Hospice | Ikajuq Care

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Opthalmic/Otic Medication

1

2

3

Rectal/vaginal medication

1

2

3

IM/SQ medication

1

2

3

IV push medications

1

2

3

IVPB medications

1

2

3

Continuous infusions

1

2

3

PPN

1

2

3

TPN

1

2

3

Hospice RN 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)

AGE OF PATIENTS CARED FOR

Newborn/Neonate (birth to 30 days)

1

2

3

Infant (31 days to 12 months)

1

2

3

Toddler/Preschool (13 months to 5 years)

1

2

3

School Age Child/adolescent (6 years to 18 years)

1

2

3

Young Adults/Middle Adult (19 years to 64 years)

1

2

3

Older Adults/Elderly (65+ years)

1

2

3

GENERAL SKILLS

Care of Patient in Restraints

1

2

3

TYPE OF FACILITY EXPERIENCE

Accudose

Omnicell

Pyxis

Metro

Promanager Rx

N/A

HOSPICE CARE

Admit and Initial Assessment

1

2

3

Infection control

1

2

3

Universal precautions

1

2

3

Isolation

1

2

3

Reverse Isolation

1

2

3

Minimize fall risks

1

2

3

Restraints

1

2

3

Lift/transfer devices

1

2

3

Interpretation and communication of lab values

1

2

3

Non-pharmacologic interventions

1

2

3

Blood Glucose monitoring

1

2

3

PLAN OF CARE

Advanced directives

1

2

3

Set Goals with Pt/family

1

2

3

Resources for Pt/family

1

2

3

Pt teaching self care

1

2

3

Quality of life issues

1

2

3

Death and dying counseling

1

2

3

Stages of grieving

1

2

3

Pt care after death

1

2

3

Facilitate family/cultural rituals/rites

1

2

3

Spiritual Care

1

2

3

Pronouncement of death

1

2

3

Coordinate mortuary services

1

2

3

COMPLIANCE

Scope and frequency of services

1

2

3

Medicare/State regulations for hospice

1

2

3

Document progression of decline

1

2

3

DME authorization and documentation of need/order

1

2

3

OASIS-C

1

2

3

PAIN MANAGEMENT

Pain assessment/management

1

2

3

Moderate sedation

1

2

3

Administration of narcotics/sedatives

1

2

3

PAINAD Scale for nonverbal patients

1

2

3

Continuous narcotic infusion

1

2

3

Transdermal agents

1

2

3

TENS units

1

2

3

Alternative therapies

1

2

3

Titration of opioids

1

2

3

Family management of medications

1

2

3

Equianalgesic Conversion Formula

1

2

3

WOUND CARE

Speciality beds

1

2

3

Prevention of pressure ulcers

1

2

3

Staging and care of pressure ulcers

1

2

3

Wound care

1

2

3

Use of Woundvac

1

2

3

Positioning Techniques

1

2

3

Educate Pt/Family on positioning/shearing

1

2

3

MEDICATIONS

Bar coding for medication administration

1

2

3

Insulin administration

1

2

3

Anticoagulation therapy

1

2

3

Medication reconciliation

1

2

3

Oral Medication

1

2

3

Topical Medication

1

2

3

Opthalmic/Otic Medication

1

2

3

Rectal/vaginal medication

1

2

3

IM/SQ medication

1

2

3

IV push medications

1

2

3

IVPB medications

1

2

3

Continuous infusions

1

2

3

PPN

1

2

3

TPN

1

2

3

J-tube/G-tube feedings

1

2

3

PHYSICAL ASSESSMENT

Cardiovascular assessment

1

2

3

Respiratory assessment

1

2

3

Use of oxygen

1

2

3

Use of Incentive Spirometer

1

2

3

Nasal cannula/face mask

1

2

3

Nebulizers

1

2

3

Use of ambu bag

1

2

3

Pulse oximetry

1

2

3

Oral and nasotracheal suctioning

1

2

3

Tracheostomy care

1

2

3

Neuro assessment

1

2

3

Sleep assessment

1

2

3

Seizure precautions

1

2

3

Gastrointestional assessment

1

2

3

Nutrition assessment

1

2

3

NG tube insertion/management

1

2

3

Feeding tube insertion/management

1

2

3

PEG/gastrostomy/ jejunostomy management

1

2

3

Ostomy care

1

2

3

Foley catheters

1

2

3

Suprapublic tube

1

2

3

Nephrostomy

1

2

3

Shunts/fistulas

1

2

3

PEDIATRICS

Developmentally appropriate assessment

1

2

3

parent/sibling support

1

2

3

pediatric support team collaboration

1

2

3

Fatigue

1

2

3

Constipation

1

2

3

Nausea/vomiting

1

2

3

Nephrostomy

1

2

3

Shunts/fistulas

1

2

3

CERTIFICATIONS

CHPN

Yes

No

ACHPN

Yes

No

CHPPN

Yes

No

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