PACU Skills Checklist

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

Cardiovascular

Open Heart Recovery(Required)

AAA Repair(Required)

Vascular Surgery(Required)

Pacemaker-Permanent & Temporary(Required)

Cardioversion(Required)

AICD Insertion(Required)

Cardiac Arrest(Required)

Cardiac Tamponade(Required)

CHF/Pulmonary Edema(Required)

Abnormal Heart Sounds/Murmurs(Required)

Pulses/Circulation Checks(Required)

Pulmonary

Ventilator Management(Required)

Fresh Tracheostomy(Required)

Thoracotomy/Lobectomy/Pneumonectomy(Required)

Pneumothorax/Hemothorax(Required)

Laryngospasm(Required)

Pulmonary Embolism(Required)

COPD(Required)

ABG Interpretation(Required)

Neurologic

Post Craniotomy(Required)

Anterior/Posterior Spinal Fusion(Required)

Carotid Endardarectomy(Required)

Spine Surgery(Required)

CVA(Required)

Stroke Scale(Required)

Glascow Coma Scale(Required)

Spinal Precautions(Required)

Hypothermia Protocol(Required)

Hypo/Hyperthermia Blanket(Required)

Sedation Scales/Levels(Required)

Gastrointestinal

Pancreas/Liver Transplant(Required)

Colon Surgery(Required)

Colostomy/Ileostomy(Required)

ERCP(Required)

G Tube/J Tube Management(Required)

T Tube Management(Required)

Renal/Genitourinary

Renal Surgery(Required)

TURP(Required)

Arteriovenous Fistula/Shunt(Required)

Nephrostomy Tubes(Required)

Endocrine Metabolic

Diabetes - Hypo/Hyperglycemic Crisis(Required)

IV Insulin Protocols(Required)

Orthopedic

Laminectomy(Required)

Total Joint Replacement(Required)

Amputation(Required)

Open Reduction/Internal Fixation(Required)

General Orthopedic Surgeries(Required)

CPM/Traction(Required)

Circulation Checks(Required)

Wound Management

Surgical Drains(Required)

Wound Vac(Required)

Surgical Wound Assessment(Required)

Skin Assessment for Breakdown(Required)

Staging Decubitus Ulcers(Required)

Staging Decubitus Ulcers

Procedural Sedation(Required)

Anesthesia Medications(Required)

Anti-Arrhythmics(Required)

Anticoagulants(Required)

Anti-Hypertensives(Required)

Anti-Seizure Medications(Required)

Benzodiazepines(Required)

Emergency Medications(Required)

Insulin(Required)

Narcotics/Opioid Analgesics(Required)

Nitrates(Required)

Non-Opioid Analgesics(Required)

Reversal Agents(Required)

Steroids(Required)

Automated Medication Dispensing (i.e. Pyxis, Omnicell)(Required)

IV Therapy

Starting Ivs(Required)

Central Line Blood Draws(Required)

Central Line/Implanted Line Care(Required)

Blood Product Administration(Required)

Cardiac Monitoring & Emergency Response

Malignant Hyperthermia(Required)

Dysrhythmia Interpretation(Required)

Dysrhythmia Management(Required)

12 Lead EKG(Required)

Professional Knowledge & Skills

National Patient Safety Goals/Core Measures(Required)

Fall Risk Assessment/Prevention(Required)

Pressure Ulcer Risk Assessment/Prevention(Required)

Age Specific/Population-Based Care(Required)

Pain Assessment & Management(Required)

Charge Experience(Required)

Interpretation and Communication of Lab Values(Required)

Specialty Beds(Required)

EMR

Epic(Required)

Cerner(Required)

Eclipsys(Required)

McKesson(Required)

Meditech(Required)

Other Computerized System(Required)

Computerized Physician Order Entry(Required)

Bar Coding for Medication Administration(Required)

Pulmonary(Required)

EMR Conversion(Required)

Yes

Certifications

BLS(Required)

Yes

BLS Expiry Date

ACLS(Required)

Yes

ACLS Expiry Date

PALS(Required)

Yes

PALS Expiry Date

CAPA(Required)

Yes

CAPA Expiry Date

CPAN(Required)

Yes

CPAN Expiry Date

Other Certification

Other Expiration

Other Certification 2

Other 2 Expiration

Age Specific Competencies

Infant (Birth - 1 year)(Required)

Preschooler (ages 2-5 years)(Required)

Childhood (ages 6-12 years)(Required)

Adolescents (ages 13-21 years)(Required)

Young Adults (ages 22-39 years)(Required)

Adults (ages 40-64 years)(Required)

Older Adults (ages 65-79 years)(Required)

Elderly (ages 80+ years)(Required)

Authorizations

Legal Consent(Required)

I agree to the terms and conditions.

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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.

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Withdrawing your consent, requesting a paper copy, or updating your contact information
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“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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