Pediatric Skills Checklist Date:* Name:* Email Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledCARDIOVASCULARAssessment* 0 1 2 3 Auscultation (Rate, Rhythm, Volume):* 0 1 2 3 Blood Pressure (Doppler/Dynamap):* 0 1 2 3 Interpretation of Lab Results* 0 1 2 3 CBC:* 0 1 2 3 Electrolytes:* 0 1 2 3 Care of the Pediatric Patient with* 0 1 2 3 Post Cardiac Arrest:* 0 1 2 3 Congenital Heart Defects/Disease:* 0 1 2 3 Congestive Heart Failure:* 0 1 2 3 Pre-Cardiac Surgery:* 0 1 2 3 Post-Cardiac Surgery:* 0 1 2 3 Rheumatic Fever:* 0 1 2 3 Medications* 0 1 2 3 Digoxin (Lanoxin):* 0 1 2 3 IV Electrolyte Replacement:* 0 1 2 3 Furosemide (Lasix):* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledPULMONARYAssessment* 0 1 2 3 Breath Sounds/Rate & Work of Breathing:* 0 1 2 3 Equipment & Procedures* 0 1 2 3 Bulb Syringe:* 0 1 2 3 Management of Chest Tubes:* 0 1 2 3 Inhalers:* 0 1 2 3 Inhaler Education to Patient/Family:* 0 1 2 3 Nasal Airway/Suctioning:* 0 1 2 3 Nebulizer:* 0 1 2 3 Oral Airway/Suctioning:* 0 1 2 3 Pulmonary Toilet:* 0 1 2 3 Pulse Oximetry:* 0 1 2 3 Tracheostomy/Suctioning:* 0 1 2 3 Home Ventilator Therapy:* 0 1 2 3 Oxygen Therapy Delivery Systems* 0 1 2 3 Face Mask/Nasal Cannula:* 0 1 2 3 Hood/Tent:* 0 1 2 3 Isolette:* 0 1 2 3 Trach Collar:* 0 1 2 3 Care of the Pediatric Patient with* 0 1 2 3 Reactive Airway Disease:* 0 1 2 3 Cystic Fibrosis:* 0 1 2 3 Epiglottitis:* 0 1 2 3 Laryngotracheobronchitis (Croup):* 0 1 2 3 Pneumonia:* 0 1 2 3 Tonsillitis:* 0 1 2 3 Medications* 0 1 2 3 Inhaled Bronchodilators:* 0 1 2 3 Inhaled Steroids:* 0 1 2 3 IV/Oral Steroids:* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledNEUROAssessment* 0 1 2 3 Level of Consciousness:* 0 1 2 3 Fontanelles:* 0 1 2 3 Equipment & Procedures* 0 1 2 3 Assist with Lumbar Puncture:* 0 1 2 3 Seizure Precautions:* 0 1 2 3 Care of the Pediatric Patient with* 0 1 2 3 Closed Head Trauma:* 0 1 2 3 Externalized VP Shunts:* 0 1 2 3 Meningitis:* 0 1 2 3 Neuromuscular Disease:* 0 1 2 3 Seizures:* 0 1 2 3 Spinal Cord Injury:* 0 1 2 3 Spinal Surgery:* 0 1 2 3 Medications* 0 1 2 3 Anti-Convulsants:* 0 1 2 3 Clonazepam (Klonopin):* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledORTHOPEDICSEquipment & Procedures* 0 1 2 3 Specialized Orthopedic Beds:* 0 1 2 3 Pin Care:* 0 1 2 3 Care of the Pediatric Patient with* 0 1 2 3 Clubfoot Repair:* 0 1 2 3 Traction - Cervical:* 0 1 2 3 Traction - Bucks/Skeletal:* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledGASTROINTESTINALAssessment* 0 1 2 3 Abdominal:* 0 1 2 3 Nutritional:* 0 1 2 3 Interpretation of Lab Results* 0 1 2 3 Serum Electrolytes/LFTs/Ammonia:* 0 1 2 3 Equipment & Procedures* 0 1 2 3 Abdominal Decompression Devices:* 0 1 2 3 Surgical Drains:* 0 1 2 3 Feedings* 0 1 2 3 Assist with Breast Feeding/Storage & Handling of Breast Milk:* 0 1 2 3 Bottle Feeding:* 0 1 2 3 Nipple/Gavage Feedings:* 0 1 2 3 Placement & Management of GI Tubes* 0 1 2 3 Gastrostomy/Button:* 0 1 2 3 Jejunostomy:* 0 1 2 3 Nasogastric/Orogastric:* 0 1 2 3 Care of the Pediatric Patient with* 0 1 2 3 Cleft Lip/Palate Surgery:* 0 1 2 3 Colostomy/Ileostomy:* 0 1 2 3 Failure to Thrive:* 0 1 2 3 Feeding Intolerance:* 0 1 2 3 Gastroenteritis/Dehydration:* 0 1 2 3 GI Reflux:* 0 1 2 3 GI Bleeding:* 0 1 2 3 Pyloric Stenosis:* 0 1 2 3 Ulcerative Colitis:* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledRENALAssessment of Fluid Balance:* 0 1 2 3 Interpretation of BUN, Creatinine, Electrolytes:* 0 1 2 3 Equipment & Procedures* 0 1 2 3 Insertion/Management of Bladder Catheters:* 0 1 2 3 Insertion/Management of Suprapubic Catheters:* 0 1 2 3 Collection of Urine Specimens:* 0 1 2 3 Care of the Pediatric Patient with* 0 1 2 3 Circumcision:* 0 1 2 3 Glomerulonephritis:* 0 1 2 3 Hemodialysis:* 0 1 2 3 Hemolytic Uremic Syndrome:* 0 1 2 3 Hypospadias Repair:* 0 1 2 3 Renal Transplant:* 0 1 2 3 Renal Failure:* 0 1 2 3 Urinary Tract Infection:* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledENDOCRINE/METABOLICEquipment & Procedures* 0 1 2 3 Bedside Blood Glucose Monitoring:* 0 1 2 3 Care of the Pediatric Patient with* 0 1 2 3 Hypo/Hyperglycemia:* 0 1 2 3 Hyperbilirubinemia:* 0 1 2 3 Medication* 0 1 2 3 Insulin:* 0 1 2 3 Dextrose:* 0 1 2 3 Oral Hypoglycemics:* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledWOUND MANAGEMENTAssessment* 0 1 2 3 Skin for Impending Breakdown:* 0 1 2 3 Surgical Wound Healing:* 0 1 2 3 Equipment & Procedures* 0 1 2 3 Specialty Beds:* 0 1 2 3 Equipment & Procedures* 0 1 2 3 Reverse Isolation:* 0 1 2 3 Care of the Pediatric Patient with* 0 1 2 3 Anemia:* 0 1 2 3 Bone Marrow Transplant:* 0 1 2 3 Depressed Immune System:* 0 1 2 3 Hodgkin's Disease:* 0 1 2 3 Inpatient Chemotherapy:* 0 1 2 3 Leukemia:* 0 1 2 3 Malignant Tumors:* 0 1 2 3 Neutropenia with Fever:* 0 1 2 3 Sickle Cell Anemia:* 0 1 2 3 Medication* 0 1 2 3 Chemotherapy:* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledINFECTIOUS DISEASEEquipment & Procedures* 0 1 2 3 Assist with Lumbar Puncture:* 0 1 2 3 Collect Culture Specimens:* 0 1 2 3 Isolation Techniques:* 0 1 2 3 Care of the Child with* 0 1 2 3 Childhood Communicable Diseases:* 0 1 2 3 Hepatitis:* 0 1 2 3 HIV:* 0 1 2 3 Immunosuppressive Disorder:* 0 1 2 3 Kawasaki Disease:* 0 1 2 3 Meningitis:* 0 1 2 3 RSV:* 0 1 2 3 Tuberculosis:* 0 1 2 3 Medications* 0 1 2 3 Aminoglycosides:* 0 1 2 3 Cephalosporins:* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledPHLEBOTOMY/IV THERAPYEquipment & Procedures* 0 1 2 3 Administration of Blood/Blood Products:* 0 1 2 3 Starting IVs:* 0 1 2 3 Care of the Patient with* 0 1 2 3 Implantable