Pediatric Intensive Care Unit (PICU) 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

MEDICATION ADMINISTRATION

Moderate/Conscious Sedation(Required)

Sedation Reversal Agents(Required)

CARDIOVASCULAR GENERAL SKILLS

Blood pressure/invasive (arterial line)(Required)

Heart Sounds/Murmurs(Required)

Central venous pressure(Required)

Invasive hemodynamic monitoring PA/Swan Ganz

Defibrillation/Cardioversion(Required)

EKG Interpretation (Basic and Advanced)(Required)

CARDIOVASCULAR-Care of the Child With:

Anaphylactic Shock(Required)

Bacterial Endocarditis(Required)

Coarctation of the Aorta(Required)

Cardiac Arrest(Required)

Cardiac Transplant(Required)

Cardiogenic shock(Required)

Cardiomyopathy(Required)

Fresh Open Heart Surgery(Required)

Hypoplastic Heart(Required)

Hypovolemic Shock(Required)

Myocarditis(Required)

Open Heart Surgery, more than 6 hours(Required)

Post Interventional Cardiac Cath(Required)

Septal Defect(Required)

Septic Shock(Required)

Tetrology of Fallot(Required)

Transposition of the Great Vessels(Required)

RESPIRATORY GENERAL SKILLS

Obtaining Blood Gases(Required)

Pulse Oximeter(Required)

Airway Management

Assist with Intubation(Required)

Assist with Extubation(Required)

Suctioning

Bulb Syringe(Required)

Nasal airway/suctioning(Required)

Oral airway/suctioning(Required)

Apnea/Apnea Monitoring(Required)

Chest Tube (assist with)

Insertion(Required)

Removal(Required)

ECMO (Extracorporeal Membrane Oxygenation)(Required)

End Tidal CO2(Required)

O2 Therapy

Bag & mask(Required)

Isolette(Required)

Oxyhood(Required)

Tent(Required)

Trach collar(Required)

Thoracentesis(Required)

Ventilators

CPAP/PEEP/BIPAP(Required)

High frequency jet ventilator(Required)

Oscillating ventilator(Required)

Pressure ventilator(Required)

Volume ventilator(Required)

Weaning(Required)

RESPIRATORY-Care of Child With:

Asthma(Required)

Asphyxiation(Required)

Bronchiolitis(RSV)(Required)

Bronchopulmonary Dysplasia(Required)

Pneumonia(Required)

Croup(Required)

Chronic respiratory disease(Required)

Cystic Fibrosis(Required)

Lung Transplant(Required)

Epiglottitis(Required)

Fresh tracheostomy(Required)

Foreign body aspiration(Required)

Flail Chest(Required)

Hemothorax(Required)

Near Drowning(Required)

Tonsillitis(Required)

Pertussis(Required)

Pneumothorax(Required)

Respiratory distress syndrome (RDS)(Required)

Respiratory Arrest(Required)

Respiratory failure(Required)

NEURO GENERAL SKILLS

Glasgow Coma Scale(Required)

Assist with lumbar puncture(Required)

Seizure Precautions(Required)

Intracranial pressure monitoring(Required)

NEURO-Care of Child With:

Epilepsy(Required)

Febrile Seizure(Required)

Head Trauma(Required)

Post Neurosurgery(Required)

Spinal Cord Injury(Required)

Status epilepticus(Required)

Coma(Required)

Brain death/organ procurement(Required)

Encephalitis(Required)

Meningitis(Required)

Externalized VP shunt/reservoirs(Required)

Neuromuscular disease(Required)

Anticonvulsants(Required)

GASTROINTESTINAL GENERAL SKILLS

Abdominal Assessment(Required)

Interpretation of Lab Results - Serum Electrolytes(Required)

Feedings (Storage and Prep of)(Required)

Bottle(Required)

Breast(Required)

Gavage(Required)

TPN(Required)

PPN(Required)

Gastrostomy/Button(Required)

J-Tubes(Required)

NG to Suction(Required)

Gastric Lavage(Required)

