Operating Room Skills Checklist

OPERATING ROOM SKILLS CHECKLIST

Name______

Date______

MedCall Northwest, Inc. Operating Room Skills Check List Initial:

OPERATING ROOM SKILLS CHECKLIST

CHECK PROFICIENCY / Scrub / Circulate /

ENDOSCOPIC

Bronchoscopy
Colonoscopy
Culdoscopy
Cystoscopy
Esphagoscopy
Gastroscopy
Hysteroscopy
Laparoscopic:
Appendectomy
Chelecystectomy/
cholangiogram
Colon resection
Hernia repair
Nissen fundoplication
Salpingo-oophorectomy
Tubal ligation
Vaginal hysterectomy
Laryngoscopy & Microlaryngoscopy
Mediastinoscopy
Pelviscopy
Sigmoidoscopy
Thorascoscopy
ENT Scrub Circulate
Acoustic Neuroma
Adenoidectomy
Caldwell - Luc
Closed reduction nasal fracture
Commandeo procedure
Ear Cases:
Mastoidectomy
Myringotomy w/PE tube
insertion
ENT (Continued)
Strapedectomy
Tympanoplasty
Ethymoidectomy
Excision of Salivary gland tumor
Fenestration procedure
Frontal flap sinus procedure
Glossectomy
Laryngectomy
Landibulectomy
Maxillary advancement withip graft
Maxillectomy
Nasal polypectomy
Open reduction:
Facial
Nasal
Tripod
Parotidectomy
Pharyngeal flap procedure
Radial neck dissection
Ranulectomy
Thinoplasty/septoplasty
Selective osteotomy of maxilla/mandible
Sinus endoscopy
Sinusotomy
Submucous resection
Tonsillectomy
Traceostomy
Vocal cord stripping
GYNECOLOGY Scrub Circulate
Caesarean section
Colpotomy
Dilation and Curretage (D&C)

Hysterectomy

Abdominal
Radical
Vaginal
Laproscopy
Marshall Marchetti
Marsupialization Bartholin Cyst

Pelvic

Anterior
Posterior
Total
Ovarian Cystectomy
Radium insertion
Sacral Spinus Fixation
Salpingoplasty
Shirodkar Procedure
Suction Curettage
Tubal Ligation
Tuboplasty/Microspace
Vaginal Reconstruction
Vaginectomy
Vulvectomy
MED/SURG Scrub Circulate
Abdominal perineal resection
Adrenaclectomy
Anal Fissurectomy
Appendectomy
Breast biopsy
Cholecystectomy/Cholangiogram
Colectomy
Colon resection
Colostomy/Ileostomy
Endoscopic procedures
Gastrectomy
Gastroplasty
Hemorrhoidectomy
Hepatic resection
Femoral

Inguinal

Umbilical
MED/SURG (Continued)

Hilatal

Herniorrhaphy
Transabdominal
Transthroacis
Hickman-Groshong/ Portacath Insertion
Hydrocelectomy
Imperforate anus reconstruction
Laveen-Peritoneal Shunt
Lumbar symphatectomy
Minor case set up
Nissed fundoplication
Omphalocele repair
Pancratectomy/pancreatogram
Pilonidal cystectomy
Portal caval shunt
Phloric stenosis
Radical mastectomy
Rectal cases
Saphenous vein ligation & stripping
Sentinel node biopsy
Splenectomy
Tenchkhoff catheter placement
Thyroidectomy
Thyroglossal duct cyst excision
Tracheostomy
Vagotomy
Whipple procedure
NEURO Scrub Circulate
A-V malformation
Anterior cervical fusion
Anterior laparoscopic spine procedures
Burr holes-subdural hematoma
Cartoid endarterectomy
Cartoid ligation
Cervical laminectomy
Cervical sympathectomy
NEURO (Continued)
Clipping of intracranial aneurysm
Cranlectomy for decompression fracture
Cranioplasty-craniotomy
Hypophysectomy
Insertion of nerve stimulators/medication pumps
Laminectomy
Lumbar laminectomy
Meningocele repair
Myelomeningocele repair
Pedicle screw insertion
Posterior lumbar interbody fusion (PLIF)
Shunt procedure/VP, VA/LP
Transphenoid hypothypectomy

Ulnar nerve transfer

Tumor excision
Using stealth equipment
Disectomy
Exterior Cervical Fusion
Ventricular procedure/ventriculoscopy
Ventriculostomy
Vinke tong insertion
OPHTHALMOLOGY Scrub Circulate
Cataract extraction
Corneal transplant
Dacyocystectomy
Dacyocystorhinostomy
Diathermy operation
Enucleation
Iridectomy
Lid and muscle procedures
Orbital implant
Phaco emulsification
Pterygium repair
Recession resection
Repair orbital blowout fracture
OPHTHALMOLOGY
Retina
Scleral buckle
Vierectomy
ORTHOPEDICS Scrub Circulate
Acetabular/pelvic ORIF
Achilles tendon repair
Amputation- leg, arm
Anterior curcudate ligament repair

Application of external fixators

Extremities
Pelvis
Application halo traction

Arthoscopy

Ankle
Elbow
Knee
Shoulder
Arthotomy
Bipolar/unipolar hips
Bunionectomy
Calcaneal reconstruction
Capsulorrhaphy
Carpal tunnel release
Closed reduction fracture
Cup arthoplasty/insertion prosthesis
Dwyer anterior fusion
Fracture table use
Hand surgery with implants
Harrington rod insertion
Heel cord lengthening