Ports/Dressings:* 0 1 2 3 Long Term Tunneled Catheters:* 0 1 2 3 Peripheral Lines/Dressings:* 0 1 2 3 PICC Lines/Dressings:* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledPAIN MANAGEMENTAssessment of Pain Level:* 0 1 2 3 Assessment of Response to Pain Management Interventions:* 0 1 2 3 Care of the Patient with* 0 1 2 3 Epidural Anesthesia/Analgesia:* 0 1 2 3 Moderate Sedation:* 0 1 2 3 Please Use The Following Key: 0 = Never Performed 1 = Partially Skilled 2 = Moderately Skilled 3 = Well SkilledMISCELLANEOUSNational Patient Safety Goals:* 0 1 2 3 Knowledge of Normal Growth & Development:* 0 1 2 3 Recognize/Report Signs of Abuse:* 0 1 2 3 Restraint Use:* 0 1 2 3 Preceptor Experience:* 0 1 2 3 Pyxis Medication Admin. System:* 0 1 2 3 Other Medication Admin. System:* 0 1 2 3 Equipment & Procedures* 0 1 2 3 Charge Experience:* 0 1 2 3 Computerized Charting* 0 1 2 3 Cerner:* 0 1 2 3 Eclipsys:* 0 1 2 3 Epic:* 0 1 2 3 GE:* 0 1 2 3 McKesson:* 0 1 2 3 Meditech:* 0 1 2 3 Other:* 0 1 2 3 Care of the Pediatric Patient with* 0 1 2 3 Multiple Trauma:* 0 1 2 3 Near Drowning:* 0 1 2 3 Overdose:* 0 1 2 3 Ingestion of Foreign Body:* 0 1 2 3 Poison Ingestion:* 0 1 2 3 Psychiatric Disorders:* 0 1 2 3 Suicide Attempt/Ideation:* 0 1 2 3 Medications* 0 1 2 3 Calculation of Drugs Delivered by IV Infusion:* 0 1 2 3 Dosage Calculations:* 0 1 2 3 Immunization Schedule:* 0 1 2 3 Knowledge of Emergency Drugs Actions/Reactions:* 0 1 2 3 Pediatric Drug Actions/Reactions:* 0 1 2 3 Please Use The Following Key: A = Newborn/Neonate (Birth - 30 days) B = Infant (31 days - 1 year) C = Toddler (1 - 2 years) D = Preschooler (3 - 4 years) E = School Age Children (5 - 12 years) F = Adolescents (13 - 18 years) G = Young Adults (19 - 39 years) H = Middle Adults (40 - 64 years) I = Older Adults (65+)Experience with age groupsAble to adapt care to incorporate normal growth and development: A B C D E F G H I Able to adapt method and terminology of patient instructions to their age, comprehension and maturity level: A B C D E F G H I Can ensure a safe environment reflecting specific needs of various age groups: A B C D E F G H I My experience is in the following settingsTotal Years in Pediatrics: Pediatric Ortho: Pediatric Surgical: Pediatric Medical: Pediatric Rehabilitation: Pediatric Neurology: Pediatric Psychiatry: Pediatric Oncology: Pediatric Telemetry: Pediatric BMT: Pediatric ED: Other Certifications/Licensures/RegistrationsBLS: MM slash DD slash YYYY PALS: MM slash DD slash YYYY Chemo Certification - Agency: MM slash DD slash YYYY PICC Certification - Agency: MM slash DD slash YYYY Areas of Expertise:Consent* By submitting this form, I agree to all terms and conditions and agree to authorize consent PhoneThis field is for validation purposes and should be left unchanged.
