Pediatric Intensive Care Unit Skills Checklist
PERSONAL INFORMATION
Name: Date:
Signature:
KEY TO COMPETENCY LEVELS
0 – No Experience
1 – Minimal experience, need review and supervision, have performed at least once
2 – Comfortable performing with resource available
3 – Competent to perform independently and safely
4 – Expert, able to act as resource to others
0 1 2 3 4
PATIENT RIGHTS
Communicates and obtains information while respecting the rights and privacy and confidentiality
of information.
Involves the patient and family and respects their role in determining the nature of care to be
provided, including Advanced Directives.
Complies with nursing staff responsibility include in the hospital policy related to Organ Donation.
Meets patient’s and family needs regarding communication, including interpreter services.
Provides accurate information to baby’s families in a timely manner.
NEUROLOGY
Assessment of the neurological system:
Glasgow coma scale
Cranial nerves
Motor response/posturing
Mental status/cognition/responsiveness
Pupillary responses
Developmental appropriateness
Caring for patient undergoing neurologic surgery (pre/post-op)
Care of Patient with:
Acute head injury
Autonomic dysreflecia
CNS infections (meningitis, abscess, encephalitis)
Drug overdose
Neuromuscular blocking agents (NMBA)
Train of four
Seizures
Spinal fusion
Spinal cord injury (SCI)
Steroid protocol for SCI
Rehabilitation of the neurological patient using:
Rotorest bed
Halo traction
2
0 1 2 3 4
CARDIOVASCULAR
Assessment of the cardiovascular system:
General appearance/activity level
Basic EKG interpretation
Capillary refill
Care of the patient undergoing cardiac catherization
Dysrhythmia interpretation
Edema
Heart sounds
Skin color/temperature
Positioning (knee/chest, posturing)
Capillary refill
Pulses
Use of the defibrillator
Care of patient with shock:
Cardiogenic
Neurogenic
Septic
Cardiopulmonary arrest (role, documentation)
Obtaining and interpreting blood lab values
Administering of blood and blood values
Caring for a patient with valvular disease
MEDICATION AND ADMINISTRATION
Knowledge of Indications, Actions, Contraindications, Side Effects, Methods of Administration, Calculation of Dose, Rate of Infusion, caring for
and monitoring patient receiving the following:
Acetaminophen
Albuterol
Antibiotics
Atropine
Calcium
Decadron
Diazepam
Digoxin
Dobutamine
Dopamine
Duramorph
Enalapril
Epinephrine
Furosemide
Growth Hormone
Heparin
Insulin
Lidocaine
Lorazepam
Magnesium Sulfate
Initials: ___________
3
0 1 2 3 4
MEDICATION AND ADMINISTRATION (cont)
Midazolam
Morphine
Naloxone
Neostigmine
Nitroprusside
Phenylephrine
Potassium Chloride
Propulsid
Prostaglandin E1
Protamine Sulfate
Rantidine
Sodium Bacarbonate
Sublimaze
Terbutaline
Theophylline
Verapamil
Wydase
“LINES” SKILLS
Specimen Collection:
Venipuncture
Arterial Puncture
Care of patient with central vascular catheter:
Arterial line
Broviac line
PCVC
UAC
UVC
IV therapy including:
Starting IV
Changing IV sites
Changing IV dressings
Changing IV tubing
Administering fluids on continuous IV pumps
Setting up and monitoring PCA
Epidurals including:
Administering epidural medications
Setting up epidurals
Monitoring of epidurals
PULMONARY
Assessing the respiratory system including:
Breath sounds
Breathing pattern/effort
Skin/nail bed color
Sputum (color/character)
Initials: ___________
4
0 1 2 3 4
PULMONARY (cont)
Administering and Monitoring 02 Therapy:
Nasal cannula, hood, endotracheal tube
Pulse oximetry
Assisting with intubation/extubation
Mask
Continuous O2 sats
Demonstrating proper use of the Ambu bag
Care and maintenance of acute airway obstruction (nasopharyngeal airway, oropharyngeal airway)
CO2 Monitoring Equipment:
TCM
ETTCO2
Caring for a patient with:
Acute respiratory failure
Acute respiratory infections
Status Asthmaticus
Flail Chest
Respiratory Distress Syndrome (RDS)
Pulmonary edema
Pulmonary emboli
Tracheostomy
Tension Pneumothorax
Chest tube management:
Identifies indications
Assists with placement and removal
Set up drainage
Setting up Pleurovac
Monitor suction level, air leak, and drainage site
Site care
Dressing change
Ventilators (use, mode, and alarm complications):
Servo 300
Infant Starr Ventilator
Oscillator
Nasal CPAP
Weaning methods
Pleural tube management including:
Identifying indications
Aspirating fluid as ordered
Monitoring patient during and after aspiration of fluid
PATIENTS WITH ENDOCRINE SYSTEM PROBLEMS
Care of the diabetic patient:
Administration of IV insulin drip
Capillary blood glucose checks
Care of the infant/child in diabetic acidosis
Initials: ___________
5
0 1 2 3 4
GASTROINTESTINAL/RENAL
Assessment of bowel sounds
Appearance/character of urine and stool
Assessing fluid and electrolyte balance
Analyzing and interpreting serum values
Urine specific gravity, osmolality, BUN, creat., urine lytes
Caring for patient on tube feedings
Feeding tube placement
Caring for patient with PEG-J
Caring for patient with abdominal surgery including:
Drainage, NG tube
Ostomy Care
Wound care
Care of the patient on:
CRRT (CAVH, CVVHD, etc.)
Hemodialysis
Peritoneal Dialysis/octopus
Peritoneal Dialysis/cycler
Care of renal transplant patient
Caring for a patient with acute GI bleed
Caring for patient in chronic renal failure
Caring for patient in acute renal failure
Caring for patient with peritoneal dialysis catheter
OTHER COMPETENCIES
Obtaining cultures for septic work-up (blood, sputum, catheter tips)
Caring for child with Meningococcemia
Caring for immunocompromised patient
Caring for patient receiving conscious sedation
Caring for patient using Jehovah Witness protocol
Care of a dying child/infant
Caring for patient during bone marrow aspiration
Latex precautions guidelines
Restraint management
Skin care protocol
Pain and comfort management
Infection control management
Antiembolic devices
Overbed frame safety
Intra-hospital transport
Providing education to patient’s family related to medical condition, self care & health care habits
Communicating discharge needs & arrangements for support through appropriate documentation
EXPERIENCE AREAS (check all that apply) YEARS MONTHS
NICU
PICU
Pediatric
Other
Initials: ___________
6
Initials: ___________
