Wound Care & Ostomy Skills Checklist

Fill Out and Submit your Skills Checklist

(Wound Care & Ostomy)

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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.

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

Acute Care – Adult:

★★★★

Clinic – Adult:

★★★★

SNF/LTAC/Subacute:

★★★★

Hospice / Palliative Care:

★★★★

Acute/Long Term Care – Pediatrics:

★★★★

Clinic – Pediatrics:

★★★★

PRESSURE ULCERS

Assessment:

★★★★

Staging:

★★★★

Prevention/ Risk Assessment Tools – Adult:

★★★★

Prevention/ Risk Assessment Tools - Pediatrics:

★★★★

Support Surface Selection:

★★★★

NEUROPATHIC ULCERS

Assessment:

★★★★

Management:

★★★★

VENOUS STASIS ULCERS

Assessment:

★★★★

Management:

★★★★

PERIPHERAL ARTERIAL ULCERS

Assessment:

★★★★

Ankle Brachial Index:

★★★★

Management:

★★★★

OTHER WOUNDS

Fistulae – Pouching / Skin Care:

★★★★

Skin Care/ Management of Drains:

★★★★

WOUND DEBRIDEMENT

Autolytic:

★★★★

Enzymatic:

★★★★

Mechanical:

★★★★

Sharp:

★★★★

DRESSINGS/ TREATMENTS

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:

★★★★

COLOSTOMY / ILEOSTOMY

Ostomy Equipment Selection:

★★★★

Continence Skin Care Management:

★★★★

Loop with Rod Stoma:

★★★★

End Stoma:

★★★★

Mucous Fistula:

★★★★

Double Barrel Stoma:

★★★★

Irrigation:

★★★★

Ileal Lavage:

★★★★

CONTINENT ILEOSTOMY

Knock pouch:

★★★★

Pelvic Pouch:

★★★★

UROSTOMY / CONTINENT

Catherization for C&S:

★★★★

Knock Pouch:

★★★★

Neobladder:

★★★★

CONTINENCE THERAPEUTIC DEVICES

Vaginal Cones:

★★★★

Penile Clamps:

★★★★

Male External Catheters:

★★★★

Internal Urethral Inserts:

★★★★

Catheters – Mgmt & Self Care Teaching:

★★★★

Magnetic Therapy:

★★★★

Urinary Incontinence Program:

★★★★

Fecal Incontinence Program:

★★★★

BURNS

Burn Management:

★★★★

PROFESSIONAL KNOWLEDGE AND SKILLS

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:

★★★★

OTHER / MISC.

Pain Management Assessment of Pain Levels without Intervention:

★★★★

Pain Management Response Assessment with Intervention:

★★★★

Experience: Charge Duty:

★★★★

Experience: Preceptor:

★★★★

AGE SPECIFIC CARE

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):

★★★★