Mother Baby Skills Checklist One program to handle all talent management needs from acquisition to development Personal Information HiddenOverall ScoreName(Required) First Middle Last Last 4 Digits of Social Security Number Email(Required) HiddenDate MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyPost-Partum InterventionsAssessmentBladder distention(Required) 1 2 3 4 Breast engorgement(Required) 1 2 3 4 DVT (Deep vein thrombosis)(Required) 1 2 3 4 Episiotomy(Required) 1 2 3 4 Fluid Balance(Required) 1 2 3 4 Fundal Height(Required) 1 2 3 4 GI function post anesthesia(Required) 1 2 3 4 Lochia Amount(Required) 1 2 3 4 Maternal vital signs(Required) 1 2 3 4 Parental/infant interaction/attachment(Required) 1 2 3 4 PerineumHematoma(Required) 1 2 3 4 Hemorrhoids(Required) 1 2 3 4 Interpretation of Lab resultsCheck urine forGlucose(Required) 1 2 3 4 Ketones(Required) 1 2 3 4 Proteins(Required) 1 2 3 4 Specific Gravity(Required) 1 2 3 4 Equipment & ProceduresAdult cardiopulmonary resuscitation(Required) 1 2 3 4 Contraceptive counseling(Required) 1 2 3 4 Discharge teaching(Required) 1 2 3 4 Foster parental-infant interaction/attachment(Required) 1 2 3 4 Insert catheterFoley(Required) 1 2 3 4 Straight(Required) 1 2 3 4 Post anesthesia careEpidural(Required) 1 2 3 4 General(Required) 1 2 3 4 Local(Required) 1 2 3 4 Spinal(Required) 1 2 3 4 Equipment & Procedures cont.Post Cesarean care(Required) 1 2 3 4 Teach and assist with(Required) 1 2 3 4 Breast feeding/parent educationLatch-on procedures(Required) 1 2 3 4 Positioning(Required) 1 2 3 4 Use of electric breast pump(Required) 1 2 3 4 Use of manual breast pump(Required) 1 2 3 4 Formula preparation and feeding(Required) 1 2 3 4 Infant care restraint systems(Required) 1 2 3 4 Infant caretaking skills(Required) 1 2 3 4 Perineal care(Required) 1 2 3 4 Sitz Bath(Required) 1 2 3 4 Care of patient withAsthma(Required) 1 2 3 4 Cardiac disease(Required) 1 2 3 4 Cesarean section(Required) 1 2 3 4 Diabetes mellitus(Required) 1 2 3 4 Infectious disease(Required) 1 2 3 4 Known substance abuse(Required) 1 2 3 4 Multiple Births(Required) 1 2 3 4 Post tubal ligation(Required) 1 2 3 4 Pregnancy induced hypertension/preeclampsia(Required) 1 2 3 4 Spontaneous vaginal delivery(Required) 1 2 3 4 MedicationsAntibiotics(Required) 1 2 3 4 Diluted oxytocin infusion(Required) 1 2 3 4 IM administration(Required) 1 2 3 4 Rhogam administration/teaching(Required) 1 2 3 4 SC medications, including narcotics(Required) 1 2 3 4 Pain Management & AnesthesiaAssessment of pain level/tolerance(Required) 1 2 3 4 Care of the patient with:Epidural anesthesia/analgesia(Required) 1 2 3 4 IV conscious sedation(Required) 1 2 3 4 Patient controlled analgesia(Required) 1 2 3 4 Phlebotomy / IV TherapyEquipment & procedures(Required) 1 2 3 4 Administration of blood/blood productsPacked red blood cells(Required) 1 2 3 4 Plasma / albumin(Required) 1 2 3 4 Whole blood(Required) 1 2 3 4 Drawing blood from central line(Required) 1 2 3 4 Drawing venous blood(Required) 1 2 3 4 Starting IVsAngiocath(Required) 1 2 3 4 Butterfly(Required) 1 2 3 4 Heparin lock(Required) 1 2 3 4 Central line/catheter/dressing(Required) 1 2 3 4 Peripheral line/dressing(Required) 1 2 3 4 Normal Neonatal CareAssessmentBallard scale(Required) 1 2 3 4 Circumference(Required) 1 2 3 4 Dubowitz Scales(Required) 1 2 3 4 Length(Required) 1 2 3 4 Neonatal Jaundice(Required) 1 2 3 4 Reflexes(Required) 1 2 3 4 Vital Signs(Required) 1 2 3 4 Weight(Required) 1 2 3 4 Neonatal Equipment & ProceduresAdminister injections to neonate(Required) 1 2 3 4 Assist with circumcisionAssess site post op(Required) 1 2 3 4 Teach circumcision care to parents(Required) 1 2 3 4 Bath Infant(Required) 1 2 3 4 Culture suspect infectious neonate(Required) 1 2 3 4 Discharge procedure(Required) 1 2 3 4 Incubator. isolettes(Required) 1 2 3 4 Infant identification(Required) 1 2 3 4 Monitor bladder and bowel patternsObtain urine specimens via specimen bag(Required) 1 2 3 4 Test stool for blood, reducing substances(Required) 1 2 3 4 Neonate cardiopulmonary resuscitation(Required) 1 2 3 4 Phototheraphy(Required) 1 2 3 4 Thermo-neutral environment to prevent cold stress(Required) 1 2 3 4 Age Appropriate CareNewborn (Birth-30days)(Required) 1 2 3 4 Infant (30 Days – 1 year)(Required) 1 2 3 4 Toddler (1-3 years)(Required) 1 2 3 4 Preschooler (3-5 years)(Required) 1 2 3 4 School Age (5-12 years)(Required) 1 2 3 4 Adolescents (12-18 years)(Required) 1 2 3 4 Young Adult (18-39 years)(Required) 1 2 3 4 Middle Adult (39-64 years)(Required) 1 2 3 4 Older Adult (64 + years)(Required) 1 2 3 4 EMRAllScript(Required) 1 2 3 4 Canopy(Required) 1 2 3 4 Epic(Required) 1 2 3 4 Cerner(Required) 1 2 3 4 Eclipsys(Required) 1 2 3 4 McKesson(Required) 1 2 3 4 Meditech(Required) 1 2 3 4 Other Computerized System(Required) 1 2 3 4 Computerized Physician Order Entry(Required) 1 2 3 4 Bar Coding for Medication Administration(Required) 1 2 3 4 AuthorizationsLegal 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. 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