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SCHOOLS
TELEPRACTICE

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Employees
Employers
Contact
Blog

HEALTHCARE
- Nursing
- Therapy
SCHOOLS
TELEPRACTICE

Dialysis 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)

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)

"*" indicates required fields

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)

Full Name*

Email*

Todays Date*

MM slash DD slash YYYY

Age Of Patients Cared For

Newborn/Neonate (birth to 30 days)

0

1

2

3

Infant (31 days to 12 months)

0

1

2

3

Toddler/Preschool (13 months to 5 years)

0

1

2

3

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

0

1

2

3

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

0

1

2

3

Older Adults/Elderly (65+ years)

0

1

2

3

General Skills

Care of Patient in Restraints

0

1

2

3

Automated Med Dispensing Systems

Accudose

Metro

Omnicell

Promanager Rx

Pyxis

N/A

Other Automated Med Dispensing Systems:

Electronic Documentation

Allscripts

Care360

Cerner

eCLinicalWorks

EPIC

MACLAB

McKesson

Meditech

PACS

Soarian

N/A

Other Electronic Documentation:

IV Pumps

Alaris

Alibaba

Bard

Baxter

Braun

CADD

IVAC

Zynomed

N/A

Other IV Pumps:

Peripheral IV Insertion, Care and Maintenance

0

1

2

3

Access/Management of Implanted Ports

0

1

2

3

Access/Management of Central Lines (CVL, Hickman, Broviac, Groshong, etc.)

0

1

2

3

Administration of Blood/Blood Products

0

1

2

3

Knowledge of "Do Not Use Abbreviations"

0

1

2

3

Do you have charge/supervisor experience?

Yes

No

Knowledge of current Joint Commission National Patient Safety Goals

0

1

2

3

Knowledge/familiarity with HCAHPS scores

0

1

2

3

Hemodialysis Setting / Procedures Experience

Acute / Inpatient Dialysis

0

1

2

3

Apheresis

0

1

2

3

Chronic / Outpatient Dialysis

0

1

2

3

Dialysis Home Care

0

1

2

3

Pediatric Dialysis

0

1

2

3

Predialysis Nursing Assessment

0

1

2

3

Plasmapheresis

0

1

2

3

Care Of Patient With

Nephrostomy Tube

0

1

2

3

A V Fistula / A V Graft

0

1

2

3

Tunneled / Non-Tunneled Catheter

0

1

2

3

Insertion of urinary catheter (straight cath or foley)

0

1

2

3

Ileal Conduit

0

1

2

3

Supra-Pubic Catheter

0

1

2

3

Renal Failure

0

1

2

3

TURP

0

1

2

3

Peritoneal Dialysis

0

1

2

3

Hemodialysis

0

1

2

3

Set Up / Initiate Dialysis Treatment

Anticoagulation

0

1

2

3

Bicarbonate Dialysate

0

1

2

3

Conductivity Testing

0

1

2

3

Priming Dialyzer

0

1

2

3

Checks for Machine / Alarm Settings

0

1

2

3

Prep Vascular Access

0

1

2

3

Fistula Gortex / Bovine Graft

0

1

2

3

Dialysis

0

1

2

3

Collect Blood Specimens

0

1

2

3

Cannulating Buttonholes

0

1

2

3

Continuous Renal Replacement Therapy (CRRT)

0

1

2

3

Peritoneal Dialysis

0

1

2

3

Assess Patient And Equipment During Dialysis

Volume Status

0

1

2

3

Vascular Access Function

0

1

2

3

Arterial and Venous Pressures

0

1

2

3

Blood Flow Rate

0

1

2

3

Subjective Response to Treatment

0

1

2

3

Management of Anticoagulation

0

1

2

3

Conductivity

0

1

2

3

Ultrafiltration Calculation

0

1

2

3

Operation of Myron L. Meter

0

1

2

3

Administration of Mannitol

0

1

2

3

Sequential Ultrafiltration / PUF

0

1

2

3

Documentation of Dialysis Treatment

0

1

2

3

Management Of Patient With

Anticoagulation Emergency

0

1

2

3

Anemia

0

1

2

3

Air Embolus

0

1

2

3

Cardiopulmonary Arrest

0

1

2

3

Chest Pain

0

1

2

3

Clotted Access / Poor Blood Flow Rate from Catheter

0

1

2

3

Disequilibrium syndrome

0

1

2

3

Filter Blood Leak

0

1

2

3

Fluid Overload

0

1

2

3

Hemolysis

0

1

2

3

Hypertension

0

1

2

3

Hypotension

0

1

2

3

Hyperkalemia

0

1

2

3

Muscle Cramps

0

1

2

3

Neuropathy

0

1

2

3

Pericarditis

0

1

2

3

Pyrogenic Reaction

0

1

2

3

Seizures

0

1

2

3

Machine Alarm Troubleshooting Procedures

Blood Leak Alarm

0

1

2

3

Arterial Pressure Alarm

0

1

2

3

Venous Pressure Alarm

0

1

2

3

Conductivity Alarm

0

1

2

3

Ultrafiltration Alarm

0

1

2

3

High Temperature Alarm

0

1

2

3

Air / Foam Detector Alarm

0

1

2

3

Power Failure Alarm

0

1

2

3

Blood Pump Alarm

0

1

2

3

LIST ANY CERTIFICATIONS HELD:

Other:

Equipment Used

Baxter

0

1

2

3

Fresnius

0

1

2

3

Cobe

0

1

2

3

Gambro

0

1

2

3

Phoenix

0

1

2

3

T Machine

0

1

2

3

Other:

awards updated 2022

SIA_CM_Member_2018

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