WOUND CARE & OSTOMY SKILLS CHECKLIST

Wound Care & Ostomy Skills Checklist

This checklist was electronically signed on (Today’s date)

Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

Proficiency Scale:

1 . No Experience

2 . Need Training

3 . Able to perform with supervision

4 . Able to perform independently

WORK SETTINGS

PRESSURE ULCERS

NEUROPATHIC ULCERS

Assessment
Management

VENOUS STASIS ULCERS

Assessment
Management

PERIPHERAL ARTERIAL ULCERS

OTHER WOUNDS

Fistulae – Pouching / Skin Care
Skin Care/ Management of Drains

WOUND DEBRIDEMENT

DRESSINGS/ TREATMENTS

COLOSTOMY / ILEOSTOMY

CONTINENT ILEOSTOMY

Knock pouch
Pelvic Pouch

UROSTOMY / CONTINENT

CONTINENCE THERAPEUTIC DEVICES

BURNS

Burn Management

PROFESSIONAL KNOWLEDGE AND SKILLS

OTHER / MISC.

AGE SPECIFIC CARE

I hereby certify that ALL information I have provided on this skills checklist and all other documentation is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

Acute Care – Adult
Clinic – Adult
SNF/LTAC/Subacute
Hospice / Palliative Care
Acute/Long Term Care – Pediatrics
Clinic – Pediatrics

Assessment
Staging
Prevention/ Risk Assessment Tools – Adult
Prevention/ Risk Assessment Tools -Pediatrics
Support Surface Selection

Autolytic
Enzymatic
Mechanical
Sharp

Hydrogels
Hydrocolloids
Silver Products
Foams
Alginates
Vacuum Assisted Closure
Growth Factors
Skin Substitutes
Hyperbaric Oxygen Therapy
Wound Cultures
Electrical Stimulation
Enzymatic Debriding Agents
Mist Therapy

Ostomy Equipment Selection
Continence Skin Care Management
Loop with Rod Stoma
End Stoma
Mucous Fistula
Double Barrel Stoma
Irrigation
Ileal Lavage

Vaginal Cones
Penile Clamps
Male External Catheters
Internal Urethral Inserts
Catheters –Mgmt & Self Care Teaching
Magnetic Therapy
Urinary Incontinence Program
Fecal Incontinence Program

National Patient Safety Goals/ Core Measures
Patient Family Teaching
Age Specific/Population Based Care
Isolation Precautions
Infection Precautions
Pain assessment & Management
Interpretation & Communication of Lab Values
EMR
EPIC
Cerner
Eclipsys
McKesson
Other Computerized System
Computerized Physician Order Entry
Bar coding for Medication
Culture

Pain Management Assessment of Pain Levels without intervention
Pain Management Response Assessment with Intervention
Experience: Charge Duty
Experience: Preceptor

Infant (Birth to 1 year)
Toddler (1-3 years)
Pre-school (3-6 years)
School Age (6-12 years)
Adolescent (12-18 years)
Young Adult (18-30 years)
Mature Adult (30-60 years)
Elderly (>60 years)

Assessment
Ankle Brachial Index
Management

Catherization for C&S
Knock Pouch
Neobladder