Medical Surgical Telemetry

One program to handle all talent management needs from acquisition to development

Personal Information

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Overall Score

Out of 4

Name(Required)

First Middle Last

Last 4 Digits of Social Security Number

Email(Required)

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Date

Proficiency Scale

1 – No Experience
2 – Need Training
3 – Able to perform with supervision
4 – Able to perform independently

AGE OF PATIENTS CARED FOR

Newborn (birth-30 days)(Required)

Infant (30 days - 1 year)(Required)

Toddler (1 - 3 years)(Required)

Preschooler (3 - 5 years)(Required)

School Age (5 - 12 years)(Required)

Adolescents (12 - 18 years)(Required)

Young Adults (18 - 39 years)(Required)

Middle Adults (39 - 64 years)(Required)

Older Adults (64+ years)(Required)

GENERAL SKILLS

Standard Precautions(Required)

Isolation Precautions(Required)

Discontinue PIV(Required)

Initiate Peripheral IV(Required)

Lift/ Transfer Devices(Required)

Pediatric Respiratory/Cardiac Arrest(Required)

Adult Respiratory/Cardiac Arrest(Required)

Crash Carts(Required)

Defibrillators(Required)

Care of Patients in Restraints(Required)

Pain Management(Required)

Automated Med Dispensing Systems(Required)

Care Planning & Discharge Planning(Required)

Patient/Family Education(Required)

Electronic Documentation(Required)

Patient Head to Toe Assessment(Required)

Knowledge of Normal Serum Lab Values(Required)

Obtaining Cultures (Blood, Sputum, Swab, Urine)(Required)

Calculate mcg/min and mcg/Kg/min(Required)

Titrating Medications(Required)

PSYCHOLOGICAL

Overdose/ Withdrawal(Required)

Suicidal Precautions(Required)

Manic Disorder/ Behavior(Required)

De-escalation techniques(Required)

Depression(Required)

Knowledge and Use of :

Anti-depressants(Required)

Anti-anxiety Medications(Required)

Psych Medications(Required)

MEDICATIONS

Anticoagulants(Required)

Narcotics(Required)

PCA for Pain Control(Required)

Epidural for Pain Control(Required)

Non-narcotic Analgesics(Required)

Topical Medications(Required)

IM Medications(Required)

SQ Medications(Required)

Oral Medications(Required)

IV Push Medications(Required)

IV Drip Medications(Required)

Antibiotics(Required)

Chemotherapy(Required)

NEURO GENERAL SKILLS

Stroke(Required)

Spinal Cord Injury - Acute(Required)

Spinal Cord Injury – Long Term(Required)

Neuromuscular Disease(Required)

Alzheimer's Disease(Required)

Knowledge and Use of :

Anticonvulsants(Required)

IV Drip Steroids(Required)

CARDIAC GENERAL SKILLS

Cardiac Monitors(Required)

Auscultation of Cardiac Sounds(Required)

EKG- 12 Lead(Required)

Recognizing Basic & Life-Threatening Dysrhythmias(Required)

Cardioversion/ Defibrillation(Required)

Pulse Checks(Required)

Interpretation of Cardiac Enzymes(Required)

Use of Doppler(Required)

Use of Automatic BP Cuff (ie Dinamap)(Required)

CARDIAC- CARE OF PATIENTS WITH:

Angina(Required)

CHF(Required)

Chest Pain(Required)

Post MI(Required)

Knowledge and Use of:

Nitrates (Oral, Topical)(Required)

Antiarrhythmics (Oral)(Required)

Antihypertensives (Oral)(Required)

Heparin Drip(Required)

RESPIRATORY GENERAL SKILLS

O2 Cannulas/Masks(Required)

Nebulizer Set-up/Use(Required)

Incentive Spirometry(Required)

Chest PT(Required)

Pulse Oximetry(Required)

Suctioning:

Oral(Required)

Tracheostomy Tube(Required)

RESPIRATORY- CARE OF PATIENT WITH:

SOB(Required)

Pulmonary Embolism(Required)

Tracheostomy Tube(Required)

COPD(Required)

Asthma Exacerbation(Required)

Pneumonia(Required)

Pre/Post Thoracic Surgery(Required)

Chest Tubes(Required)

Tuberculosis(Required)

Knowledge and Use of: *

O2 Therapy(Required)

Bronchodilators(Required)

Oral Steroids(Required)

IV Steroids(Required)

Inhaler(Required)

GASTROINTESTINAL GENERAL SKILLS

Insertion, Care & Maintenance of Nasogastric Tubes (ie Salem Pump, Levine)(Required)

Nasointestinal Tubes (ie Cantor, Miller-Abbot)(Required)

Jejunostomy, Gastrostomy, Cecostomy Tubes(Required)

Tube Feedings via Flexible Tubes:

by Gravity Infusion(Required)

by Feeding Pump(Required)

