LPN Licensed Practical Nurse 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)

MM slash DD slash YYYY

MEDICATIONS ADMINISTRATION

General Medication Administration
Oral Medications(Required)
Subcutaneous Injections(Required)
Intramuscular Injections(Required)
Z-Track Injections(Required)
Heparin Lock(Required)
Intrademal(Required)
Vaginal Suppositories(Required)
Ophthalmic Drops(Required)
Nasal Drops(Required)
Ophthalmic Ointments(Required)
Topical Ointments(Required)
Inhalers(Required)
Rectal Suppositories(Required)
Emergency Meds-Crash Carts(Required)

INTRAVENOUS

General Intravenous
Starting an IV(Required)
Change IV Tubing(Required)
Discontinuing an IV(Required)
Chemo-Therapy(Required)
Piggyback Administration(Required)
IV Push Drugs(Required)
Plasma(Required)
Packed RBC(Required)
Regulate Flow(Required)
Maintain IV Site(Required)
Hyperalimentation(Required)
CVP Line(Required)
Medication Addition(Required)
Whole Blood Administration(Required)
Serum Albumin(Required)
Platelets(Required)

INFECTION CONTROL

GENERAL ASSESSMENT
Knowledge of Universal Precautions(Required)
Knowledge of Waste Disposal(Required)
Proper Disposal of Sharps(Required)
Management of Patient in Respiratory Isolation(Required)
Care of the Patient in Reverse Isolation(Required)
Cleaning of Equipment(Required)

ASSESSMENT

General Assessment
Perform Neurological Assessment(Required)
Management of the Patient with Drug(Required)
Interaction/Allergic Reaction(Required)
Management of Patient with Cardio-Pulmonary (Arrest)(Required)
Perform Cardiovascular Assessment(Required)
Perform Gastrointestinal Assessment(Required)
Perform Muskuloskelatal Assessment(Required)
Perform Genitourinary Assessment(Required)
Perform Respiratory Assessment(Required)

BODY MECHANICS/TRANSFER

General Body Mechanics/Transfer
Lifting and Pulling(Required)
Transfer to Chair(Required)
Turning and Positioning(Required)
Transfer Patient to Wheelchair(Required)
Transfer Patient to and from Toilet(Required)
Transfer Patient to and from Gurney(Required)

RESTRAINTS

General Restraints
Application of Soft Limb Restraints(Required)
Application of Leather Restraints(Required)
Application of Posey Restraints(Required)
Observation of Patient in Restraints(Required)
Documentation(Required)
Knowledgeable of Safety Guidelines for Patient(Required)

EQUIPMENT

General Equipment
Hemovac/Davol Suction Pump(Required)
Use of Wall Suction(Required)
Use of Corstavac Suction(Required)
Alternate Pressure Mattress(Required)
Care of Patient with PCS Pump(Required)
Infusion Devices (Volumetric Pump)(Required)
Venturi Mask(Required)
Management of Trach Collar(Required)
Knowledge of Use of Incentive Spirometer(Required)
ABG Kits(Required)
Knowledge of Use of Bed Scale(Required)
Knowledge of use of Heating Pad(Required)
Use of Hoyer Lift(Required)
Assist with/Set-up of Water Seal Suction(Required)
Pleurevac/Emerson Suction(Required)
Knowledge of Use of Egg Crate Mattress(Required)
Enteral Pump(Required)
Management of Oxygen Mask(Required)
Management of Nasal Cannula(Required)
Use of Ambu-Bag(Required)
Humidifiers(Required)
Application of TED Hose(Required)
Use of Heat Lamb(Required)
Use of Blood Glucose Monitors(Required)

SPECIMEN COLLECTION

General Specimen Collection
Obtain Urine for Specific Gravity(Required)
Obtain Urine Culture(Required)
Obtain Foley Catheter Specimen(Required)
Obtain Stool Specimen(Required)
Perform Straight Catheterization(Required)
Obtain Sputum Specimen(Required)
Instruct Patient/Assist with Clean(Required)
Catch/Midstream Urine Specimen(Required)
Collect 24 hour Urine Specimen(Required)
Obtain Stool Hemocult(Required)
Obtain Stool Ova/Parasite(Required)

PROCEDURES

General Procedures
Set-up/Instruct Patient in Sitz bath(Required)
Perform Personal Hygiene/Oral Care(Required)
Perform Wound Irrigation(Required)
Perform Catheterization (Female & Male)(Required)
Administer Tap/Saline Enema(Required)
Administer Soap Suds Enema(Required)
Administer Oil Retention Enema(Required)
Administer Fleets Enema(Required)
Administer Post-Mortem Care(Required)
Perform Wet to Dry Dressing(Required)
Perform Sterile Dressing Changes(Required)
Perform Bladder Irrigation(Required)
Perform Ostomy Care(Required)
Perform NG Tube Feeding(Required)
Perform Gastrostomy Tube Feeding(Required)
Administer Douches(Required)
Management of Levine Tube(Required)
Management of Nephrostomy Catheter(Required)
Management of Jejunostomy Tube(Required)
Management of Chest Tube(Required)
Perform Nasal Suctioning(Required)
Perform Oral Suctioning(Required)

COMMUNICATION/DOCUMENTATION

General Communication/Documentation
Reporting on Assigned Patients(Required)
Performing Team Leader Duties(Required)
Giving Oral Reports(Required)
Giving Tape Reports(Required)
Making Assignments(Required)
Making Rounds(Required)

Age Specific:

Please indicate the frequency with which you provide care for each age group:
Infant (Birth to 1 year)(Required)
Toddler (1-3 years)(Required)
Pre-school (3-6 years)(Required)
School Age (6-12 years)(Required)
Adolescent (12-18 years)(Required)
Young Adult (18-30 years)(Required)
Mature Adult (30-60 years)(Required)
Elderly (>60 years)(Required)

OTHER SKILLS