Menu Corner

v Partnering
v Vision
v Philosophy & Approach
 

PACU 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

RESPIRATORY

Respiratory assessment

N/A  

1

2

3

4

Insertion/removal oral airway

N/A  

1

2

3

4

Insertion/removal nasal airway

N/A  

1

2

3

4

Administer O2

N/A  

1

2

3

4

Nasal Prongs

N/A  

1

2

3

4

Trache Collar

N/A  

1

2

3

4

Mask with and without Mist

N/A  

1

2

3

4

Face Tent

N/A  

1

2

3

4

Nasal cannula

N/A  

1

2

3

4

Mask

N/A  

1

2

3

4

Ambu bag

N/A  

1

2

3

4

Face tent

N/A  

1

2

3

4

Use of Ambu bag

N/A  

1

2

3

4

Setting up for use

N/A  

1

2

3

4

Weaning from ventilator

N/A  

1

2

3

4

Troubleshoot Alarms

N/A  

1

2

3

4

Endotracheal tube

N/A  

1

2

3

4

Tracheostomy

N/A  

1

2

3

4

Nasotracheal

N/A  

1

2

3

4

Oropharyngeal

N/A  

1

2

3

4

Ability to measure pressure cuff

N/A  

1

2

3

4

Ability to determine air leaks

N/A  

1

2

3

4

Ability to determine placement

N/A  

1

2

3

4

Upper airway obstruction

N/A  

1

2

3

4

Bronchospasm

N/A  

1

2

3

4

Aspiration

N/A  

1

2

3

4

Pneumothorax

N/A  

1

2

3

4

Hemothorax

N/A  

1

2

3

4

Breath sounds

N/A  

1

2

3

4

Care/maintenance Chest Tubes

N/A  

1

2

3

4

 

CARDIOVASCULAR

ABG interpretation

N/A  

1

2

3

4

Pulse oximetry

N/A  

1

2

3

4

Doppler

N/A  

1

2

3

4

Arterial lines

N/A  

1

2

3

4

Swan-Ganz

N/A  

1

2

3

4

CVP

N/A  

1

2

3

4

Subclavian Lines

N/A  

1

2

3

4

Cardiac ouptut

N/A  

1

2

3

4

Use of cardiac monitors:

N/A  

1

2

3

4

Recognizing arrythmias

N/A  

1

2

3

4

Interpreting 12 Lead EKG’s

N/A  

1

2