Chesapeake Home Health Care JAN 2015 (Revised) 1 ANNUAL/PERIODIC COMPETENCY SKILLS CHECKLIST FOR PEDIATRIC NURSING NAME: TITLE: Evaluation: Clinician ability to demonstrate to the provider’s Nurse Supervisor or designee, on a continuing basis, the ability to carry out competently specified nursing services. This document meets COMAR Regulations 10.09.53.03 – D 2, 4, and 5 PROCEDURE Date Satisfactory Need further Training RN Initials COMMENTS MEDICATION ADMINISTRATION P.O. () () Parenteral () () IV Therapy () () Central Line Care/Dressing () () Venous Access Devices () () IV TPN/Intra Lipids () () CARDIOVASCULAR PROBLEMS Apnea/Bradycardia monitor () () Cardiopulmonary resuscitation of an infant () () Cardiopulmonary resuscitation of a child () () Cardiovascular Assessment () () Blood pressure: a. Doppler () () b. Palpation () () c. Sphygmomanometer () () RESPIRATORY PROBLEMS Assessment of breath sounds () () Change tracheotomy tube () () Care of infant/child on ventilator () () Chest physiotherapy (CPT) () () Tracheotomy care () () Suctioning: a. Tracheal () () b. Nasal () () c. Oral () () CARE OF THE INFANT/CHILD WITH: a. Respiratory Disease () () b. Pneumonia () () c. Brain Injury () () Transcutaneous oxygen monitor (Pulse Oximeter) () () Oxygen saturation monitor () () Ventilation with ambu bag () () Use of respiratory assistance equipment a. Nasal cannula () () b. Oxygen analyzer () () c. Ventilators () () d. C. Pap () () e. Bi Pap () () f. Chest Phisiotherapy Vest () () Weaning of an infant/child from a respirator () () PROCEDURE Date Satisfactory Need RN Initials COMMENTS