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SCHOOLS
TELEPRACTICE

About Us
Employees
Employers
Contact
Blog

HEALTHCARE
- Nursing
- Therapy
SCHOOLS
TELEPRACTICE

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)

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

Blood draws from PICC line, Central line

0

1

2

3

PCA/Epidural pumps

0

1

2

3

Administration of Blood/Blood Products

0

1

2

3

Occluded ports or catheters

0

1

2

3

NG tube insertion

0

1

2

3

Enterostomy/ostomy care

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

Hospice Care

Admit and Initial Assessment

0

1

2

3

Infection control

0

1

2

3

Universal precautions

0

1

2

3

Isolation

0

1

2

3

Reverse Isolation

0

1

2

3

Minimize fall risks

0

1

2

3

Restraints

0

1

2

3

Lift/transfer devices

0

1

2

3

Interpretation and communication of lab values

0

1

2

3

Non-pharmacologic interventions

0

1

2

3

Blood Glucose monitoring

0

1

2

3

Plan Of Care

Advanced directives

0

1

2

3

Set Goals with Pt/family

0

1

2

3

Resources for Pt/family

0

1

2

3

Pt teaching self care

0

1

2

3

Quality of life issues

0

1

2

3

Death and dying counseling

0

1

2

3

Stages of grieving

0

1

2

3

Pt care after death

0

1

2

3

Facilitate family/cultural rituals/rites

0

1

2

3

Spiritual Care

0

1

2

3

Pronouncement of death

0

1

2

3

Coordinate mortuary services

0

1

2

3

Compliance

Scope and frequency of services

0

1

2

3

Medicare/State regulations for hospice

0

1

2

3

Document progression of decline

0

1

2

3

DME authorization and documentation of need/order

0

1

2

3

OASIS-C

0

1

2

3

Pain Management

Pain assessment/management

0

1

2

3

Moderate sedation

0

1

2

3

Administration of narcotics/sedatives

0

1

2

3

PAINAD Scale for nonverbal patients

0

1

2

3

Continuous narcotic infusion

0

1

2

3

Transdermal agents

0

1

2

3

TENS units

0

1

2

3

Alternative therapies

0

1

2

3

Titration of opioids

0

1

2

3

Family management of medications

0

1

2

3

Disposal of Medications

0

1

2

3

Equianalgesic Conversion Formula

0

1

2

3

Wound Care

Speciality beds

0

1

2

3

Prevention of pressure ulcers

0

1

2

3

Staging and care of pressure ulcers

0

1

2

3

Wound care

0

1

2

3

Use of Woundvac

0

1

2

3

Positioning Techniques

0

1

2

3

Educate Pt/Family on positioning/shearing

0

1

2

3

Medications

Bar coding for medication administration

0

1

2

3

Insulin administration

0

1

2

3

Anticoagulation therapy

0

1

2

3

Medication reconciliation

0

1

2

3

Oral Medication

0

1

2

3

Topical Medication

0

1

2

3

Opthalmic/Otic Medication

0

1

2

3

Rectal/vaginal medication

0

1

2

3

IM/SQ medication

0

1

2

3

IV push medications

0

1

2

3

IVPB medications

0

1

2

3

Continuous infusions

0

1

2

3

PPN

0

1

2

3

TPN

0

1

2

3

J-tube/G-tube feedings

0

1

2

3

Physical Assessment

Cardiovascular assessment

0

1

2

3

Respiratory assessment

0

1

2

3

Use of oxygen

0

1

2

3

Use of Incentive Spirometer

0

1

2

3

Nasal cannula/face mask

0

1

2

3

Nebulizers

0

1

2

3

Use of ambu bag

0

1

2

3

Pulse oximetry

0

1

2

3

Oral and nasotracheal suctioning

0

1

2

3

Tracheostomy care

0

1

2

3

Neuro assessment

0

1

2

3

Sleep assessment

0

1

2

3

Seizure precautions

0

1

2

3

Gastrointestional assessment

0

1

2

3

Nutrition assessment

0

1

2

3

NG tube insertion/management

0

1

2

3

Feeding tube insertion/management

0

1

2

3

PEG/gastrostomy/ jejunostomy management

0

1

2

3

Ostomy care

0

1

2

3

Foley catheters

0

1

2

3

Suprapublic tube

0

1

2

3

Nephrostomy

0

1

2

3

Shunts/fistulas

0

1

2

3

Pediatrics

Developmentally appropriate assessment

0

1

2

3

parent/sibling support

0

1

2

3

pediatric support team collaboration

0

1

2

3

Fatigue

0

1

2

3

Constipation

0

1

2

3

Nausea/vomiting

0

1

2

3

Certifications

CHPN

Yes

No

ACHPN

Yes

No

CHPPN

Yes

No

awards updated 2022

SIA_CM_Member_2018

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