CYNET_SYSTEMS_MAIN_LOGO.gif   Pediatric Emergency Department Skills Checklist
   NAME    
   LAST 4 OF SSN      
   DATE    
I hereby certify that ALL information I have provided to IMCS Group on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.  
Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.  
Proficiency Scale: 1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

  
       
Rating Stars (Click) CARDIOVASCULAR 1 2 3 4  
Cardiac Anomalies  
CHF/Pulmonary Edema  
Cardiogenic Shock  
Cardioversion  
Heart Sounds  
Rating Stars (Click) PULMONARY 1 2 3 4  
Reactive Airway Disease  
Croup  
Pneumonia  
Epiglottitis  
Aspiration  
Airway Obstruction  
Hemo/Pneumothorax  
Chest Tube Placement/Management  
ABG Interpretation  
Rating Stars (Click) NEUROLOGICAL 1 2 3 4  
Meningitis/Encephalitis  
Seizures-Febrile/Epileptic  
Lumbar Puncture  
Migraine  
Rating Stars (Click) ORTHOPEDIC 1 2 3 4  
Fractures/Casting  
Open/Complex Fractures  
Nursemaid's Elbow  
Apply/Manage Splints  
Circulation Checks  
Crutch Walking  
Car Seat Instruction for Casted Patient  
Rating Stars (Click) GASTROINTESTINAL 1 2 3 4  
Abdominal Trauma/Peritoneal Lavage  
Abdominal Pain  
Constipation  
GI Bleeding  
Hepatitis/Liver Failure  
Poison Ingestion  
Rating Stars (Click) ENDOCRINE/METABOLIC 1 2 3 4  
Hypoglycemia  
Hyperglycemia  
DKA  
Rating Stars (Click) GENITOURINARY 1 2 3 4  
Acute Renal Failure  
UTI/Pyelonephritis  
Renal Trauma  
Testicular Torsion  
Rating Stars (Click) OB/GYN 1 2 3 4  
Menstrual Pain  
Ovarian Cyst  
Ectopic Pregnancy  
Pelvic Inflammatory Disease/STD  
Sexual Assault  
Reporting Acts of Violence  
Rating Stars (Click) EENT 1 2 3 4  
Foreign Body - Eye  
Foreign Body - Ear  
Foreign Body - Nose  
Epistaxis  
Rating Stars (Click) TRAUMA 1 2 3 4  
Glasgow Coma/Pediatric Trauma Scale  
Trauma Code  
Trauma Team Member  
Brain Injury  
Spinal Cord Injury  
Spinal Precautions  
Facial/Dental Trauma  
Penetrating Trauma  
Blunt Trauma  
Traumatic Amputation  
Hypovolemic Shock  
Neurogenic Shock  
Anaphylactic Shock  
Septic Shock  
Burns - 2nd Degree  
Burns - 3rd Degree  
Rating Stars (Click) INFECTIOUS DISEASE/IMMUNOSUPPRESSION 1 2 3 4  
Contagious/Infectious Patients  
Isolation  
Reporting Communicable Disease  
Neutropenia/Reverse Isolation  
Rating Stars (Click) PSYCHIATRIC 1 2 3 4  
Drug /ETOH Overdose/Withdrawal  
Psychiatric Hold  
Suicidal Patient  
Rating Stars (Click) MEDICATIONS 1 2 3 4  
Pediatric Dosage Calculations  
Anti-Arrhythmics  
Anticoagulants (IV, Oral & Injection)  
Anti-Hypertensives  
Anti-Psychotics  
Anti-Seizure Medications  
Benzodiazepines  
Continuous IV Paralytics  
Continuous IV Sedation  
Procedural Sedation - Administration  
Ketamine  
Emergency Medications  
Inhaled Medications  
Insulin  
IV Vasopressors  
Narcotics/Opioid Analgesics (IV, Oral & Injection)  
Reversal Agents  
Steroids (IV, Oral & Inhaled)  
Automated Medication Dispensing (i.e. Pyxis, Omnicell)  
Rating Stars (Click) PROFESSIONAL KNOWLEDGE AND SKILLS 1 2 3 4  
Recognizing/Reporting Abuse  
Triage  
Ambulance/Paramedic Radio  
Charge Experience  
EMTALA  
National Patient Safety Goals/Core Measures  
Fall Risk Assessment/Prevention  
Pressure Ulcer Risk Assessment/Prevention  
Restraints/Use of Least Restrictive Device  
Patient Family Teaching  
Car Seat Specific Standards/Teaching  
Age/Developmentally Specific/Population Based Care  
Pain Assessment and Management - Verbal/Non-Verbal  
Interpretation and Communication of Lab Values  
Rating Stars (Click) EMR   1 2 3 4  
Epic   
Cerner   
Eclipsys   
McKesson   
Meditech   
Allscripts   
Other Computerized System  
Computerized Physician Order Entry  
Bar Coding for Medication Administration  
MY EXPERIENCE IS PRIMARILY IN:  
Unit No. of Years Unit No. of Years  
BURN POST PARTUM  
CRITICAL UNIT LABOR & DELIVERY  
PACU NEWBORN NURSERY  
NEUROLOGY LEVEL II NICU  
TELEMETRY LEVEL III NICU  
MEDICAL PICU  
SURGICAL  PEDIATRICS  
ONCOLOGY OB/GYN  
ORTHOPEDICS PSYCHIATRY  
OPERATING ROOM RRT  
EMERGENCY ROOM CRT  
TRAUMA CENTER LEVEL 1    
COMMUNITY ER    
RURAL ER    
Rating Stars (Click)  Age Specific Competencies 1 2 3 4  
Newborn/Neonatal (birth – 30 days)  
Infant (30 days-1 year)  
Toddler (1-3 years)  
Preschool (3-5 years)  
School Age Children (5-12 years)  
Adolescent (12-17 years)  
Young Adults (18-44 years)  
Middle Adults (45-64 years)  
Older Adults (>65 years)  
Certificate   Expiry Date :   
BLS  
PALS  
PEARS  
ACLS  
TNCC  
ENPC  
CEN  
Other: Specify  
  Other: Specify