OR Nurse - Scrub 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)

MM slash DD slash YYYY

Scrub Experience With The Following Ages:

Newborn/Neonate (birth to 30 days)
Infant (31 days to 12 months)
Toddler/Preschool (13 months to 5 years)
School Age Child/adolescent (6 years to 18 years)
Young Adults/Middle Adult (19 years to 64 years)
Older Adults/Elderly (65+ years)

General Skills

Automated Med Dispensing Systems
Electronic Documentation
Peripheral IV Insertion, Care and Maintenance
IV Pumps
Access/Management of Implanted Ports
Access/Management of Central Lines (CVL, Hickman, Broviac, Groshong, etc.)
Time Out Procedure Pre-Op
Knowledge of "Do Not Use Abbreviations"
Do you have charge/supervisor experience?
Knowledge of current Joint Commission National Patient Safety Goals
Knowledge/familiarity with HCAHPS scores

General Surgery

Abdominal Perineal Resection
Bowel Resection
Cholecystectomy
Gastrectomy
Herniorrhaphy-Femoral/Inguinal, ventral, umbilical
Hiatal Herniorrhaphy-Transabdominal
Laparoscopic General Surgeries
Organ Procurement
Radical Mastectomy
Breast biopsy
Appendectomy
Gastric Bypass
Splenectomy
Thyroidectomy
Tracheostomy

Laparoscopic Procedures

Cholecystectomy
Appendectomy
Hysterectomy
Hernia Repair
Colon Resection

Gynecology

Cesarean Section
Dilation & Curettage
Hysterectomy-Vaginal
Hysterectomy-Abdominal
Laser Surgery
Salpingo-Oopherectomy
Tubal Ligation
Vaginectomy
Vaginal Reconstruction

G.u. And Cysto

Circumcision
Cystoscopy/Cystostomy
Cystectomy
Hypospadius Repair
Lithotripsy
Nephrectomy
Orchiectomy
Penile Implant
Prostatectomy
Ureterolithotomy
T.U.R.P./T.U.R.B.
Vasectomy

Orthopedic

Anterior Cruciate Ligament Reconstruction
Carpal Tunnel surgery
Arthroscopy/Arthrotomy
Closed Pinning & Reduction of Extremities
External Compression Devices
Total Joint Replacement - Knee, Hip
Spinal Fusion-Harrington Rods
Spica Cast Application
O.R.I.F.-Shoulder, Hip, Humerus etc.
Patellectomy
Tendon Implants & Reanastomosis

Neurosurgery

Anterior Cervical Fusion
Burrholes for Subdural Hematoma
Craniotomy
Laminectomy
Shunt Procedures-VP/VA

Plastics

Abdominoplasty/Abdominal Lipectomy
Augmentation Mammoplasty
Cleft Lip/Palate Repair
Facelift
Liposuction
Otoplasty
Rhinoplasty
Reduction of Facial Fracture
Scar Revision
Skin Meshing
Split Thickness Skin Grafting

Eye

Excision of Chalazion
Canthotomy
Correction of Ectropian/Entropian
Corneal Transplant
Enucleation
I.O.I. Implants
Lacrimal Duct Probing
Refractive Keratoplasty
Repair of Retinal Detachment
Vitrectomy

Ear, Nose & Throat

Caldwell-Luc
Ethymoidectomy
Frontal Flap Sinus Procedure
Laryngectomy
Open Reduction Facial Fractures
Radical Neck
Tonsillectomy & Adenoidectomy
Myringotomy
Mastoidectomy
Tympanoplasty
Stapedectomy
Nasal Polypectomy
Laryngoscopy

Thoracic

Hiatal Hernia
Pneumonectomy/Lobectomy
Esophagogastrectomy
Thoracotomy
Endoscopic Thoracic Procedures
Lung/Wedge Resection

Endoscopy

Bronchoscopy
Upper Endoscopy (EGD)
Cystoscopy
Gastroscopy
Colonoscopy

Cardiovascular

A-V Shunts
Aortic Aneurysm, Abdominal
Aorto-Femoral-Pop Bypass Graft
Cardiac Valve Replacement
Coronary Artery Bypass Graft-on pump
Coronary Artery Bypass Graft-off pump
Endarterectomy-Carotid/Femoral
Femoral-Popliteal Bypass
Permanent Pacemaker Insertion
Intra-Aortic Balloon Pump Catheter
Patent Ductus Repair
Pericardial Windows
Portasystemic Shunt
Repair of Septal Defects
Thrombectomy
Vena Cava Ligation

Transplants

Pancreas
Heart
Lung
Liver
Kidney
Eye

Equipment

Robotics
Fracture Tables
Video Systems
CUSA
Cell Saver
PACS Diagnostics
Electrocautery
Drills
Stapling Devices
Ventilators
Cardiac Monitors
Stapling Devices

Sterilization Of Equipment

Log
Biological Indicators
Autoclave Operation
High Level
STERIS
Steam
Gas
Flash