Placement of Naso/Orogastric Tube(Required)

GASTROINTESTINAL-Care of Child with:

Anal Fissure(Required)

Anorexia/Bulimia(Required)

Cleft Lip/Palate(Required)

Colostomy(Required)

Ileostomy(Required)

Fresh Ostomy(Required)

Diaphragmatic Hernia(Required)

Severe Failure to Thrive (FTT)(Required)

Pancreatitis(Required)

Pyloric Stenosis Repair(Required)

GE Reflux(Required)

GI Bleeding(Required)

Crohn's Disease(Required)

Ulcerative Colitis(Required)

Severe Gastroenteritis/Dehydration(Required)

Intestinal Parasites(Required)

Necrotizing Enterocolitis (NEC)(Required)

Surgical Abdomen(Required)

Liver Transplant(Required)

Small Bowel Transplant(Required)

Poison Ingestion/Overdose(Required)

RENAL/GENITOURINARY GENERAL SKILLS

Assessment of fluid balance(Required)

Interpretation of Lab Results (UA/BUN/Creatinine)(Required)

Test urine and interpret(Required)

Collection of urine specimens(Required)

Assist with suprapubic tap(Required)

Insertion & Care of Straight and Foley Catheter(Required)

Suprapubic(Required)

RENAL/GENITOURINARY-Care of Child With:

Acute renal failure(Required)

CAVH(Required)

Peritoneal dialysis(Required)

Hemodialysis(Required)

Hemolytic uremic syndrome (HUS)(Required)

Nephritis(Required)

Nephrotic syndrome(Required)

Renal transplant(Required)

Syndrome of inappropriate ADH (SIADH)(Required)

ENDOCRINE/METABOLIC GENERAL SKILLS

Diabetes mellitus(Required)

Diabetic ketoacidosis(Required)

Diabetic coma(Required)

Hyper/hypocalcemia(Required)

Hyperbilirubinemia(Required)

Kawasaki's Disease(Required)

Thyroid dysfunction(Required)

ORTHOPEDICS GENERAL SKILLS

Specialized orthopedic bed(Required)

ORTHOPEDICS-Care of Child With:

Cervical traction(Required)

Fracture/Cast Care(Required)

Splints(Required)

Open Fracture(Required)

Closed Fracture(Required)

Pinned fractures(Required)

Post vertebral surgery(Required)

WOUND MANAGEMENT

Assessment of skin status(Required)

Stasis ulcers(Required)

Multiple abdominal wounds and drains(Required)

Gunshot Wounds(Required)

Stab Wounds(Required)

Hazardous Material Exposure(Required)

Surgical wound healing(Required)

Lacerations(Required)

Sterile dressing changes(Required)

Wound care/irrigations(Required)

Drains(Required)

JP(Required)

Penrose(Required)

Hemovac(Required)

WOUNDS-Care of Child With:

Burns(Required)

Rule of Nines(Required)

First Degree(Required)

Second Degree(Required)

Third Degree(Required)

Fluid Resuscitation Burn Formulas(Required)

Radiation Exposure(Required)

Pressure sores(Required)

Electrical Burns(Required)

Traumatic wounds(Required)

ONCOLOGY/BLOOD DYSCRASIAS

Reverse isolation(Required)

Interpretation of Lab Result(Required)

ONCOLOGY-Care of Child With:

Malignant tumors(Required)

Hodgkins Disease(Required)

Fresh oncologic surgery(Required)

Acute tumor lysis syndrome(Required)

Leukemia(Required)

Wilm's Tumor(Required)

Bone Marrow transplant(Required)

Disseminated intravascular coagulation(Required)

Sickle Cell Anemia(Required)

Chemotherapy(Required)

Radiation implant(Required)

INFECTIOUS DISEASES GENERAL SKILLS

Cultures (Including sensitivities)(Required)

CBC/differential (shift)(Required)

INFECTIOUS DISEASES-Care of Child With:

Isolation Precautions/Procedures(Required)

Cytomegalovirus (CMV)(Required)

