Long Term Care | Magnet Medical

skills checklist

Long Term Care Skills

Please rank the following skills on a scale of 1 to 4

1 = No theory and/or experience
2 = Limited experience
3 = Experienced/minimal support needed to perform
4 = Proficient

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
General Skills
Standard Precautions*
- 1
- 2
- 3
- 4
Isolation Precautions*
- 1
- 2
- 3
- 4
Pediatric Respiratory/Cardiac Arrest*
- 1
- 2
- 3
- 4
Adult Respiratory/Cardiac Arrest*
- 1
- 2
- 3
- 4
Crash Carts*
- 1
- 2
- 3
- 4
Defibrillators*
- 1
- 2
- 3
- 4
Care of Patients in Restraints*
- 1
- 2
- 3
- 4
Pain Management*
- 1
- 2
- 3
- 4
Automated Med Dispensing*
- 1
- 2
- 3
- 4
Care Planning and Discharge Planning*
- 1
- 2
- 3
- 4
Patient/Family Education*
- 1
- 2
- 3
- 4
Electronic Documentation*
- 1
- 2
- 3
- 4
Patient Head to Toe Assessment*
- 1
- 2
- 3
- 4
Dressing Changes*
- 1
- 2
- 3
- 4
Medication – Knowledge and Use of
Pouring from Stock medications*
- 1
- 2
- 3
- 4
Narcotic Administration*
- 1
- 2
- 3
- 4
IV Push/Drip*
- 1
- 2
- 3
- 4
Antibiotics*
- 1
- 2
- 3
- 4
Oral*
- 1
- 2
- 3
- 4
Topical*
- 1
- 2
- 3
- 4
Otic*
- 1
- 2
- 3
- 4
Rectal*
- 1
- 2
- 3
- 4
Vaginal*
- 1
- 2
- 3
- 4
Ophthalmic*
- 1
- 2
- 3
- 4
Continuous Subcutaneous Infusion*
- 1
- 2
- 3
- 4
TPN*
- 1
- 2
- 3
- 4
Peripheral Parenteral Nutrition*
- 1
- 2
- 3
- 4
PCA*
- 1
- 2
- 3
- 4
Phlebotomy/IV Therapy
Blood Draw – Peripheral*
- 1
- 2
- 3
- 4
Blood Draw – Central Line/Port*
- 1
- 2
- 3
- 4
Insertion, Care, and Maintenance of Peripheral IV*
- 1
- 2
- 3
- 4
Care and maintenance of Implanted Port-A-Cath*
- 1
- 2
- 3
- 4
Mixing IV’s*
- 1
- 2
- 3
- 4
Regulating IV’s*
- 1
- 2
- 3
- 4
IV Infusion Pumps*
- 1
- 2
- 3
- 4
Cardiac General Skills and Care of Patient
Cardiac Monitors*
- 1
- 2
- 3
- 4
EKG – 12 Lead*
- 1
- 2
- 3
- 4
Recognizing Basic and Life-Threatening Dysthymias*
- 1
- 2
- 3
- 4
Cardioversion/Defibrillation*
- 1
- 2
- 3
- 4
Pulse Checks*
- 1
- 2
- 3
- 4
Interpretation of Cardiac Enzymes*
- 1
- 2
- 3
- 4
Use of Automatic BF Cuff*
- 1
- 2
- 3
- 4
Care of Patient With
Heart Failure*
- 1
- 2
- 3
- 4
CHF*
- 1
- 2
- 3
- 4
MI*
- 1
- 2
- 3
- 4
Arrhythmias*
- 1
- 2
- 3
- 4
Hypertension*
- 1
- 2
- 3
- 4
Hypotension*
- 1
- 2
- 3
- 4
CAD*
- 1
- 2
- 3
- 4
Respiratory General Skills and Care of Patient:
O2 Cannulas/Masks*
- 1
- 2
- 3
- 4
Nebulizer Set-Up/Use*
- 1
- 2
- 3
- 4
Incentive Spirometry*
- 1
- 2