Hip compression nails & lag screws

Jewett
Kuntscher rod
Lottes
Rush
Schneider
Zimmer
ORTHOPEDICS (Continued)
Iliac crest bone graft
IM rodding
Insertion austin moor hip prosthesis
Insertion tibial plateau prosthesis

Intramedullary rods

Exraction
Femoral
Humeral
Insertion
Supracondylar
Tibial
Laminectomy
Nailing procedures
Olecranon bursa (excision of)
Patellectomy
Putti Platt/Bankartt procedure/rotator cuff repair
Reduction with compression sets
Reimplantation of digits
Repair hammer toes
Sacro-iliac joint screws
Sharrard procedure
Spica cast, application of
Spinal fusion
Swanson finger prosthesis, insertion of
Tendon implants
Tendon transplants, hand and foot
Total joint replacement/revision
Hip
Knee
Shoulder
Zimmer hip compression

PLASTICS Scrub Circulate

Abdominal lipectomy
Blepharoplasty
Dermabrasion
PLASTICS (Continued
Mentoplasty
Myelomeningocele repair
Otoplasty

Mammoplasty

Augmentation
Reduction
Tramflaps with reconstructive
Pedicle grafts
Rhinoplasty
Scar revisions
Split thickness skin grafting
Tissue expanders

THORACIC/OPEN HEART Scrub Circulate

ASD/(Arterial Septal Defect)
CABG
CME
Cervial rib excision
Chamberlain procedure
Closed thoracotomy
Correction pectus excavatum
Esophagetomy
Heller procedure
Mitral commissurotomy

Open heart valve replacement

Mitral aortic valve replacement
Patent ductus arterisus
Septal defect repairs
Tetrology of Fallot

Pacemaker implantation

Endocardial
Myocardial
Pericardictomy
Pneumonectomy/lobectomy
Port-a-cath insertion
Resection coarctation aorta
Rib resection
Thoracoplasty
Trachael resection

THORACIC/OPEN HEART

Transthoracic diaphragmatic hemiorrhaphy
Transplant experience

TRANSPLANT Scrub Circulate

Bone
Bone marrow
Corneal
Harvesting
Heart
Kidney
Liver
Lung
Multi organ
Pancreas
Skin
TRAUMA Scrub Circulate
Burns
Gunshot wounds
Abdominal
Chest
Head
Motor vehicle accidents/multiple injuries
Traumatic amputations
UROLOGY Scrub Circulate
Adult circumcision
Cystectomy
Cystoscopy/lureteroscopy
Hypospadias repair
Implants: penile, testicular
Lithrotipsy
Nephrectomy
UROLOGY (Continued)
Nephrolithotomy
Orchiopexy
Perineal prostatetomy
Subrapubic prostateomy
Pyelolithotomy
Pyeloplasty
Radical node dissection
Scott incontinence device
Scott penile prosthesis
TURP
Ureterolithotomy
Vasectomy
Vasovasotomy
Waterhouse procedure
VASCULAR Scrub Circulate
A-V access graft
Aortic aneurysm
Aortic/Illiac/Femoral graft
Brachio axillary dacron fistula
Peripheral vascular bypass
Resection carotid aneurysm with graft
Tenchkhoff catheter placement
Carotid endarterectomy
Femoral-popliteal graft
Leaking ruptured aneurysm
Mohin-Uddin umbrella
Thrombectomy/embolectomy
Vena cava filter/umprella
Vena cava ligation

MedCall Northwest, Inc. Operating Room Skills Check List Initial:

OPERATING ROOM SKILLS CHECKLIST

My OR experience is primarily in:
OR Nurse / Year(s) / Ortho / Year(s)
Endoscopy / Year(s) / Plastic / Year(s)
ENT / Year(s) / Thoracic/open heart / Year(s)
Gynecology / Year(s) / Transplant / Year(s)
Med/Surg / Year(s) / Trauma / Year(s)
Neuro / Year(s) / Urology / Year(s)
Ophthalmology / Year(s) / Vascular / Year(s)
Please check the box/es below for each group in which you have provided age-appropriate care:
Newborn/Neonate (birth-30days) / Adolescents (12-18 years)
Infant (30 days-1 year) / Young adults (18-39 years)
Toddler (1-3 years) / Middle adults (39-64 years)
Preschooler (3-5 years) / Older adults (64-79 years)
School age children (5-12 years) / Elderly adults (80+ years)

Please enter your full legal name as it appears on yourSocial Security Card.

First Name* Middle Name * Last Name*

Last 4 of Social Security Number * Date * (mm/dd/yyyy)

* Electronic Signature Agreement. By signing and typing the last 4 of your Social Security Number (SSN) on this document, you are signing the Document electronically. You agree your electronic signature is the legal equivalent of your manual signature on the Agreement

Reviewed by:______Title:______

Registered Nurse Job Description Operating Room

Name: ______Date: ______

Essential duties and responsibilities include:

One year general OR experience in a hospital setting.
Current RN License (in good standing, without disciplinary investigation or actions).
Current BCLS.
Ability to take call.
Ability to circulate all types of cases including general, ortho, plastics, ENT, OB/Gyn, etc.
Able to work in and maintain sterile environment.
Able to care for acute and chronically ill patients.
Knowledge of surgical procedures and appropriate consent forms.
Basic lV and central line skills.
Basic understanding of pre-op preps.
Ability to function in team setting.
Care of patients of all ages, including adult and pediatric, if applicable.
Other duties, as assigned.

Please enter your full legal name as it appears on yourSocial Security Card.

First Name* Middle Name * Last Name*

Last 4 of Social Security Number * Date * (mm/dd/yyyy)

Reviewed by:______Title:______

MedCall Northwest, Inc. Operating Room Skills Check List Initial: