PACU 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 independentlyCardiovascularOpen Heart Recovery 1 2 3 4 AAA Repair 1 2 3 4 Vascular Surgery 1 2 3 4 Pacemaker-Permanent & Temporary 1 2 3 4 Cardioversion 1 2 3 4 AICD Insertion 1 2 3 4 Cardiac Arrest 1 2 3 4 Cardiac Tamponade 1 2 3 4 CHF/Pulmonary Edema 1 2 3 4 Abnormal Heart Sounds/Murmurs 1 2 3 4 Pulses/Circulation Checks 1 2 3 4 PulmonaryVentilator Management 1 2 3 4 Fresh Tracheostomy 1 2 3 4 Thoracotomy/Lobectomy/Pneumonectomy 1 2 3 4 Pneumothorax/Hemothorax 1 2 3 4 Laryngospasm 1 2 3 4 Pulmonary Embolism 1 2 3 4 COPD 1 2 3 4 ABG Interpretation 1 2 3 4 NeurologicPost Craniotomy 1 2 3 4 Anterior/Posterior Spinal Fusion 1 2 3 4 Carotid Endardarectomy 1 2 3 4 Spine Surgery 1 2 3 4 CVA 1 2 3 4 Stroke Scale 1 2 3 4 Glascow Coma Scale 1 2 3 4 Spinal Precautions 1 2 3 4 Hypothermia Protocol 1 2 3 4 Hypo/Hyperthermia Blanket 1 2 3 4 Sedation Scales/Levels 1 2 3 4 GastrointestinalPancreas/Liver Transplant 1 2 3 4 Colon Surgery 1 2 3 4 Colostomy/Ileostomy 1 2 3 4 ERCP 1 2 3 4 G Tube/J Tube Management 1 2 3 4 T Tube Management 1 2 3 4 Renal/GenitourinaryRenal Surgery 1 2 3 4 TURP 1 2 3 4 Arteriovenous Fistula/Shunt 1 2 3 4 Nephrostomy Tubes 1 2 3 4 Endocrine MetabolicDiabetes - Hypo/Hyperglycemic Crisis 1 2 3 4 IV Insulin Protocols 1 2 3 4 OrthopedicLaminectomy 1 2 3 4 Total Joint Replacement 1 2 3 4 Amputation 1 2 3 4 Open Reduction/Internal Fixation 1 2 3 4 General Orthopedic Surgeries 1 2 3 4 CPM/Traction 1 2 3 4 Circulation Checks 1 2 3 4 Wound ManagementSurgical Drains 1 2 3 4 Wound Vac 1 2 3 4 Surgical Wound Assessment 1 2 3 4 Skin Assessment for Breakdown 1 2 3 4 Staging Decubitus Ulcers 1 2 3 4 MedicationsProcedural Sedation 1 2 3 4 Anesthesia Medications 1 2 3 4 Anti-Arrhythmics 1 2 3 4 Anticoagulants 1 2 3 4 Anti-Hypertensives 1 2 3 4 Anti-Seizure Medications 1 2 3 4 Benzodiazepines 1 2 3 4 Emergency Medications 1 2 3 4 Insulin 1 2 3 4 Narcotics/Opioid Analgesics 1 2 3 4 Nitrates 1 2 3 4 Non-Opioid Analgesics 1 2 3 4 Reversal Agents 1 2 3 4 Steroids 1 2 3 4 Automated Medication Dispensing (i.e. Pyxis, Omnicell) 1 2 3 4 IV TherapyStarting Ivs 1 2 3 4 Central Line Blood Draws 1 2 3 4 Central Line/Implanted Line Care 1 2 3 4 Blood Product Administration 1 2 3 4 Cardiac Monitoring & Emergency ResponseMalignant Hyperthermia 1 2 3 4 Dysrhythmia Interpretation 1 2 3 4 Dysrhythmia Management 1 2 3 4 12 Lead EKG 1 2 3 4 Professional Knowledge & SkillsNational 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 Age Specific/Population-Based Care 1 2 3 4 Pain Assessment & Management 1 2 3 4 Charge Experience 1 2 3 4 Interpretation and Communication of Lab Values 1 2 3 4 Specialty Beds 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 Other Computerized System 1 2 3 4 Computerized Physician Order Entry 1 2 3 4 Bar Coding for Medication Administration 1 2 3 4 Pulmonary 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 CAPA Yes CAPA Expiry Date MM slash DD slash YYYY CPAN Yes CPAN 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 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. 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.
