LTAC RN - Wayward Medical

LTAC

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Name*

First Last

Phone*

Email*

Age Specific Care

Proficiency Rating

Frequency Rating

Newborn/Neonate (birth - 30 days) *

Newborn/Neonate (birth - 30 days) proficiency*

Newborn/Neonate (birth - 30 days) frequency*

Infant (30 days - 1 year) *

Infant (30 days - 1 year) proficiency*

Infant (30 days - 1 year) frequency*

Toddler (1 - 3 years) *

Toddler (1 - 3 years) proficiency*

Toddler (1 - 3 years) frequency*

Preschooler (3 - 5 years) *

Preschooler (3 - 5 years) proficiency*

Preschooler (3 - 5 years) frequency*

School Age Child (5 - 12 years) *

School Age Child (5 - 12 years) proficiency*

School Age Child (5 - 12 years) frequency*

Adolescents (12 - 18 years) *

Adolescents (12 - 18 years) proficiency*

Adolescents (12 - 18 years) frequency*

Young Adults (18 - 39 years) *

Young Adults (18 - 39 years) proficiency*

Young Adults (18 - 39 years) frequency*

Middle Adults (39 - 64 years) *

Middle Adults (39 - 64 years) proficiency*

Middle Adults (39 - 64 years) frequency*

Older Adults (64+ years) *

Older Adults (64+ years) proficiency*

Older Adults (64+ years) frequency*

Elderly Adults (over 79+ years) *

Elderly Adults (over 79+ years) proficiency*

Elderly Adults (over 79+ years) frequency*

Clinical Settings

Proficiency Rating

Frequency Rating

Hospital within Hospital *

Hospital within Hospital proficiency*

Hospital within Hospital frequency*

Free - Standing LTAC *

Free - Standing LTAC proficiency*

Free - Standing LTAC frequency*

General Skills

Proficiency Rating

Frequency Rating

Admission *

Admission proficiency*

Admission frequency*

Advance Directives *

Advance Directives proficiency*

Advance Directives frequency*

Collect Appropriate Data *

Collect Appropriate Data proficiency*

Collect Appropriate Data frequency*

Organ / Tissue Donation *

Organ / Tissue Donation proficiency*

Organ / Tissue Donation frequency*

Patient and Family Teaching *

Patient and Family Teaching proficiency*

Patient and Family Teaching frequency*

Electronic Medical *

Electronic Medical proficiency*

Electronic Medical frequency*

Cardiovascular

Proficiency Rating

Frequency Rating

ASSESS

Abnormal Heart Sounds / Murmurs *

Abnormal Heart Sounds / Murmurs proficiency*

Abnormal Heart Sounds / Murmurs frequency*

Capillary Refill *

Capillary Refill proficiency*

Capillary Refill frequency*

PATIENT EXPERIENCE

Acute MI *

Acute MI proficiency*

Acute MI frequency*

Angina *

Angina proficiency*

Angina frequency*

Cardiac Arrest / CPR *

Cardiac Arrest / CPR proficiency*

Cardiac Arrest / CPR frequency*

Cardiomyopathy *

Cardiomyopathy proficiency*

Cardiomyopathy frequency*

Congestive Heart Failure *

Congestive Heart Failure proficiency*

Congestive Heart Failure frequency*

Pacemaker *

Pacemaker proficiency*

Pacemaker frequency*

AICD (Automatic Implanted Cardioverter / Defibrillator) *

AICD (Automatic Implanted Cardioverter / Defibrillator) proficiency*

AICD (Automatic Implanted Cardioverter / Defibrillator) frequency*

Post Cardio - Thoracic Surgery *

Post Cardio - Thoracic Surgery proficiency*

Post Cardio - Thoracic Surgery frequency*

MONITORING

CVP Monitoring *

CVP Monitoring proficiency*

CVP Monitoring frequency*

Arterial Line *

Arterial Line proficiency*

Arterial Line frequency*

Cardiac Monitoring *

Cardiac Monitoring proficiency*

Cardiac Monitoring frequency*

LABS

BNP (Brain Natriuretic Peptide) *

BNP (Brain Natriuretic Peptide) proficiency*

BNP (Brain Natriuretic Peptide) frequency*

Cardiac Enzymes and Isoenzymes *

Cardiac Enzymes and Isoenzymes proficiency*

Cardiac Enzymes and Isoenzymes frequency*

Coagulation Studies *

Coagulation Studies proficiency*

Coagulation Studies frequency*

Troponin *

Troponin proficiency*

Troponin frequency*

Pulmonary

Proficiency Rating