- 3
- 4
Chest PT*
- 1
- 2
- 3
- 4
Pulse Oximetry*
- 1
- 2
- 3
- 4
Suctioning – Oral*
- 1
- 2
- 3
- 4
Suctioning – Chest Tube*
- 1
- 2
- 3
- 4
SOB*
- 1
- 2
- 3
- 4
Pulmonary Embolism*
- 1
- 2
- 3
- 4
Tracheostomy Tube*
- 1
- 2
- 3
- 4
Asthma Exacerbation*
- 1
- 2
- 3
- 4
Pneumonia*
- 1
- 2
- 3
- 4
Non-Rebreather Mask*
- 1
- 2
- 3
- 4
Ventilator Patient*
- 1
- 2
- 3
- 4
COPD*
- 1
- 2
- 3
- 4
Knowledge and Use of
Nitrates (Oral, Topical)*
- 1
- 2
- 3
- 4
Antiarrhythmics (oral)*
- 1
- 2
- 3
- 4
Antihypertensives (oral)*
- 1
- 2
- 3
- 4
Anticoagulants*
- 1
- 2
- 3
- 4
Steroids*
- 1
- 2
- 3
- 4
Neuro General Skills and care of patients:
Assessing Levels of Consciousness*
- 1
- 2
- 3
- 4
Pupil Checks*
- 1
- 2
- 3
- 4
Seizure Precautions*
- 1
- 2
- 3
- 4
Aneurysm Precautions*
- 1
- 2
- 3
- 4
Assisting with Lumbar Puncture*
- 1
- 2
- 3
- 4
Use of Hyper/Hypothermia Blanket*
- 1
- 2
- 3
- 4
CVA/Stroke*
- 1
- 2
- 3
- 4
Spinal Cord – Acute or Long term*
- 1
- 2
- 3
- 4
Alzheimer’s Disease*
- 1
- 2
- 3
- 4
Neuromuscular Disease*
- 1
- 2
- 3
- 4
Wandering*
- 1
- 2
- 3
- 4
Hallucinations*
- 1
- 2
- 3
- 4
Anxiety*
- 1
- 2
- 3
- 4
Swallow Precautions*
- 1
- 2
- 3
- 4
Reality Orientation*
- 1
- 2
- 3
- 4
Agitation*
- 1
- 2
- 3
- 4
Knowledge and Use of
Anticonvulsant*
- 1
- 2
- 3
- 4
Sedative*
- 1
- 2
- 3
- 4
Sensory Deficits – Care of Patients with
Dentures*
- 1
- 2
- 3
- 4
Hearing Aids*
- 1
- 2
- 3
- 4
Hearing Loss*
- 1
- 2
- 3
- 4
Prosthetic Eye*
- 1
- 2
- 3
- 4
Contact Lens Care*
- 1
- 2
- 3
- 4
Blindness*
- 1
- 2
- 3
- 4
Macular Degeneration*
- 1
- 2
- 3
- 4
Gastrointestianl – Care of Patients With
Nasogastric Tubes*
- 1
- 2
- 3
- 4
Nasointestinal Tubes*
- 1
- 2
- 3
- 4
Jejunostomy, gastrostomy, cecostomy tubes*
- 1
- 2
- 3
- 4
Colostomy, Ileostomy*
- 1
- 2
- 3
- 4
Bronchoscopy Lung/Wedge Resection*
- 1
- 2
- 3
- 4
GI General
Collection of Specimens*
- 1
- 2
- 3
- 4
Bowel Prep and Cleaning procedures*
- 1
- 2
- 3
- 4
Administration of Tube Feedings via Flexible Tubes*
- 1
- 2
- 3
- 4
Bowel Disimpaction*
- 1
- 2
- 3
- 4
Bowel Retraining*
- 1
- 2
- 3
- 4
Sitz Bath Treatments*
- 1
- 2
- 3
- 4
Insertion and Checking placement/Patency NG tubes*
- 1
- 2
- 3
- 4
Knowledge and Use of
Single Type Insulin*
- 1
- 2
- 3
- 4
Mixed Insulins*
- 1
- 2
- 3
- 4
Insulin Infusion*
- 1
- 2
- 3
- 4
Renal/GU – care of Paitients with
Incontinence*
- 1
- 2
- 3
- 4
Urinary Retention*
- 1
- 2
- 3
- 4
UTI*
