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/Caseload Management
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Admission Visit: Patient Orientation, Charges, HIPAA, Rights & Responsibilities, etc

Determining Frequency of Visits/Completing Schedule

Timeliness/Submission of Paperwork

Guidelines for Aide Supervision and Scheduling

Patient teaching

Reporting to Supervisor

OASIS Assessment & Documentation

Caseload Management

Medication reconciliation

Frontloading visits

Telehealth

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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Lab Collection
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Stool

Sputum

Venipuncture

Wound Culture

Throat Culture

Blood Culture

Urine Collection

Clean Catch

Cathed Specimen

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Urinary Catheters
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Indwelling Male/Female

Sterile Specimen

Catheter Care

Bladder Training

Intermittent self-catheterization male/female

Suprapubic

Bladder Irrigation

Texas Catheter

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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

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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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Tracheostomy Care
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Stomacare

Dressings

Tube Insertion :

Cuffed

Uncuffed

Cannula Care

Tube Removal

Use of Trach ties or Velcro

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Pulmonary Hygiene
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Operating suction machine

Nasopharyngeal suctioning

Tracheal suctioning

Oral suctioning

Yankauer suction

Postural drainage

Percussion

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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

Sterile gloving

Dry sterile dressings

Wet to dry dressings

Stomahesive

Occlusive dressings

Antimicrobials – Honey, Silver or Iodine

Debriding agents

Hydrocolloids

Dead Space Filler

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

Site Care/Dressing

Peritoneal Dialysis

Peritoneal Drainage

Drainage Bag Change

Cath Transfer Set Change Procedure

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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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Ambulatory Assist

Transfers

ROM—active and passive

Hoyer Lift

Sit-Stand Lift

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Peripheral Lines
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Frequency of Site Change

Dressing Change

Cap Changes

Flushesshock

Insertion of Butterfly Angiocath

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PICC
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Dressing Change

Cap Change

Flushes

Removal

Withdrawing Lab Specimens—special considerations

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Implanted Port
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Access/Deaccess

Dressing Change

Flushes

Withdrawing Lab Specimens

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Tunneled Catheters
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Groshong

Hickman

Broviac

Shiley

Dressing Change

Cap Change

Flushes

Withdrawing Lab Specimens

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Subcutaneous Infusions
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Needle/Site Changes

Maximum Volume/Hr

Dressing Change

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Epidural Catheters
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Dressing Change

Cap Change

Flushes

Maximum Volume/Hr

Special considerations

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Use of Specific Pumps
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CADD PCA

CADD PLUS

CADD TPN

AIM Plus

SIGMA

Ball Infuser

Other :

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Other
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Caring for the dying patient

Vital Signs

Patient with pacemaker/AICD

Assessment/intervention for anaphylactic shock

Body mechanics

Assessment of fall risk/ prevention

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