Home Health RN Skills Checklist

Please rate your experience / frequency within the last year

0 = No Experience / Observed Only
1 = Limited Experience / Rarely Done (<6 times/year)
2 = May Need Some Review / Occasionally Done (1 – 2 times/month)
3 = Experienced / Frequently Done (daily or weekly)

Name(Required)

Email(Required)

Date(Required)

Send to(Required)

AGE OF PATIENTS CARED FOR

Newborn/ Neonate (birth to 30 days)(Required)

Infant (31 days to 12 months)(Required)

Toddler/Preschool (13 months to 5 years)(Required)

School Age Child/adolescent (6 years to 18 years)(Required)

Young Adults Middle Adult (19 years to 64 years)(Required)

Older Adults/Elderly (65+ years)(Required)

GENERAL SKILLS

Care of Patient in Restraints(Required)

Automated Med Dispensing Systems

Accudose

Metro

Omnicell

Promanager Rx

Pyxis

N/A

Other Automated Med Dispensing Systems:

Electronic Documentation

CARDIOVASCULAR

Cardiac Auscultation (Rate, Rhythm)(Required)

Clinical Identification of Arrhythmias(Required)

Fluid Overload/ CHF(Required)

Peripheral Pulses/Circulation Checks(Required)

PT/PTT/INR(Required)

Holter Monitor(Required)

Pacemaker/ AID(Required)

Pre/ Post Cardiac Surgery(Required)

Pre/ Post Vascular Surgery(Required)

Medications:

ACE Inhibitors(Required)

Anti-arrhythmic(Required)

Antibiotics(Required)

Anticoagulants(Required)

Antihypertensives(Required)

Antiplatelet Medications(Required)

Beta Blockers(Required)

Calcium Channel Blockers(Required)

Diuretics(Required)

Digoxin (Lanoxin)(Required)

Oral and Topical Nitrates(Required)

Narcotics(Required)

Potassium Supplements(Required)

Statin Medications(Required)

PULMONARY

Asthma

Auscultation of Lung Sounds/Rate & Work of Breathing(Required)

Pulse Oximetry(Required)

Administration of O2 via Nasal Cannula(Required)

Apnea Monitor(Required)

Chest Percussion(Required)

Establishing an Airway(Required)

Incentive Spirometry(Required)

Orotracheal and Nasotracheal Suctioning(Required)

Tracheostomy Care and Protocols, including Suctioning(Required)

Nebulizer(Required)

CPAP(Required)

BiPAP(Required)

Ventilator Management(Required)

Chronic Obstructive Pulmonary Disease (COPD)(Required)

Lung Cancer(Required)

Primary Pulmonary Hypertension(Required)

Pulmonary Fibrosis(Required)

Pulmonary Emboli(Required)

NEUROLOGICAL

Neurological Signs/Level of Consciousness (LOC)(Required)

Neuro-Motor/Sensory Functions(Required)

Seizure Precautions(Required)

Alzheimer's Disease(Required)

Dementia(Required)

Degenerative Neurological Disorders (ALS, MS, etc.)(Required)

Cerebral Tumors(Required)

Post-Cerebrovascular Accident(Required)

Guillain-Barre Syndrome(Required)

Hemiparesis(Required)

Meningitis(Required)

Parkinson's Disease(Required)

Seizure Disorders(Required)

Paraplegia/Quadriplegia(Required)

Traumatic Brain Injury (TBI)(Required)

ORTHOPEDICS

Circulation/Skin Checks(Required)

Assistive Devices(Required)

TENS units(Required)

Wheelchairs/Lift Equipment(Required)

Amputation(Required)

Arthritis(Required)

Cast/Brace(Required)

Fractures(Required)

Traction(Required)

Total hip/Knee/ Joint Replacement(Required)

In home PT/INR(Required)

GASTROINTESTINAL

Nutritional Status(Required)

Colostomy/Ileostomy Care(Required)

Long-Term Feeding Tube(Required)

Nasogastric (NG) Tube(Required)

PEG/Gastrostomy Tube(Required)

Drainage Devices/Tubes(Required)

Tube Feeding(Required)

Feeding Pumps(Required)

Bowel Obstruction(Required)

Fecal Incontinence(Required)

Gastrointestinal Bleeding (G.I. Bleed)(Required)

Post-Gastrointestinal Surgery(Required)

Hepatitis(Required)

Inflammatory Bowel Disease(Required)

Liver Failure/ Transplant(Required)

RENAL/GENITOURINARY

Arterio-Venous Fistula/Shunt(Required)

3-Way Bladder Catheter(Required)

Foley Catheter Insertion/Maintenance(Required)

Straight Catheterization(Required)

Self-Catheterization(Required)

Prostatectomy(Required)

Peritoneal Dialysis(Required)

Nephrostomy Tube(Required)

Suprapubic Catheter(Required)

Urostomy(Required)

Hemodialysis (Receiving in an Out Pt. Clinic Setting)(Required)

