Respiratory Therapist 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 independentlyGeneral SkillsCare of Patient in Restraints 1 2 3 4 Electronic Documentation 1 2 3 4 Isolation Precautions 1 2 3 4 Medicare Documentation 1 2 3 4 Patient/Family Education 1 2 3 4 Written Documentation 1 2 3 4 Care of Patients withAcute/Chronic Bronchitis 1 2 3 4 ARDS 1 2 3 4 Aspiration Pneumonia 1 2 3 4 Asthma 1 2 3 4 Atelectasis 1 2 3 4 Bacterial/Viral Pneumonia 1 2 3 4 Bronchiectasis 1 2 3 4 Broncho-Pulmonary Dysplasia 1 2 3 4 Cardiac Surgery 1 2 3 4 Congestive Heart Failure 1 2 3 4 Croup 1 2 3 4 Cystic Fibrosis 1 2 3 4 Diabetic Ketoacidosis 1 2 3 4 Emphysema 1 2 3 4 Epiglottitis 1 2 3 4 Failure to Thrive 1 2 3 4 Fem-pop Bypass 1 2 3 4 Gullian Barre 1 2 3 4 Hayaline Membrane Disease (HMD/IRDS) 1 2 3 4 Lung Cancer 1 2 3 4 Meconium Aspiration 1 2 3 4 Myasthenia Gravis 1 2 3 4 Myesthena Gravis 1 2 3 4 Myocardial Infarction 1 2 3 4 Near Drowning 1 2 3 4 Neonatal Pneumonia 1 2 3 4 Open Hearts 1 2 3 4 Pacemakers 1 2 3 4 Persistant Fetal Circulation 1 2 3 4 Pulmonary Interstitial Emphysema (PIE) 1 2 3 4 Pleural Effusion 1 2 3 4 Pulmonary Edema 1 2 3 4 Pulmonary Embolism 1 2 3 4 Respiratory Failure 1 2 3 4 Respiratory Syncytial Virus 1 2 3 4 Respiratory Distress Syndrome 1 2 3 4 Respiratory Distress Syndrome 1 2 3 4 Tracheo-Esophageal Fistula 1 2 3 4 Transient Tachpnea 1 2 3 4 Thoracotomies 1 2 3 4 Tuberculosis 1 2 3 4 Therapy & ProceduresApnea Monitor 1 2 3 4 Assessment of Breath Sounds 1 2 3 4 Carbogen Delivery 1 2 3 4 Diaphragmatic Breathing 1 2 3 4 Disinfection and Sterilization 1 2 3 4 End-Tidal CO2 Monitoring 1 2 3 4 Nasal-Oral Airway Placement 1 2 3 4 Oximetry 1 2 3 4 Pursed Lip Breathing 1 2 3 4 Transcutaneous Monitoring 1 2 3 4 Oxygen AdministrationAcapella 1 2 3 4 Aerosol Set Up/Mask/Trach 1 2 3 4 Analyze Oxygen 1 2 3 4 BiPAP Nasal/Mask 1 2 3 4 Bronchial Hygiene Therapy 1 2 3 4 Chest Physical Therapy/Postural Drainage 1 2 3 4 CPAP Nasal/Mask 1 2 3 4 Continuous Medication Nebulizer 1 2 3 4 Cough Assisted Machine 1 2 3 4 Croup Tent Set Up 1 2 3 4 EzPAP Expansion Therapy 1 2 3 4 Flutter Valve Therapy 1 2 3 4 Hand Held Nebulizer 1 2 3 4 Heated Aerosol Mask/Trach Collar 1 2 3 4 Heliox Delivery 1 2 3 4 Incentive Spirometry (IS) 1 2 3 4 Infant Hood Set Up 1 2 3 4 Intrapulmonary Percussive Ventilation (IPV) 1 2 3 4 Metered Dose Inhaler 1 2 3 4 Nasal Cannula 1 2 3 4 Nitric Oxide Delivery 1 2 3 4 Oxgen Tank Set Up/Change Tank 1 2 3 4 Partial Rebreather/Non-Rebreather Mask 1 2 3 4 PEP Mask/PEP Valve Therapy 1 2 3 4 Positive Pressure Breathing (IPPB) 1 2 3 4 Simple Mask 1 2 3 4 Splint Cough 1 2 3 4 Sputum Induction 1 2 3 4 Venturi Mask 1 2 3 4 Vest Airway Clearance 1 2 3 4 Obtaining Arterial