Frequency Rating

ASSESS

Adventitious Breath Sounds *

Adventitious Breath Sounds proficiency*

Adventitious Breath Sounds frequency*

Oxygenation Status *

Oxygenation Status proficiency*

Oxygenation Status frequency*

Rate and Work of Breathing *

Rate and Work of Breathing proficiency*

Rate and Work of Breathing frequency*

PATIENT EXPERIENCE

Acute Pneumonia *

Acute Pneumonia proficiency*

Acute Pneumonia frequency*

Chest Tube *

Chest Tube proficiency*

Chest Tube frequency*

COPD *

COPD proficiency*

COPD frequency*

Pulmonary Edema *

Pulmonary Edema proficiency*

Pulmonary Edema frequency*

Pulmonary Embolism *

Pulmonary Embolism proficiency*

Pulmonary Embolism frequency*

Tracheostomy *

Tracheostomy proficiency*

Tracheostomy frequency*

Tuberculosis *

Tuberculosis proficiency*

Tuberculosis frequency*

MONITORING

Pulse Oximetry *

Pulse Oximetry proficiency*

Pulse Oximetry frequency*

End Tidal CO2 *

End Tidal CO2 proficiency*

End Tidal CO2 frequency*

LABS

ABGs *

ABGs proficiency*

ABGs frequency*

Neurology

Proficiency Rating

Frequency Rating

ASSESS

Level of Consciousness *

Level of Consciousness proficiency*

Level of Consciousness frequency*

Neuro Assessment *

Neuro Assessment proficiency*

Neuro Assessment frequency*

Reflex / Motor Deficits *

Reflex / Motor Deficits proficiency*

Reflex / Motor Deficits frequency*

Visual / Communication Deficits *

Visual / Communication Deficits proficiency*

Visual / Communication Deficits frequency*

PATIENT EXPERIENCE

Alzheimer’s Disease *

Alzheimer’s Disease proficiency*

Alzheimer’s Disease frequency*

Coma *

Coma proficiency*

Coma frequency*

CVA / Stroke *

CVA / Stroke proficiency*

CVA / Stroke frequency*

Neuromuscular Disease *

Neuromuscular Disease proficiency*

Neuromuscular Disease frequency*

Seizure Disorder *

Seizure Disorder proficiency*

Seizure Disorder frequency*

Spinal Cord Injury *

Spinal Cord Injury proficiency*

Spinal Cord Injury frequency*

Traumatic Brain Injury *

Traumatic Brain Injury proficiency*

Traumatic Brain Injury frequency*

Halo Traction / Cervical Tongs *

Halo Traction / Cervical Tongs proficiency*

Halo Traction / Cervical Tongs frequency*

Gastrointestinal

Proficiency Rating

Frequency Rating

ASSESS

Nutritional Status *

Nutritional Status proficiency*

Nutritional Status frequency*

Bowel Sounds *

Bowel Sounds proficiency*

Bowel Sounds frequency*

GI Assessment *

GI Assessment proficiency*

GI Assessment frequency*

PATIENT EXPERIENCE

Abdominal Wounds *

Abdominal Wounds proficiency*

Abdominal Wounds frequency*

Bowel Obstruction *

Bowel Obstruction proficiency*

Bowel Obstruction frequency*

Colostomy *

Colostomy proficiency*

Colostomy frequency*

GI / Esophageal Bleeding *

GI / Esophageal Bleeding proficiency*

GI / Esophageal Bleeding frequency*

Hepatitis *

Hepatitis proficiency*

Hepatitis frequency*

Pancreatitis *

Pancreatitis proficiency*

Pancreatitis frequency*

Liver Failure *

Liver Failure proficiency*

Liver Failure frequency*

Cancer *

Cancer proficiency*

Cancer frequency*

LABS

Serum Amylase *

Serum Amylase proficiency*

Serum Amylase frequency*

Serum Ammonia *

Serum Ammonia proficiency*

Serum Ammonia frequency*

Liver Function Tests *

Liver Function Tests proficiency*

Liver Function Tests frequency*

Renal / Genitourinary

Proficiency Rating

Frequency Rating

ASSESS

Fluid Status *

Fluid Status proficiency*

Fluid Status frequency*

PATIENT EXPERIENCE

Acute Renal Failure *

Acute Renal Failure proficiency*

Acute Renal Failure frequency*

End Stage Renal Failure *

End Stage Renal Failure proficiency*

End Stage Renal Failure frequency*

Hemodialysis *

Hemodialysis proficiency*

Hemodialysis frequency*

Nephrostomy *

Nephrostomy proficiency*

Nephrostomy frequency*

Urinary Tract Infection *

Urinary Tract Infection proficiency*

Urinary Tract Infection frequency*