Home Hemodialysis(Required)

Peritoneal Dialysis(Required)

Post-Bladder Surgery(Required)

Post-Prostate Surgery(Required)

Shunts and Fistulas(Required)

Urinary Incontinence(Required)

ENDOCRINE/METABOLIC

Diabetic Skin Assessment(Required)

Hyper- and Hypoglycemia(Required)

Glucometers(Required)

Indwelling Insulin Pumps(Required)

Diabetes(Required)

Post Kidney Transplantation Surgery(Required)

Thyroid Disease(Required)

WOUND/SKIN CARE MANAGEMENT

Assessment(Required)

Braden Assessment Scale(Required)

Surgical Wound Healing(Required)

Skin Grafts(Required)

Burns(Required)

Pressure Ulcer Staging(Required)

Care of Pressure Ulcers(Required)

Dry and Wet to Dry Dressing Changes(Required)

Positioning of Patients(Required)

Special Mattresses and Positioning Devices(Required)

Wound Care (Sterile)(Required)

Wound Cultures(Required)

Wound Irrigations(Required)

Wound Vac(Required)

ONCOLOGY

Immune Status(Required)

Symptoms Management(Required)

Signs/Symptoms of Infection(Required)

Reverse Isolation(Required)

Radiation Therapy(Required)

Leukemia/Lymphoma(Required)

Post-Oncology Surgery(Required)

Terminal Disease(Required)

INFECTIOUS DISEASE

Signs/Symptoms of Infection(Required)

Isolation Precautions(Required)

HIV Infection(Required)

Tuberculosis(Required)

MRSA/VRE(Required)

C. Difficile(Required)

PHLEBOTOMY/IV THERAPY

Blood Draws from Lines(Required)

Management of Long Term IV Catheters(Required)

TPN/Hyperalimentation(Required)

CVP Lines/Dressings(Required)

PICC Lines/Dressings(Required)

Tunneled Lines/Dressings(Required)

Long-Term Lines/Dressings(Required)

PSYCHIATRY

Monitoring Symptoms(Required)

Compliance with Medications(Required)

Cognitive Disorders(Required)

Schizophrenia/Psychotic Disorders(Required)

Substance-Related Disorders(Required)

Mood Disorders (Anxiety/Depression, etc.)(Required)

WOMEN'S HEALTH/MATERNAL-INFANT CARE

Fetal Heart Tones(Required)

Contractions(Required)

Breast Feeding Teaching(Required)

Pregnancy-Related Complications(Required)

Post-Mastectomy(Required)

Post-partum Mother/Baby Visit(Required)

Newborn Care(Required)

Bulb Suctioning(Required)

Cord and Circumcision Care(Required)

Phototherapy(Required)

PEDIATRICS

Growth and Development Stages(Required)

Croup Tent(Required)

Ventilator(Required)

Trach(Required)

Broncho Pulmonary Dysplasia(Required)

Cystic Fibrosis(Required)

Near Drowning(Required)

Pre- and Post-Cardiac Surgery(Required)

RSV(Required)

Reye's Syndrome(Required)

Pre- and Post-Spinal Surgery(Required)

Sickle Cell Disease(Required)

Spina Bifida(Required)

PAIN MANAGEMENT

Assessment

Pain Scale(Required)

Response to Pain Management Interventions(Required)

Pharmacologic Pain Relief(Required)

Non-pharmacologic Pain Relief Measures(Required)

PCA Pump(Required)

Epidural Catheter/Site Monitoring/Pump(Required)

MEDICATIONS

Alzheimer's Medications(Required)

Antibiotics(Required)

Anti HIV(Required)

Antivirals(Required)

Anti Parkinson's(Required)

Bone Marrow Stimulants(Required)

Bronchodilators(Required)

Chemotherapy(Required)

Low Molecular Weight Heparins (Fragmin, Lovenox)(Required)

Immunizations(Required)

Insulin(Required)

Inhalers(Required)

Oral hypoglycemics(Required)

Sedative/Hypnotics(Required)

PALLIATIVE AND END-OF-LIFE CARE

Family Support and Teaching(Required)

Medication Protocols(Required)

Symptom Management(Required)

After Death Protocol and Management(Required)

MISCELLANEOUS

Safety Assessment(Required)

Recognizing Failure to Thrive Across the Lifespan(Required)

Advanced Directives(Required)

CASE MANAGEMENT

Experience as a Case Manager(Required)

Case Load, usual number of patients cared for

Supervision of Home Health Aides(Required)

EXPERIENCE WITH

Long-term/Short-term Disability(Required)

Management of Complaints(Required)

Medicare/Medicaid(Required)

Pre-certifications(Required)

Private Insurance(Required)

Telephone Assessments(Required)

Utilization Review(Required)

Workman's Compensation(Required)

DOCUMENTATION

Diagnosis Coding (ICD Coding)(Required)

Document Plan of Care (Form 485)(Required)

OASIS Documentation(Required)

Computer Charting(Required)