- 1
- 2
- 3
- 4
Insertion of Foley Cath – Female*
- 1
- 2
- 3
- 4
Insertion of Foley Cath – Male*
- 1
- 2
- 3
- 4
Straight Cath – Female*
- 1
- 2
- 3
- 4
Straight Cath – Male*
- 1
- 2
- 3
- 4
Application of Condom Cath*
- 1
- 2
- 3
- 4
Bladder Retraining*
- 1
- 2
- 3
- 4
Urinary Diversion*
- 1
- 2
- 3
- 4
Bladder Irrigation*
- 1
- 2
- 3
- 4
Peritoneal Dialysis
Manual*
- 1
- 2
- 3
- 4
Automatic Cycler Machine*
- 1
- 2
- 3
- 4
Orthopedic Care of Patients with
Total Joint Replacements*
- 1
- 2
- 3
- 4
Rheumatic/Arthritic Disease*
- 1
- 2
- 3
- 4
Amputation*
- 1
- 2
- 3
- 4
Fracture*
- 1
- 2
- 3
- 4
Orthopedic General
Cast Care*
- 1
- 2
- 3
- 4
CMS Checks*
- 1
- 2
- 3
- 4
Traction – Skin*
- 1
- 2
- 3
- 4
Traction – Skeletal*
- 1
- 2
- 3
- 4
Range of Motion*
- 1
- 2
- 3
- 4
Use of Assistive Devices*
- 1
- 2
- 3
- 4
Application of Splints of Extremities*
- 1
- 2
- 3
- 4
CPM*
- 1
- 2
- 3
- 4
Transfer Techniques*
- 1
- 2
- 3
- 4
Use of Sliding Board*
- 1
- 2
- 3
- 4
Gait Training/Retraining*
- 1
- 2
- 3
- 4
Application of Prosthetic Devices*
- 1
- 2
- 3
- 4
Application of Orthotic Devices*
- 1
- 2
- 3
- 4
Wound Care
Dressing Change*
- 1
- 2
- 3
- 4
Air Fluidized*
- 1
- 2
- 3
- 4
Pressure Relief*
- 1
- 2
- 3
- 4
Pressure Sores*
- 1
- 2
- 3
- 4
Leg Ulcers*
- 1
- 2
- 3
- 4
Burns*
- 1
- 2
- 3
- 4
Irrigations*
- 1
- 2
- 3
- 4
Identifying Skin Problems*
- 1
- 2
- 3
- 4
Use of Pressure Relief Devices*
- 1
- 2
- 3
- 4
Pressure relief Mattress/Seat Cushion*
- 1
- 2
- 3
- 4
Additional Skills
Hemovacs*
- 1
- 2
- 3
- 4
Jackson-Pratt Tubes*
- 1
- 2
- 3
- 4
Penrose Drains*
- 1
- 2
- 3
- 4
T-Tubes*
- 1
- 2
- 3
- 4
Wound Vac*
- 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*
MM slash DD slash YYYY

skills checklist

Long Term Care Skills

Experience with the Following Ages

General Skills

Medication – Knowledge and Use of

Phlebotomy/IV Therapy

Cardiac General Skills and Care of Patient

Care of Patient With

Respiratory General Skills and Care of Patient:

Knowledge and Use of

Neuro General Skills and care of patients:

Knowledge and Use of

Sensory Deficits – Care of Patients with

Gastrointestianl – Care of Patients With

GI General

Knowledge and Use of

Renal/GU – care of Paitients with

Peritoneal Dialysis

Orthopedic Care of Patients with

Orthopedic General

Wound Care

Additional Skills

Travelers

Providers

Magnet

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