OR Nursing – Circulate Skills Checklist

OR Nursing - Circulate 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)

Full Name:(Required)

Email(Required)

Date:

Send to(Required)

CIRCULATE EXPERIENCE WITH THE FOLLOWING AGES:

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

Automated Med Dispensing Systems

Accudose

Metro

Omnicell

Promanager Rx

Pyxis

N/A

Other Automated Med Dispensing Systems:

Electronic Documentation

GENERAL SURGERY

Abdominal Perineal Resection(Required)

Bowel Resection(Required)

Cholecystectomy(Required)

Gastrectomy(Required)

Herniorrhaphy-Femoral/Inguinal, ventral, umbilical(Required)

Hiatal Herniorrhaphy-Transabdominal(Required)

Laparoscopic General Surgeries(Required)

Organ Procurement(Required)

Radical Mastectomy(Required)

Splenectomy(Required)

Thyroidectomy(Required)

Tracheostomy(Required)

LAPAROSCOPIC PROCEDURES

Cholecystectomy(Required)

Appendectomy(Required)

Hysterectomy(Required)

Hernia Repair(Required)

Colon Resection(Required)

GYNECOLOGY

Cesarean Section(Required)

Dilation & Curettage(Required)

Hysterectomy-Vaginal(Required)

Hysterectomy-Abdominal(Required)

Laser Surgery(Required)

Salpingo-Oopherectomy(Required)

Tubal Ligation(Required)

Vaginectomy(Required)

Vaginal Reconstruction(Required)

G.U. AND CYSTO

Circumcision(Required)

Cystoscopy/Cystostomy(Required)

Cystectomy(Required)

Hypospadius Repair(Required)

Lithotripsy(Required)

Nephrectomy(Required)

Orchiectomy(Required)

Penile Implant(Required)

Prostatectomy(Required)

Ureterolithotomy(Required)

T.U.R.P./T.U.R.B.(Required)

Vasectomy(Required)

ORTHOPEDIC

Anterior Cruciate Ligament Reconstruction(Required)

Carpal Tunnel surgery(Required)

Arthroscopy/Arthrotomy(Required)

Closed Pinning & Reduction of Extremities(Required)

External Compression Devices(Required)

Total Joint Replacement - Knee, Hip(Required)

Spinal Fusion-Harrington Rods(Required)

Spica Cast Application(Required)

O.R.I.F.-Shoulder, Hip, Humerus etc.(Required)

Patellectomy(Required)

Tendon Implants & Reanastomosis(Required)

NEUROSURGERY

Anterior Cervical Fusion(Required)

Burrholes for Subdural Hematoma(Required)

Craniotomy(Required)

Laminectomy(Required)

Shunt Procedures-VP/VA(Required)

PLASTICS

Abdominoplasty/Abdominal Lipectomy(Required)

Augmentation Mammoplasty(Required)

Cleft Lip/Palate Repair(Required)

Facelift(Required)

Liposuction(Required)

Otoplasty(Required)

Rhinoplasty(Required)

Reduction of Facial Fracture(Required)

Scar Revision(Required)

Skin Meshing(Required)

Split Thickness Skin Grafting(Required)

EYE

Excision of Chalazion(Required)

Canthotomy(Required)

Correction of Ectropian/Entropian(Required)

Corneal Transplant(Required)

Enucleation(Required)

I.O.I. Implants(Required)

Lacrimal Duct Probing(Required)

Refractive Keratoplasty(Required)

Repair of Retinal Detachment(Required)

Vitrectomy(Required)

EAR, NOSE & THROAT

Caldwell-Luc(Required)

Ethymoidectomy(Required)

Frontal Flap Sinus Procedure(Required)

Laryngectomy(Required)

Open Reduction Facial Fractures(Required)

Radical Neck(Required)

Tonsillectomy & Adenoidectomy(Required)

Myringotomy(Required)

Mastoidectomy(Required)

Tympanoplasty(Required)

Stapedectomy(Required)

Nasal Polypectomy(Required)

Laryngoscopy(Required)

THORACIC

Hiatal Hernia(Required)

Pneumonectomy/Lobectomy(Required)

Thoracotomy(Required)

Endoscopic Thoracic Procedures(Required)

Lung/Wedge Resection(Required)

ENDOSCOPY

Bronchoscopy(Required)

Cystoscopy(Required)

Gastroscopy(Required)

Colonoscopy(Required)

CARDIOVASCULAR

A-V Shunts(Required)

Aortic Aneurysm, Abdominal(Required)

Aorto-Fem-Pop Bypass Graft(Required)

Graft Insertion(Required)

Cardiac Valve Replacement(Required)

Coronary Artery Bypass Graft-on pump(Required)

Coronary Artery Bypass Graft-off pump(Required)

Endarterectomy-Carotid/Femoral(Required)

Permanent Pacemaker Insertion(Required)

Intra-Aortic Balloon Pump Catheter(Required)

Patent Ductus Repair(Required)

Pericardial Windows(Required)

Portasystemic Shunt(Required)

Repair of Septal Defects(Required)

Thrombectomy(Required)

Vena Cava Ligation(Required)

TRANSPLANTS

Pancreas(Required)

Heart(Required)

Lung(Required)

Liver(Required)

Kidney(Required)

Eye(Required)

EQUIPMENT

Robotics(Required)

List Type:

Fracture Tables(Required)

Video Systems(Required)

STERILIZATION OF EQUIPMENT

Log(Required)

Biological Indicators(Required)

Autoclave Operation(Required)

High Level(Required)

STERIS(Required)

Steam(Required)

Gas(Required)

Flash(Required)

OTHER SKILLS

List Types: