ACCS Telemetry / Step-Down Skills Checklist
0= No Experience
1= Limited Experience
2= One to Three Years Experience
3= Able to Function Independently
4= Expert (Able to Teach and Supervise)
Email address *
Your Name *
Last Name, First Name
Your answer
BCLS *
Expiration Date
MM
/
DD
/
YYYY
ACLS *
Expiration Date
MM
/
DD
/
YYYY
CCRN
Expiration Date
MM
/
DD
/
YYYY
NALS
Expiration Date
MM
/
DD
/
YYYY
PALS
Expiration Date
MM
/
DD
/
YYYY
If you have any other applicable certifications, please list them and their expiration dates here:
Your answer
MM
/
DD
/
YYYY
COURSES TAKEN
Critical Care Course - Where Taken?
Your answer
Expiration Date
MM
/
DD
/
YYYY
Arrhythmia Interpretation - Where Taken?
Your answer
Expiration Date
MM
/
DD
/
YYYY
Other Course -- Name and Where Taken?
Your answer
How Many years have you worked in Telemetry/Step-Down? *
Your answer
Dates worked in Telemetry/Step-Down *
MM
/
DD
/
YYYY
TO *
MM
/
DD
/
YYYY
More Dates worked in Telemetry/Step Down
MM
/
DD
/
YYYY
TO
MM
/
DD
/
YYYY
CARDIOVASCULAR SYSTEM REVIEW:
Placement of Cardiac Monitor
Arrhythmia interpretation
12 Lead EKG Interpretation
Defibrillation/Cardioversion
CPR
Care of Patient with Pacemaker:
Permanent
Transvenous
Transthoracic
Placement (External)
Assist with Pacemaker Insertion/Setup
Central Venous Catheter - Perform CVP Readings
Central Venous Catheter - Assist with Insertion of CVP Catheter
Obtain Samples & Interpret Blood Values for ABG
Obtain Samples & Interpret Blood Values for Mixed Venous ABG
Obtain Samples & Interpret Blood Values for Electrolyte Imbalances
EMERGENCY MEDICATION ADMINISTRATION:
Dopamine
Lidocaine
Epinephrine
Atrophine
Bicarbonate
MANAGEMENT OF PATIENT ON CARDIOVASCULAR / VASOACTIVE DRIPS:
Amiodarone
Nitroglycerine
Digitalis
Dopamine
Dobutamine
Care of Pre/Post PTCA Patient - Removal of Sheaths
Care of Post-MI Patient
Cardiac Rehab
NEUROLOGICAL SYSTEM REVIEW:
Perform basic neuro/assess/ vitals
Recognition and Intervention of Complications (e.g. CSF leak, clot, hemiation)
Use of Rotating Bed
Stryker Frame
CARE OF PATIENT WITH:
Halo Traction / Cervical Tongs
Ventriculostomy
Craniotomy
Acute CVA
Head Injury
Spinal Cord Injury
Cerebral Aneurysm
Seizures
PULMONARY SYSTEM REVIEW:
Identify and Intervene Respiratory Complications (e.g. tension pneumo-thorax, aspirations, pulmonary edema, laryngospasm)
Assist with Intubation
Assist with Extubation
Assist with Chest Tube Insertion / set -up / Removal
Assist with Thoracentesis
Assist with Bronchoscopy
Care of Patient with Tracheostomy
Care of Intubated Patient
Continuous O2 and CO2 Monitoring Equipment
Troubleshoot Ventilator Complications
Weaning Patient from Vent
MODES OF VENTILATION:
IMV
CPAP
PEEP
Assist / Control
Blowby
Pressure Support
Perform Arterial Puncture
Interpret ABGs
Care of Patient with ARDS
Care of Patient with Pulmonary Edema
Care of Patient with Lung Transplant
Administration of Nebulizer Meds
MISCELLANEOUS - Care of Patient With:
Insulin Drip
Heparin Drip
GI Bleed
Abdominal Surgery
Burns
AIDS
Septic Shock
Renal Failure
Multiple Abdominal Wounds and Drains
Colostomy Care
Ileal Conduit
Continuous Bladder Irrigation
Suprapubic Catheter
Hemodialysis
Peritoneal Dialysis
Orthopedic Traction
Multiple Trauma
Isolation
Organ and Tissue Donation
Insertion of PICC Line
Care of PICC Line
Transfusion of Blood and Blood Products
Initiating IVs
UNIT EXPERIENCE
Please indicate years of experience in each area:
Medical
Your answer
Surgical
Your answer
Trauma
Your answer
Cardiothoracic
Your answer
Cardiovascular
Your answer
Coronary Care
Your answer
Burn
Your answer
Neuro
Your answer
Stepdown
Your answer
ER
Your answer
PACU
Your answer
I certify that this is my skills checklist. *
Please type your full name in lieu of a signature.
Your answer
Date *
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service