Ideal HomeHealth Care, LLC

Self Assessment
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Do you have any experience with this skill?
Are you competent performing the following?
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Competent in Knowledge and Performance
Requires instruction and demonstration
Supervisor’s Initials for Competence
Comments
Yes
No
Yes
No
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Infection Control
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Hand washing

Universal Precautions

Proper Waste Disposal

Equipment disinfection

Needle disposal

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Assessment of
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Cardiovascular system

Respiratory system

GI System

GU System

Head/Neck

Neurological System

Integumentary System

Musculoskeletal System

Pain—Wong Baker Scale

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Disease Management
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Diabetes

Heart Failure

Hypertension

PVD

CAD

Chronic Respiratory-COPD, asthma, or emphysema

Alzheimer’s

Chronic Neurological disease – MS or Parkinson’s

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Organization
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Patient Orientation

Charges

HIPAA, R&R, etc.

Timeliness/submission of paperwork or electronic documentation

Patient teaching

Reporting to RN and 30-day supervision

Medication reconciliation

Frontloading visits

Complete and teach patient emergency care plan

Care Planning

Interdisciplinary Communication

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Medication
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Injection Sites

Intramuscular injections

Intradermal injections

Subcutaneously

Topical medications

Ear drops

Eye ointment

Vaginal suppositories

Vaginal irrigations

Perineal care

Eye drops

Eye irrigation

Pain control

IV antibiotics

TPN

Oral hygiene

Gastric or J-tube

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Urinary Catheters and Care
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Sterile Specimen

Suprapubic

Indwelling Male/Female

Catheter Care

Bladder Training

Intermittent self-catheterization male/female

Suprapubic

Texas Catheter

Bladder Irrigation

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Bowel Protocols
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Fleets Enema

Soapsuds Enema

Tap water Enema

Oil Retention Enema

Bowel training

Checking & removal of fecal impaction

Adm. rectal suppositories

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Naso-Gastric Tubes
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Insertion

Check Placement

Removal

Medication Administration

Irrigation

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Caring for Patients with GI/GU Ostomies
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Colostomy care

Colostomy irrigation

Ileostomy care

Ileal conduit care

Peristomal care

Stomahesive

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Gastrostomy Tubes
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Insertion

Check Placement

Site Care

Removal

Medication Administration

Irrigation

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Enteral Feedings
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Bolus

Continuous

Gravity

Pumps

Kangaroo

Flexiflo

Other :

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Pulmonary Hygiene
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Operating suction machine

Nasopharyngeal suctioning

Tracheal suctioning

Oral suctioning

Yankauer

Postural drainage

Percussion

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Trach Care
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Stomacare

Dressings

Tube Insertion :

Cuffed

Uncuffed

Cannula Care

Tube Removal

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Inhalation Therapy
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O2 Therapy

Face Mask

Non-rebreather

Venturi

Tracheal O2

Bipap

Cpap

Nebulizer

Nebulized MSO4

Pulse Oximeter

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Wound Care
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Removing sutures/staples

Irrigation

Packing

Cleansing wounds

Wet to Dry dressings

Occlusive dressings

Antimicrobials – Honey, Silver or Iodine

Debriding agents

Hydrocolloids

Wound care for burns

Wound V.A.C.

Wound Identification

Pressure ulcer classification

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Drains
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Hemovac

Jackson Pratt (closed drain/low pressure devices)

Penrose-open drain

Chest tube – Aspire/Pleurex

Abdominal Drains- Aspire/Tenekhoff

Stool

Sputum

Venipuncture

Wound Culture

Throat Culture

Blood Culture

Urine Collection

Clean Catch

Cathed Specimen

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Mobility
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Ambulatory Assist

Transfers

ROM—active and passive

Hoyer Lift

Sit-Stand Lift

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Procedures
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Cast care

Unna boot

Ace bandages

Stump care

Prosthetic/orthopedic devices

Applying ice

Applying hot compresses

Sitz baths

Intake & Output

Use of Doppler

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Mobility
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Caring for the dying patient

Vital Signs

Patient with pacemaker/ACID

Assessment/intervention for anaphylactic shock

Body mechanics

I have been instructed and have knowledge and ability in the nursing skill areas indicated on this form.