 4 IV Maintenance 1 2 3 4 Septic Shock 1 2 3 4 Vomiting/Diarrhea/Nausea 1 2 3 4 Skin Care 1 2 3 4 Blood/Blood Byproducts 1 2 3 4 Normal Serum Labs Values 1 2 3 4 Radiation Therapy 1 2 3 4 Surgical Patient Care 1 2 3 4 Chemotherapy Protocols 1 2 3 4 Implantable Vascular Ports 1 2 3 4 Patient Teaching 1 2 3 4 Implantable Infusion Pumps 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 AuthorizationsSignature(Required)The information I have given is true and accurate to the best of my knowledge. 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