Suprapubic Cath *

Suprapubic Cath proficiency*

Suprapubic Cath frequency*

Fistula / Shunt *

Fistula / Shunt proficiency*

Fistula / Shunt frequency*

MONITORING

I & O Measurement *

I &O Measurement proficiency*

I &O Measurement frequency*

Fluid Balance *

Fluid Balance proficiency*

Fluid Balance frequency*

LABS

Serum Electrolytes *

Serum Electrolytes proficiency*

Serum Electrolytes frequency*

BUN and Creatinine *

BUN and Creatinine proficiency*

BUN and Creatinine frequency*

Endocrine / Metabolic

Proficiency Rating

Frequency Rating

PATIENT EXPERIENCE

Diabetes *

Diabetes proficiency*

Diabetes frequency*

Blood Glucose *

Blood Glucose proficiency*

Blood Glucose frequency*

Musculoskeletal

Proficiency Rating

Frequency Rating

ASSESS

Pulse / Circulation Checks *

Pulse / Circulation Checks proficiency*

Pulse / Circulation Checks frequency*

PATIENT EXPERIENCE

Amputation *

Amputation proficiency*

Amputation frequency*

Joint Replacement *

Joint Replacement proficiency*

Joint Replacement frequency*

Skeletal / Skin Traction *

Skeletal / Skin Traction proficiency*

Skeletal / Skin Traction frequency*

Cast Care *

Cast Care proficiency*

Cast Care frequency*

Immunology / Hematology / Oncology

Proficiency Rating

Frequency Rating

PATIENT EXPERIENCE

Cancer *

Cancer proficiency*

Cancer frequency*

HIV / AIDS *

HIV / AIDS proficiency*

HIV / AIDS frequency*

Treatment Side Effects - Chemo / Radiation *

Treatment Side Effects - Chemo / Radiation proficiency*

Treatment Side Effects - Chemo / Radiation frequency*

Sepsis *

Sepsis proficiency*

Sepsis frequency*

Wounds / Integument

Proficiency Rating

Frequency Rating

ASSESS

S/S Infection *

S/S Infection proficiency*

S/S Infection frequency*

Staging of Pressure Ulcers *

Staging of Pressure Ulcers proficiency*

Staging of Pressure Ulcers frequency*

Skin Assessment *

Skin Assessment proficiency*

Skin Assessment frequency*

PATIENT EXPERIENCE

Burns *

Burns proficiency*

Burns frequency*

Pressure Ulcers *

Pressure Ulcers proficiency*

Pressure Ulcers frequency*

Surgical Wounds and Drains *

Surgical Wounds and Drains proficiency*

Surgical Wounds and Drains frequency*

Statis Ulcers *

Statis Ulcers proficiency*

Statis Ulcers frequency*

Wounds *

Wounds proficiency*

Wounds frequency*

MONITORING

Skin Breakdown *

Skin Breakdown proficiency*

Skin Breakdown frequency*

Medication / Therapeutic Interventions

Proficiency Rating

Frequency Rating

MEDICATION ADMINISTRATION

Administer IM and SQ Meds *

Administer IM and SQ Meds proficiency*

Administer IM and SQ Meds frequency*

Administer PO Medications *

Administer PO Medications proficiency*

Administer PO Medications frequency*

Administer IVP Medications *

Administer IVP Medications proficiency*

Administer IVP Medications frequency*

Administer IVPB Medications *

Administer IVPB Medications proficiency*

Administer IVPB Medications frequency*

Administer IV Drips and Titration *

Administer IV Drips and Titration proficiency*

Administer IV Drips and Titration frequency*

Administer Meds per Feeding Tubes *

Administer Meds per Feeding Tubes proficiency*

Administer Meds per Feeding Tubes frequency*

IV THERAPY

Assess / Maintain IV *

Assess / Maintain IV proficiency*

Assess / Maintain IV frequency*

Heparin Lock *

Heparin Lock proficiency*

Heparin Lock frequency*

Vascular Access Device - Care / Maintenance *

Vascular Access Device - Care / Maintenance proficiency*

Vascular Access Device - Care / Maintenance frequency*

Peripheral IV Insertion *

Peripheral IV Insertion proficiency*

Peripheral IV Insertion frequency*

BLOOD

Administer Blood / Blood Products *

Administer Blood / Blood Products proficiency*

Administer Blood / Blood Products frequency*

NUTRITION THERAPY

Enteral Feeding Administration *

Enteral Feeding Administration proficiency*