Blood GasesABG Interpretation/Analyzer 1 2 3 4 Airway Pressure Release Ventilation (ARPV) 1 2 3 4 Allen Test 1 2 3 4 Arterial Blood Gas Analysis 1 2 3 4 Arterial Line Insertion 1 2 3 4 Arterial Line Maintenance 1 2 3 4 Bronchoscopies/Assist 1 2 3 4 Change, Clean Trach Tubes 1 2 3 4 Check Intracuff Pressures 1 2 3 4 Continuous Positive Airway Pressure (CPAP) 1 2 3 4 Endotracheal 1 2 3 4 Extubations 1 2 3 4 Perform Independently 1 2 3 4 Assist Only 1 2 3 4 Femoral Artery 1 2 3 4 Flow/Volume/Pressure Waveform Interpretation 1 2 3 4 High Frequency Ventilator 1 2 3 4 Independent Sychronous Lung Ventilation 1 2 3 4 Inhaler Reservoirs 1 2 3 4 Intra Aortic Balloon Pump (IABP) 1 2 3 4 Intubations 1 2 3 4 Perform Independently 1 2 3 4 Assist Only 1 2 3 4 Inverse Ratio Ventilation 1 2 3 4 Nasotracheal 1 2 3 4 Negative Inspiratory Force 1 2 3 4 Peak Flow Rat Monitoring 1 2 3 4 Positive End Expiratory Pressure (PEEP) 1 2 3 4 Pressure Assist/Control 1 2 3 4 Pressure Regulated Volume Control (PRVC) 1 2 3 4 Pressure Support Ventilation (PSV) 1 2 3 4 Pulmonary Function Testing 1 2 3 4 Pulmonary Stress Testing 1 2 3 4 Radial/Brachial Artery 1 2 3 4 Ventilator ManagementIntermittent Mandatory Ventilation (IMV) 1 2 3 4 Inverse Ratio Ventilation 1 2 3 4 Pressure Release Modes/Techniques 1 2 3 4 Suctioning 1 2 3 4 Synchronized Intermittent Mandatory Ventilation (SIMV) 1 2 3 4 Ventilate Patient with Manual Resuscitator 1 2 3 4 Ventilator Modes 1 2 3 4 Ventilator Set Up/On Tanks 1 2 3 4 Volume Assist/Control 1 2 3 4 Other SettingsAcute Care 1 2 3 4 Adult Critical Care Unit 1 2 3 4 Burn ICU 1 2 3 4 Emergency Room 1 2 3 4 Home Care 1 2 3 4 Medical/Surgical General Floor Care 1 2 3 4 Neonatal ICU Level II 1 2 3 4 Neonatal ICU Level III 1 2 3 4 Pediatric General Floor Care 1 2 3 4 Pediatric ICU 1 2 3 4 Pediatric ICU Level II 1 2 3 4 Pediatric ICU Level III 1 2 3 4 Pulmonary Rehabilitation 1 2 3 4 Pulmonary Function Lab 1 2 3 4 Skilled Nursing 1 2 3 4 Sleep Lab 1 2 3 4 Transplant 1 2 3 4 Transports 1 2 3 4 EquipmentBird/Avea 1 2 3 4 Drager 1 2 3 4 Puritan-Bennett 1 2 3 4 Sechrist-Infant Star 1 2 3 4 Servo 1 2 3 4 Siemens 1 2 3 4 SIMS 1 2 3 4 Age Specific CompetenciesNewborn (Birth - 30 days) 1 2 3 4 Infant (30 days - 1 year) 1 2 3 4 Toddler (1-3 years) 1 2 3 4 Preschooler (3-5 years) 1 2 3 4 School Age (5-12 years) 1 2 3 4 Adolescent (12-18 years) 1 2 3 4 Young Adult (18-39 years) 1 2 3 4 Mature Adult (39-64 years) 1 2 3 4 Elderly (64+ years) 1 2 3 4 List Any Additional SkillsSkill Skill Skill Skill Additional TrainingTaining Taining Taining Taining Additional Tools & EquipmentTools & Equipment Tools & Equipment Tools & Equipment Tools & Equipment 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.
