Skill Checklists
Acute Dialysis
Name
Email
LAST 4 OF SSN
This checklist was electronically signed on (Today’s date)
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
Acute/Inpatient Dialysis
Chronic Outpatient Dialysis
Dialysis Home Care
Pediatric Dialysis
Apheresis
Plasmapheresis
Predialysis Nursing Assessment
Charge Experience
Bicarbonate Dialysate
Conductivity Testing
Priming Dialyzer
Prep Vascular Access
Fistula Gortex/Bovine Graft
Anticoagulation Management
Cannulating Buttonholes
Continuous Renal Replacement Therapy
Peritoneal Dialysis
Vascular Access Function
Arterial and Venous Pressures
Blood Flow Rate
Management of Anticoagulation
Conductivity
Ultra Filtration Calculation
Operation of Myron L. Meter
Administration of Blood and Blood Products
Administration of Mannitol
Sequential Ultrafiltration/PUF
Fluid Overload
Hypertension
Hypotension
Disequilibrium Syndrome
Hyperkalemia
Seizures
Muscle Cramps
Clotted Access/Poor Blood Flow Rate from Catheter
Pyrogenic Reaction
Hemolysis
Air Embolus
Chest Pain
Anemia
Neuropathy
Pericarditis
Filter Blood Leak
Cardiopulmonary Arrest
Anticoagulation Emergencies
Baxter
Cobe
Fresenius H/K
Gambro
Phoenix
T Machine
Other
National Patient Safety Goals
Patient Isolation/Infection Prevention
Management of Dialysis Equipment Alarms
Bedside Blood Glucose Monitoring
Pyxis Medication Admin. System
Computerized Charting
Proton Charting Experience
AMI Charting Experience
Ecube Charting Experience
Infant (Birth - 1 year)
Preschooler (ages 2-5 years)
Childhood (ages 6-12 years)
Adolescents (ages 13-21 years)
Young Adults (ages 22-39 years)
Adults (ages 40-64 years)
Older Adults (ages 65-79 years)
Elderly (ages 80+ years)
BLS
5
CNRN
ACLS
CCRN
Other:
I hereby certify that ALL information I have provided 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.
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