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Dialysis Skills Checklist
*required fields
 

My responses in this checklist represent a true reflection of my experience and comfort level.

 

Please self-rate your comfort level in performing tasks in connection with the below checklist.  Rate your level of comfort for each line item by following the below ranking system.  Simply fill in the appropriate option immediately following the rating number.

 

Typed Name (typing your name below serves as an electronic signature) *      Date*

                                                         

 

Phone*

           

 

 My Recruiting Professional at Health Source Group is: 

 

Level of Comfort/Experience

N/A=Non-applicable

1=Inexperienced in this area

2=Limited comfort/experience in this area

3=Comfortable/experienced in this area

4=Very comfortable/highly experienced in this area

 

Area

Not applicable

Inexperienced

Limited

Experienced

Highly Experienced

EXPERIENCE

Acute/Inpatient Dialysis

N/A  

1

2

3

4

Chronic/Outpatient Dialysis

N/A  

1

2

3

4

Dialysis Home Care

N/A  

1

2

3

4

Pediatric Dialysis

N/A  

1

2

3

4

Teaching the Dialysis Patient and Family

N/A  

1

2

3

4

Charge Nurse Experience

N/A  

1

2

3

4

 

SET UP/INITIATE DIALYSIS TREATMENT

Bicarbonate Dialysate

N/A  

1

2

3

4

Conductivity Testing

N/A  

1

2

3

4

Priming Dialyzer

N/A  

1

2

3

4

Machine and Alarm Setting Checks

N/A  

1

2

3

4

Prep Vascular Access

N/A  

1

2

3

4

Fistula/Vein Graft

N/A  

1

2

3

4

Dialysis

N/A  

1

2

3

4

Blood Specimen Collection

N/A  

1

2

3

4

Anticoagulation

N/A  

1

2

3

4

 

ASSESSMENT AND CARE OF PATIENT DURING DIALYSIS

Systems Assessment of Patient

N/A  

1

2

3

4

Volume Status

N/A  

1

2

3

4

Vascular Access Function

N/A  

1

2

3

4

Arterial and Venous Pressures

N/A  

1

2

3

4

Blood Flow Rate

N/A  

1

2

3

4

Subjective Response to Treatment

N/A  

1

2

3

4

Assess and Management of Anticoagulation

N/A  

1

2

3

4

Conductivity

N/A  

1

2

3

4

Ultrafiltration Calculation

N/A  

1

2

3

4

Administration of Blood and Blood Products

N/A  

1

2

3

4

Administration of Mannitol

N/A  

1

2

3

4

Sequential Ultrafiltration/PUF

N/A  

1

2

3

4

Documentation of Dialysis Treatment

N/A  

1

2

3

4

 

MANAGEMENT OF THE PATIENT WITH

Air Embolus

N/A  

1

2

3

4

Anemia

N/A  

1

2

3

4

Blood Leak

N/A  

1

2

3

4

Cardiopulmonary Arrest

N/A  

1

2

3

4

Chest Pain

N/A  

1

2

3

4

Disequilibrium Syndrome

N/A  

1

2

3

4

Fluid Overload

N/A  

1

2

3

4

Hemolysis

N/A  

1

2

3

4

Hyperkalcemia

N/A  

1

2

3

4

Hypertension

N/A  

1

2

3

4