Operating Room RN – Circulate Only

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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

OR Nursing - Circulate 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

Automated Med Dispensing Systems

Accudose

Omnicell

Pyxis

Metro

Promanager Rx

N/A

GENERAL SURGERY

Abdominal Perineal Resection

1

2

3

Bowel Resection

1

2

3

Cholecystectomy

1

2

3

Gastrectomy

1

2

3

Herniorrhaphy-Femoral/Inguinal, ventral, umbilical

1

2

3

Hiatal Herniorrhaphy-Transabdominal

1

2

3

Laparoscopic General Surgeries

1

2

3

Organ Procurement

1

2

3

Radical Mastectomy

1

2

3

Splenectomy

1

2

3

Thyroidectomy

1

2

3

Tracheostomy

1

2

3

LAPAROSCOPIC PROCEDURES

Cholecystectomy

1

2

3

Appendectomy

1

2

3

Hysterectomy

1

2

3

Hernia Repair

1

2

3

Colon Resection

1

2

3

GYNECOLOGY

Cesarean Section

1

2

3

Dilation & Curettage

1

2

3

Hysterectomy-Vaginal

1

2

3

Hysterectomy-Abdominal

1

2

3

Laser Surgery

1

2

3

Salpingo-Oopherectomy

1

2

3

Tubal Ligation

1

2

3

Vaginectomy

1

2

3

Vaginal Reconstruction

1

2

3

G.U. AND CYSTO

Circumcision

1

2

3

Cystoscopy/Cystostomy

1

2

3

Cystectomy

1

2

3

Lithotripsy

1

2

3

Nephrectomy

1

2

3

Orchiectomy

1

2

3

Penile Implant

1

2

3

Prostatectomy

1

2

3

Ureterolithotomy

1

2

3

T.U.R.P./T.U.R.B.

1

2

3

Vasectomy

1

2

3

ORTHOPEDIC

Anterior Cruciate Ligament Reconstruction

1

2

3

Carpal Tunnel surgery

1

2

3

Arthroscopy/Arthrotomy

1

2

3

Closed Pinning & Reduction of Extremities

1

2

3

External Compression Devices

1

2

3

Total Joint Replacement - Knee, Hip

1

2

3

Spinal Fusion-Harrington Rods

1

2

3

Spica Cast Application

1

2

3

O.R.I.F.-Shoulder, Hip, Humerus etc.

1

2

3

Patellectomy

1

2

3

Tendon Implants & Reanastomosis

1

2

3

NEUROSURGERY

Anterior Cervical Fusion

1

2

3

Burrholes for Subdural Hematoma

1

2

3

Craniotomy

1

2

3

Laminectomy

1

2

3

Shunt Procedures-VP/VA

1

2

3

PLASTICS

Abdominoplasty/Abdominal Lipectomy

1

2

3

Augmentation Mammoplasty

1

2

3

Cleft Lip/Palate Repair

1

2

3

Facelift

1

2

3

Liposuction

1

2

3

Otoplasty

1

2

3

Rhinoplasty

1

2

3

Reduction of Facial Fracture

1

2

3

Scar Revision

1

2

3

Skin Meshing

1

2

3

Split Thickness Skin Grafting

1

2

3

EYE

Excision of Chalazion

1

2

3

Canthotomy

1

2

3

Correction of Ectropian/Entropian

1

2

3

Corneal Transplant

1

2

3

Enucleation

1

2

3

I.O.I. Implants

1

2

3

Lacrimal Duct Probing

1

2

3

Refractive Keratoplasty

1

2

3

Repair of Retinal Detachment

1

2

3

Vitrectomy

1

2

3

EAR, NOSE & THROAT

Caldwell-Luc

1

2

3

Ethymoidectomy

1

2

3

Frontal Flap Sinus Procedure

1

2

3

Laryngectomy

1

2

3

Open Reduction Facial Fractures

1

2

3

Radical Neck

1

2

3

Tonsillectomy & Adenoidectomy

1

2

3

Myringotomy

1

2

3

Mastoidectomy

1

2

3

Tympanoplasty

1

2

3

Stapedectomy

1

2

3

Nasal Polypectomy

1

2

3

Laryngoscopy

1

2

3

THORACIC

Hiatal Hernia

1

2

3

Pneumonectomy/Lobectomy

1

2

3

Thoracotomy

1

2

3

Endoscopic Thoracic Procedures

1

2

3

ENDOSCOPY

Bronchoscopy

1

2

3

Cystoscopy

1

2

3

Gastroscopy

1

2

3

Colonoscopy

1

2

3

CARDIOVASCULAR

A-V Shunts

1

2

3

Aortic Aneurysm, Abdominal

1

2

3

Aorto-Fem-Pop Bypass Graft

1

2

3

Graft Insertion

1

2

3

Cardiac Valve Replacement

1

2

3

Coronary Artery Bypass Graft-on pump

1

2

3

Endarterectomy-Carotid/Femoral

1

2

3

Permanent Pacemaker Insertion

1

2

3

Intra-Aortic Balloon Pump Catheter

1

2

3

Patent Ductus Repair

1

2

3

Pericardial Windows

1

2

3

Portasystemic Shunt

1

2

3

Repair of Septal Defects

1

2

3

Thrombectomy

1

2

3

Vena Cava Ligation

1

2

3

TRANSPLANTS

Pancreas

1

2

3

Heart

1

2

3

Lung

1

2

3

Liver

1

2

3

Kidney

1

2

3

Eye

1

2

3

EQUIPMENT

Robotics

1

2

3

List Type:

Fracture Tables

1

2

3

Video Systems

1

2

3

STERILIZATION OF EQUIPMENT

Log

1

2

3

Biological Indicators

1

2

3

Autoclave Operation

1

2

3

High Level

1

2

3

STERIS

1

2

3

Steam

1

2

3

Gas

1

2

3

Flash

1

2

3

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