Collection of Stool Specimens(Required)

Bowel Preparation & Cleansing Procedures(Required)

GASTROINTESTINAL- CARE OF PATIENTS WITH:

Stoma(Required)

Bowel Obstruction(Required)

Pancreatitis(Required)

Post Abdominal Surgery(Required)

Ileostomy(Required)

Colostomy(Required)

Inflammatory Bowel Disease(Required)

Obstruction(Required)

Hepatitis(Required)

Hepatitis

Total Parenteral Nutrition (TPN)(Required)

Peripheral Parenteral Nutrition (PPN)(Required)

Antiemetics(Required)

Proton Pump Inhibitors(Required)

RENAL/GU PROBLEMS GENERAL SKILLS

Insertion of Catheter Straight(Required)

Insertion of Catheter Foley(Required)

Bladder Irrigation Continuous(Required)

Bladder Irrigation Intermittent(Required)

Peritoneal Dialysis(Required)

Automatic Cycler Machine(Required)

Collection of Urine Specimens(Required)

Hemodialysis(Required)

A-V Fistula/Shunt Care(Required)

Pre- & Post- Dialysis Care(Required)

Suprapubic Catheter(Required)

Nephrostomy Tube(Required)

RENAL/GU- CARE OF PATIENT WITH:

Urinary Tract Infection(Required)

Pyelonephritis(Required)

Renal Calculi(Required)

Urinary Retention/Incontinence(Required)

ENDOCRINE GENERAL SKILLS

Performing Fingersticks(Required)

Use of Blood Glucose Meter Device(Required)

Use of Visual Blood Glucose Strips(Required)

Endocrine- Care of Patient With:

Hyper/Hypoglycemia(Required)

DKA(Required)

Thyroid Disorders(Required)

Knowledge and Use of Insulin:

Single Type(Required)

Dextrose(Required)

Mixed Insulins(Required)

Insulin Infusion(Required)

ORTHOPEDIC GENERAL SKILLS

Cast Care(Required)

C.M.S. Checks(Required)

Traction – Skin(Required)

Traction – Skeletal(Required)

Range of Motion(Required)

Use of Assistive Devices(Required)

Applications of Splints Extremities(Required)

Total Joint Replacement(Required)

ORTHOPEDIC- CARE OF PATIENTS WITH:

Continuous Passive Motion Machine (CPM)(Required)

Total Joint Replacement(Required)

Amputation(Required)

WOUND/SKIN CARE

Dressing Changes(Required)

Air Fluidized, Low Airloss Beds(Required)

Pressure Relief Mattress/Seat Cushion(Required)

Pressure Sores(Required)

Leg Ulcers(Required)

Burns(Required)

WOUND VACS

Hemovacs(Required)

Jackson-Pratt Tubes(Required)

Penrose Drains(Required)

T-Tubes(Required)

Surgical Wound Irrigations & Dressings(Required)

VASCULAR

Discontinue PICC(Required)

Care of Patient with DVT(Required)

Draw Blood from Arterial Line(Required)

Draw Blood from Central Line(Required)

Peripheral IV Insertion, Care & Maintenance(Required)

Discontinue Peripheral IV(Required)

IV Infusion Pumps(Required)

CVP Lines – Measurement of CVP(Required)

Central Line Care & Maintenance (including dressing changes)(Required)

Blood/Blood Product Administration(Required)

Multi-Lumen Central Catheters(Required)

Port-A-Caths (Infusa-Ports)(Required)

Continuous Subcutaneous Infusion Pumps(Required)

Authorizations

Legal Consent(Required)

I agree to the terms and conditions.

Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures

Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. By signing this document you are agreeing that you have reviewed this Consumer Disclosure and consent and intend to transact business electronically; to use electronic signatures instead of wet ink signatures and paper documents, and to receive notices and disclosures electronically.

You are not required to sign documents electronically or to receive notices and disclosures electronically. If you prefer not to transact business electronically, you may request paper copies from the “sending party” and withdraw your consent at any time, as described below.

Scope of Consent
By utilizing this Service, you agree to receive electronic signature documents with all related and identified documents, notices, and disclosures provided during your relationship with the “sending party.” You may withdraw your consent, at any time, by following the procedures outlined below.

Paper Copies
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Withdrawing your consent, requesting a paper copy, or updating your contact information
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“Requesting A Paper Copy” To allow the “sending party” to identify you to provide a paper copy of the document requiring your signature, the notice, or disclosure, please provide the sending party with your name, email address, mailing address, telephone number, and name of the document of which you are requesting a paper copy .

“Update Your Contact Information” To allow the “sending party” to identify you in order to update your contact information, please provide them with your name, email address, mailing address, and telephone number.

The “sending party” will inform you of any fees related to costs for printing and mailing paper copies or your withdrawal consent to transact business electronically.

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