Enteral Feeding Administration frequency*

TPN / Procalamine *

TPN / Procalamine proficiency*

TPN / Procalamine frequency*

Tube Feeding Pumps *

Tube Feeding Pumps proficiency*

Tube Feeding Pumps frequency*

Bolus Tube Feedings *

Bolus Tube Feedings proficiency*

Bolus Tube Feedings frequency*

NGT / SBFT Insertion *

NGT / SBFT Insertion proficiency*

NGT / SBFT Insertion frequency*

PEG / G-Tube *

PEG / G-Tube proficiency*

PEG / G-Tube frequency*

OXYGEN ADMINISTRATION

Nasal Cannula *

Nasal Cannula proficiency*

Nasal Cannula frequency*

Venti Mask *

Venti Mask proficiency*

Venti Mask frequency*

Non - Rebreather Mask *

Non - Rebreather Mask proficiency*

Non - Rebreather Mask frequency*

Ambu - Bag *

Ambu - Bag proficiency*

Ambu - Bag frequency*

Trach Collar *

Trach Collar proficiency*

Trach Collar frequency*

Portable Oxygen Ventilator (IMV, AC, PEEP) *

Portable Oxygen Ventilator (IMV, AC, PEEP) proficiency*

Portable Oxygen Ventilator (IMV, AC, PEEP) frequency*

PAIN MANAGEMENT

Assess Pain Level Tolerance *

Assess Pain Level Tolerance proficiency*

Assess Pain Level Tolerance frequency*

Functional Pain Goal *

Functional Pain Goal proficiency*

Functional Pain Goal frequency*

Epidural Analgesia *

Epidural Analgesia proficiency*

Epidural Analgesia frequency*

Patient Controlled Analgesia *

Patient Controlled Analgesia proficiency*

Patient Controlled Analgesia frequency*

Procedures / Equipment

Proficiency Rating

Frequency Rating

PERFORM / MAINTAIN

Chest Tube Drainage Systems *

Chest Tube Drainage Systems proficiency*

Chest Tube Drainage Systems frequency*

Doppler *

Doppler proficiency*

Doppler frequency*

Dressing Changes *

Dressing Changes proficiency*

Dressing Changes frequency*

Drains (JP - Hemovac - Penrose) *

Drains (JP - Hemovac - Penrose) proficiency*

Drains (JP - Hemovac - Penrose) frequency*

Suctioning (Oral - Naso - Pharnyx) *

Suctioning (Oral - Naso - Pharnyx) proficiency*

Suctioning (Oral - Naso - Pharnyx) frequency*

Tracheostomy Care / Suctioning *

Tracheostomy Care / Suctioning proficiency*

Tracheostomy Care / Suctioning frequency*

Indwelling Urinary Catheter *

Indwelling Urinary Catheter proficiency*

Indwelling Urinary Catheter frequency*

Isolation *

Isolation proficiency*

Isolation frequency*

Wound Vac *

Wound Vac proficiency*

Wound Vac frequency*

Wound Care / Irrigations *

Wound Care / Irrigations proficiency*

Wound Care / Irrigations frequency*

SPECIMEN COLLECTIONS

Finger Stick *

Finger Stick proficiency*

Finger Stick frequency*

Butterfly Stick *

Butterfly Stick proficiency*

Butterfly Stick frequency*

Central - Line Blood Draw *

Central - Line Blood Draw proficiency*

Central - Line Blood Draw frequency*

Clean Catch Urine *

Clean Catch Urine proficiency*

Clean Catch Urine frequency*

Urine Catheter Culture Collection *

Urine Catheter Culture Collection proficiency*

Urine Catheter Culture Collection frequency*

Blood Cultures *

Blood Cultures proficiency*

Blood Cultures frequency*

Venipuncture *

Venipuncture proficiency*

Venipuncture frequency*

24 Hour Urine *

24 Hour Urine proficiency*

24 Hour Urine frequency*

ASSIST

Bedside Invasive Procedures *

Bedside Invasive Procedures proficiency*

Bedside Invasive Procedures frequency*

Bronchoscopy *

Bronchoscopy proficiency*

Bronchoscopy frequency*

Central Line Insertion *

Central Line Insertion proficiency*

Central Line Insertion frequency*

Chest Tube Insertion *

Chest Tube Insertion proficiency*

Chest Tube Insertion frequency*

Endotracheal Intubation *

Endotracheal Intubation proficiency*

Endotracheal Intubation frequency*

Procedure / Moderate Sedation *

Procedure / Moderate Sedation proficiency*

Procedure / Moderate Sedation frequency*

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Skills/Competences

Proficiency

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