Hospice | Magnet Medical

Experience with the Following Ages

Newborn/Neonate (birth to 30 days)*

1
2
3
4

Infant (1 month to 1 year)*

1
2
3
4

Toddler (1 year to 3 years)*

1
2
3
4

Preschooler (3 years to 5 years)*

1
2
3
4

School Age Child (5 years to 12 years)*

1
2
3
4

Adolescents (12 years to 18 years)*

1
2
3
4

Young Adults (18 to 39 years)*

1
2
3
4

Middle Adults (39 to 64 years)*

1
2
3
4

Older Adults (64 years to 79 years)*

1
2
3
4

Elderly Adults (over 79+ years)*

1
2
3
4

Work Setting

Home Hospice*

1
2
3
4

Home Health*

1
2
3
4

Inpatient Hospice*

1
2
3
4

Pediatric Hospice*

1
2
3
4

Pediatric Home Health*

1
2
3
4

Plan of Care

Set goals with Patient/Family*

1
2
3
4

Collaborate with other team members*

1
2
3
4

Symptom Management

Urgent assessment of symptoms*

1
2
3
4

Reduce symptoms to level acceptable*

1
2
3
4

Report symptoms/management to provider*

1
2
3
4

Treat underlying cause*

1
2
3
4

Severity scale*

1
2
3
4

Management of nausea*

1
2
3
4

Management of constipation*

1
2
3
4

Anorexia/Cachexia*

1
2
3
4

Restlessness*

1
2
3
4

Educate family of Symptom Management*

1
2
3
4

Pain Management

Identify score of pain*

1
2
3
4

Pain severity*

1
2
3
4

PAINAD Scale for nonverbal patient*

1
2
3
4

Reduce Pain to acceptable level to patient*

1
2
3
4

WHO 3-Step Ladder*

1
2
3
4

Non Pharmacological management of pain*

1
2
3
4

Pharmacological management of pain*

1
2
3
4

Effects of Pharmacological treatment*

1
2
3
4

Nociceptive/Neuropathic/Mixed Pain*

1
2
3
4

Management of Nociceptive Pain*

1
2
3
4

Management of Neuropathic Pain*

1
2
3
4

Educate family on pain management*

1
2
3
4

Wound Care

Positioning Techniques*

1
2
3
4

Bed/Support Surface Selection*

1
2
3
4

Pressure Ulcer Staging/Management*

1
2
3
4

Response to treatment*

1
2
3
4

Evaluate Factors that impede healing*

1
2
3
4

Educate family on positioning/shearing*

1
2
3
4

Shunts and fistulas*

1
2
3
4

Urinary Incontinence*

1
2
3
4

Pediatric

Developmentally Appropriate Assessment*

1
2
3
4

Parental/Sibling Support*

1
2
3
4

Pediatric Support Team Collaboration*

1
2
3
4

Medication Administration

Equianalgesic Conversion Formula*

1
2
3
4

Titration of Drips*

1
2
3
4

IV Pump management*

1
2
3
4

Evaluate the effectiveness of medications*

1
2
3
4

Family Management of medications*

1
2
3
4

Disposal of Medications*

1
2
3
4

After Death

Family/Cultural Rituals/Rights*

1
2
3
4

Patient Care after Death*

1
2
3
4

Coordinate Mortuary Services*

1
2
3
4

Bereavement Services*

1
2
3
4

Compliance

Scope and Frequency of services*

1
2
3
4

Medicare/State regulations for Hospice*

1
2
3
4

DME Authorization and Documentation of Need/Order*

1
2
3
4

OASIS-C*

1
2
3
4

Professional Knowledge and Skills

Identify source of suffering*

1
2
3
4

Palliative care philosophy*

1
2
3
4

Patient/Family Directs goals of care*

1
2
3
4

Maximize quality of life*

1
2
3
4

Cultural Diversity*

1
2
3
4

Supervision of Ancillary Staff*

1
2
3
4

National Patient Safety goals*

1
2
3
4

Fall Risk Assessment/Prevention*

1
2
3
4

Infection Prevention*

1
2
3
4

Isolation Precautions*

1
2
3
4

Interpretation and communication of Lab Values*

1
2
3
4

Electronic Documentation*

1
2
3
4

List Types:*

Automated Med Dispensing Systems*

1
2
3
4

I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified within the last 2 years.

The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Magnet Medical to release this Skills Checklist to staffing clients of Magnet Medical. Submit this skills evaluation with your initial application. To be updated annually.

Name*

First Last

Email*

Signature

Date*

skills checklist

Hospice Skills

Experience with the Following Ages

Work Setting

Plan of Care

Symptom Management

Pain Management

Wound Care

Pediatric

Medication Administration

After Death

Compliance

Professional Knowledge and Skills

Travelers

Providers

Magnet

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