Telemetry Skills Checklists 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 independentlyCardiacAcute Coronary Syndrome 1 2 3 4 Congestive Heart Failure 1 2 3 4 Post Open Heart (12-24 hours) 1 2 3 4 Carotid Endarterectomy 1 2 3 4 Post Vascular Surgery 1 2 3 4 Heart Transplant 1 2 3 4 Pacemaker - Temporary/Permanent 1 2 3 4 Pacemaker - Epicardial 1 2 3 4 Sheath Removal 1 2 3 4 Heart Sounds 1 2 3 4 PulmonaryPneumonia 1 2 3 4 Respiratory Distress 1 2 3 4 COPD 1 2 3 4 Breath Sounds 1 2 3 4 Post Thoracic Surgery 1 2 3 4 Chest Tube Placement & Management 1 2 3 4 Trach Management 1 2 3 4 Modes of Ventilation (AC/PC/SIMV/CPAP) 1 2 3 4 Intubation/Extubation 1 2 3 4 External CPAP/BiPAP 1 2 3 4 Interpretation of Arterial Blood Gases 1 2 3 4 Neurologic & PsychiatricStroke Scale Assessment 1 2 3 4 CVA 1 2 3 4 Brain Injury 1 2 3 4 Post Craniotomy 1 2 3 4 Spinal Cord Injury 1 2 3 4 Seizure Disorders 1 2 3 4 ETOH/Drug Withdrawal 1 2 3 4 GastrointestinalGI Bleeding 1 2 3 4 GI Surgery 1 2 3 4 Liver Failure 1 2 3 4 Pancreatitis 1 2 3 4 Liver Transplant 1 2 3 4 Pancreas Transplant 1 2 3 4 Renal/GenitourinaryRenal Failure 1 2 3 4 Renal Surgery 1 2 3 4 Renal Transplant 1 2 3 4 Arteriovenous Fistula/Shunt 1 2 3 4 Nephrostomy Tubes 1 2 3 4 Peritoneal Dialysis 1 2 3 4 Endocrine MetabolicDiabetes - Hypo/Hyperglycemic Crisis 1 2 3 4 Pituitary Disorders 1 2 3 4 IV Insulin Protocols 1 2 3 4 Indwelling Insulin Pumps 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 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 Procedural Sedation 1 2 3 4 Diuretics 1 2 3 4 Emergency Medications 1 2 3 4 Inhaled Medications 1 2 3 4 Insulin 1 2 3 4 Titrate Vasoactive Drips 1 2 3 4 Manage Vasoactive Drips - No Titration 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 Steroids (IV, Oral, Inhaled) 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 Arterial Line Management 1 2 3 4 TPN & Lipids 1 2 3 4 Blood Product Administration 1 2 3 4 Administration of Chemotherapy 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 Lead EKG 1 2 3 4 Cardioversion 1 2 3 4 Defibrillation 1 2 3 4 Malignant Hyperthermia 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 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 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 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 PCCN Yes CAPA Expiry Date MM slash DD slash YYYY CCRN Yes CPAN Expiry Date MM slash DD slash YYYY Critical Care Course Yes Critical Care Course Expiry Date MM slash DD slash YYYY Telemetry Certificate/Course Yes Telemetry Certificate/Course 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.
