Skills Checklist:
RRT/CRT

Skills Checklist – RRT/CRT

Endotracheal*

Nasotracheal*

In-line suctioning*

This self-evaluation is for assessing your experience in specific clinical areas. This self-evaluation will not be a determining factor in accepting your application to become an employee of Connected Health Care.

0 = Not Applicable
1 = No Experience
2 = Some Experience
3 = Intermittent Experience
4 = Experienced
5 = Very Experienced

AGE:(Required)

	0	1	2	3	4	5
Newborn/Neonatal (birth - 30 days)*
Infant (30 days - 1 year)*
Toddler (1 - 3 years)*
Preschooler (3 - 5 years)*
School Age (5 - 12 years)*
Adolescents (12 - 18 years)*
Young Adults (18 - 39 years)*
Middle Adults (39 - 64 years)*
Older Adults (64+ years)*

GENERAL SKILLS(Required)

	0	1	2	3	4	5
Standard Precautions*
Isolation Precautions*
Patient Head to Toe Assessment*
Infant/ Neonatal Cardiac/ Respiratory Arrest*
Adult Respiratory/Cardiac Arrest*
Prep and Administration of Emergency Meds*
Crash Carts*
Defibrillators*
Care of Patients in Restraints*
Automated Med Dispensing System*
Electronic Documentation*
Care Planning & Discharge Planning*

CARE OF PATIENTS WITH:(Required)

	0	1	2	3	4	5
Acute/ chronic bronchitis*
ARDS (adult respiratory distress syndrome)*
Aspiration Asthma*
Status Asthmaticus*
Bronchoscopy*
Bronco-Pulmonary dysplasia*
CHF (congestive heart failure)*
Croup*
Cystic fibrosis*
Epiglottis*
Guillain Barre*
Hemopneumothorax*
Myasthenia Gravis*
Pneumonia*
Pulmonary edema*
Pulmonary embolism*
Smoke inhalation*
TB (tuberculosis)*
Tension pneumothorax*
Thoracotomy*
Tracheal-esophageal fistula*
Tracheotomy*
Failure to thrive*
Fem-pop bypass*
Laryngospasm*
Meconium aspiration*
Near drowning*
Persistent pulmonary hypertension*
Pulmonary interstitial emphysema*
RSV (respiratory syncytial virus)*
Transient tachypnea of newborn*

MEDICATION ADMINISTRATION:(Required)

KNOWLEDGE OF EFFECTS OF:(Required)

	0	1	2	3	4	5
Alupent*
Anectine*
Atropine*
Azmacort*
Bronkosol*
Corticosteroids*
Cromolyn sodium*
Decadron*
Diazepam*
Digoxin*
Dopamine*
Flovent*
Heliox therapy*
Inhaled steroids*
Ketamine*
Lasix*
Lidocaine*
Morphine*
Nitric oxide*
Pavulon*
Propofol*
Tobramycin*
Versed*

EQUIPMENT: Ventilator set up(Required)

	0	1	2	3	4	5
Achieva*
Siemens*
Bi-Pap*
PB7*
Sechrist IV B*
Servo V6*
Assist control*
CPAP*
Flow-by*
High frequency ventilator*
IMV*
Inverse ratio vent*
Pressure support*
Pressure vents*
SIMV*
Troubleshooting high and low alarms*

EQUIPMENT: Oxygen/ Air delivery systems(Required)

MEDICATION DELIVERY: Nebulizer(Required)

MEDICATION DELIVERY: MDI (metered dose inhaler)(Required)

PROCEDURES:(Required)

	0	1	2	3	4	5
Postural drainage*
Chest percussion therapy*
Sputum collection/ sampling*
ABG’s (arterial blood gas)*
Allen test*
Femoral*
Arterial*
Set up and calibrate arterial lines*
Radial*
Analyzing ABG’s*
Interpreting ABG’s*

AIRWAY MANAGEMENT & SUCTIONING:(Required)

AIRWAY MANAGEMENT & SUCTIONING: Adult(Required)

AIRWAY MANAGEMENT & SUCTIONING: Manual ventilation(Required)

AIRWAY MANAGEMENT & SUCTIONING: DIAGNOSTIC:(Required)

AIRWAY MANAGEMENT & SUCTIONING: Assist with high risk deliveries(Required)

TEACHING:(Required)

WORK SETTINGS:(Required)

Name

First Last

Date

Specialty

By Signing this, I am authorizing that the information I have given is true and accurate to the best of my knowledge. I hereby authorize Connected Health Care to release this Skills Checklist to staffing clients of Connected Health Care. Submit this skills evaluation with your initial application.

Signature(Required)

	0	1	2	3	4	5
Atrovent*
Albuterol*
Bicarbonate*
Breo*
Combivent*
Incruse*
Isuprel*
Mucomyst*
Pulmicort*
Racemic epinephrine*
Spiriva*
Terbutaline sulfate*
Theophylline*
Xopenex*

	0	1	2	3	4	5
Ambu bag*
Croup tent*
e-cylinders*
Nasal cannula*
Non-rebreather*
T-piece*
Trach collar*
Venturi mask*

	0	1	2	3	4	5
CCU/ ICU*
Emergency department*
Home care*
Neonatal ICU*
Pediatric*
Pediatric ICU*
Pulmonary rehabilitation*
Transport*

	0	1	2	3	4	5
Aero chamber*
IPPB (intermittent positive pressure)*

	0	1	2	3	4	5
Neo-natal*
Pediatrics*

	0	1	2	3	4	5
Pulmonary function testing*
Assist with bronchoscopes*