HIV/AIDS(Required)

MRSA(Required)

VRE(Required)

Tuberculosis(Required)

C- Difficile(Required)

Hepatitis(Required)

Common childhood communicable diseases(Required)

PHLEBOTOMY/IV THERAPY

Peripheral IV Insertion, Care and Maintenance(Required)

Intraosseous Line(Required)

Hickman(Required)

Groshong(Required)

Saline Lock(Required)

Aortocath(Required)

Broviac(Required)

Quinton Catheter(Required)

Central Line Care and Maintenance(Required)

PICC Line Care and Maintenance(Required)

Peripheral Line(Required)

Arterial Line(Required)

Drawing Blood from Central Line/PICC Line(Required)

Drawing Venous Blood(Required)

Administration of Blood/Blood Products

Cryoprecipitate(Required)

Packed Red Blood Cells(Required)

Whole Blood(Required)

PAIN MANAGEMENT GENERAL SKILLS

Assessment - Pain Level Using Age Appropriate Scales(Required)

MISCELLANEOUS

Normal Growth & Development(Required)

Normal Laboratory Values(Required)

Recognize Signs of Abuse or Neglect(Required)

Immunization Schedule(Required)

MISCELLANEOUS-Care of Child With:

Anorexia/Bulimia(Required)

Craniofacial Reconstruction(Required)

Depression(Required)

HEENT Surgery(Required)

Suicide attempt(Required)

MEDICATION ADMINISTRATION FOR CHILDREN

Calculation of Pediatric Doses(Required)

Titration of IV drips(Required)

Eye/Ear Installations(Required)

Metered Dose Inhaler(Required)

Intravenous medications (IV)(Required)

Subcutaneous (SQ) injections(Required)

Z Trach(Required)

Knowledge of emergency drug action and reaction(Required)

Pediatric drug actions & reactions(Required)

Antipyretics(Required)

Adenosine(Required)

Aminophylline(Required)

Atropine(Required)

Anticoagulants(Required)

Anticonvulsants(Required)

Antibiotics(Required)

Antihypertensives(Required)

Charcoal(Required)

Cardizem(Required)

Decadron(Required)

Dilantin(Required)

Dopamine(Required)

Diuretics(Required)

Digoxin(Required)

Epinephrine(Required)

Growth Hormone(Required)

Heparin(Required)

Hyperalimentation(Required)

Immunizations(Required)

Inotropes (Dobutamine, Primacor)(Required)

Intrathecal Medications(Required)

Inocor(Required)

Insulin(Required)

Insulin Drips(Required)

Isuprel(Required)

Kayexalate(Required)

Lidocaine(Required)

Mannitol(Required)

Narcotic Analgesics(Required)

Narcan(Required)

Nitroglycerin(Required)

Nipride(Required)

Steroids(Required)

Sodium Bicarbonate(Required)

TPA(Required)

Vasopressin(Required)

Ventolin (albuterol)(Required)

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Alabama (NLC)
Alaska
Arizona (NLC)
Arkansas (NLC)
California
Colorado (NLC)
Connecticut
Delaware (NLC)
Florida (NLC)
Georgia (NLC)
Hawaii
Idaho (NLC)
Illinois
Indiana (NLC)
Iowa (NLC)
Kansas (NLC)
Kentucky (NLC)
Louisiana (NLC)
Maine (NLC)
Maryland (NLC)
Massachusetts
Michigan
Minnesota
Mississippi (NLC)
Missouri (NLC)
Montana (NLC)
Nebraska (NLC)
Nevada
New Hampshire (NLC)
New Jersey
New Mexico (NLC)
New York
North Carolina (NLC)
North Dakota (NLC)
Ohio (NLC)
Oklahoma (NLC)
Oregon
Pennsylvania
Rhode Island
South Carolina (NLC)
South Dakota (NLC)
Tennessee (NLC)
Texas (NLC)
Utah (NLC)
Vermont
Virginia (NLC)
Washington
West Virginia (NLC)
Wisconsin (NLC)
Wyoming (NLC)