Urgent Care/Clinic Skills Checklist

Name______

Date______

CHECK PROFICIENCY / 1 / 2 / 3 / 4 /

PATIENT’S RIGHTS

Communicates and obtains information while respecting the rights and privacy and confidentiality of information in accordance with the Health Insurance. Portability and Accountability Act of 1996 (HIPAA)
Involves the patient and family and respects their role in determining the nature of care to be provided, including Advance Directives.
Complies with nursing staff responsibility included in the hospital policy related to Organ Donation.
Meets patient and family’s needs regarding communication, including interpreter services.
Provides accurate information to patient and families in a timely manner.
CARDIOVASCULAR
Assessment
Auscultation/Irregular Heart Sounds
Peripheral Edema
PQRST Assessment
Interpretation of Labs/Tests
EKG
Lab Test (Cardiac Enzymes Troponin, BNP)
Equipment & Procedures
Arrhythmia Interpretation
12 Lead Set Up
12 Lead Basic Interpretation
Defibrillation
External Pacer

Care of Patients with

Chest Pain/ACS
Arrhythmias
CHF
AED
Cardiac Arrest/CPR
CHECK PROFICIENCY / 1 / 2 / 3 / 4 /
CARDIOVASCULAR /

Medications

Nitroglycerin
Morphine
Heparin
ALS (Epinephrine, Atropine, Anti-Arrhythmics)

PULMONARY

Assessment

Abnormal Breath Sounds (Wheezing, Stridor, Crackles)
Abnormal Breathing Pattern (Rapid, Labored, Slow)

Interpretation of Lab/Tests

Pulse Oximetry
ABGs
Equipment & Procedures
Oxygen Therapy (Nasal Cannula, Face Mask)
Manual Resuscitation Bag (MRB, Ambu Bag)
Metered-Dose Inhaler (MDI
Nebulizers

Care of Patients with

Aspiration
Asthma/Reactive Airway Disease
COPD
Pneumonia
Pulmonary Edema
Pulmonary Embolism

Medications

Bronchodilators
Steroids
Diuretics

NEUROLOGICAL

Assessment

Signs & Symptoms of Stroke
Altered LOC
Equipment & Procedures
Assist with Lumbar Puncture
Cervical Collar

Spinal Immobilization

CHECK PROFICIENCY / 1 / 2 / 3 / 4 /
NEUROLOGICAL (Continued)
/
Care of the Patient with
/
Head Injury /
Meningitis /
Migraine /
Seizures /
TIA/Stroke /

Medications

/
Imitrex (Sumatriptan Succinate) /
Phenobarbital /
Dilantin (Phenytoin) /
Depakote /
Analgesic /

ORTHOPEDICS

/

Assessment

/
Range of Motion /
Color, Warmth, Movement, Sensation /
Fracture/Dislocation /

Equipment & Procedures

/
Apply Splints /
Assist with Casting /
Assist with Reduction of Dislocaton /
Spinal Immobilization /
Transfer Boards /

Care of the Patients with

/
Casts/Splints /
Dislocation /
External Appliance /
Sprain/Fracture /

Medications

/
Analgesia/Sedation /
GASTROINTESTINAL /

Assessment

/
Bowel Sounds /
Distention /
Fluid Balance /
Nutritional Status /
Equipment & Procedures /
Enemas /
Gastric Lavage /
G-Tubes /
NG Tubes /

Care of Patient with

/
Colostomy /
CHECK PROFICIENCY / 1 / 2 / 3 / 4 /
GASTROINTESTINAL (Continued) /
Care of the Patients with /
Constipation/Impaction /
Diarrhea
G-Tube (Reinsertion/Replacement)
Nausea/Vomiting

Medications

Ipecac
Charcoal
Antiemetics
Antispasmodics

RENAL/GENITOURINARY

Assessment

Fluid Status
Shunt/Fistula (Thrill/Bruit)
Interpretation of Labs
BUN/Creatinine/Electrolytes

Equipment & Procedures

Urine Dipstick/C&S
Placement & Management of Bladder Catheters
Care of the Patient with
Pyelonephritis/UTI
Obstruction
Renal Calculi
Renal Trauma
Testicular Torsion
Priapism

Medications

Antibiotics

ENDOCRINE/METABOLIC

Assessment

Hypo/Hyperglycemia
Interpretation of Labs
Blood Gluscose
Urine Ketones
Equipment & Procedures
Bedside Blood Glucose Monitoring

Care of the Patient with

Hypoglycemia/Insulin Shock
Hyperglycemia/DKA

Medications

Dextrose
Insulin
Oral Hypoglycemics
CHECK PROFICIENCY / 1 / 2 / 3 / 4
EENT
Assessment
Visual Acuity
Foreign Body
Enlarged Tonsils
Equipment & Procedures
Ear Irrigation/Removal Foreign Body
Eye Injury/Foreign Body/Detached Retina
Assist with Removal of Nasal Foreign Body
Epistaxis
Set Up/Assist Cautery
Set Up Slit Lamp

Medication

Silver Nitrate
Liquid Cocaine
Anti-Hypertensive

INFECTIOUS DISEASE

Assessment

Communicable Disease
Interpret Culture Results

Equipment & Procedures

Obtain Cultures
Fever Management
Isolation
Reverse Isolation/Hepa Filter
Use of Personal Protective Equipment
Care of the Patient with
Communicable Disease
Infectious Disease
Immunosuppression/Neutropenia

Medication

Antibiotics
Antivirals
WOUND MANAGEMENT
Burn Care
Dressing Change
Wound Repair (Staples/Sutures, etc)

PAIN MANAGEMENT

Assessment of Pain Level/Use of Pain Scale
Assessment of Response to Pain Management Interventions
CHECK PROFICIENCY / 1 / 2 / 3 / 4
PAIN MANAGEMENT (Continued)
Monitoring of Patients after Pain Medications
Comfort Care
Moderate Sedation
PSYCHIATRIC

Assessment

Behavior
Drug/ETOH
Risk for Violence
Equipment & Procedures
Managing Threatening/violent Behavior
Psychiatric Hold
Care of the Patient with
Drug OD
ETOH OD
Depression/Anxiety
Restraints
Suicide Risk

Medications

Antipsychotics/Antidepressants
Reversal Agents
WOMAN’S HEALTH

Assessment

Vaginal Bleeding
Doppler/Fetal Heart Tones
Ectopic Pregnancy
Equipment & Procedures
Obtain Cultures
Pelvic Tray
Care of the Patient with
Ectopic Pregnancy
Hemorrhage
Pelvic Inflammatory Disease
Placenta Abruptio/Previa
Precipitous Delivery
Pregnancy-Induced Hypertension
Spontaneous Abortion

PEDIATRICS

Child Abuse Recognition/Reporting
Shaken Baby Syndrome
CHECK PROFICIENCY / 1 / 2 / 3 / 4
PEDIATRICS (Continued)
Obtaining Consent to Treat

Assessment

Normal VS for age groups
Use of Dynamap/Doppler Leg Cuffs for B/P
Failure to Thrive
Equipment & Procedures
Assist with Fracture Stabilization
Cooling/Warming Measures
Draw Labs (Venous/Butterfly)
Ear Care-Assist with Cleaning/Wash, Insert Ear Drops
IM/SQ Medications in Pediatric Patients
Obtain RSV Culture
Obtain Urine Culture (Cath/Bag)
Lumbar Puncture
Papoose Board/Therapeutic Hold
Start IV in Pediatric Patient
Care of the Patient with
Abdominal Pain
Aspiration
Asthma/Reactive Airway Disease
Burns
Dehydration
Epiglottitis
Fever
Foreign Object
Fracture
Head Injury
Hypo/Hyperglycemia
Hypo/Hyperthermia
Lacerations
Near Drowning
Nursemaid’s Elbow
Medications (Others in System Specific Areas)
Ipecac/Charcoal
Bronchodilators/Nebulizers
Fluid Replacement

MISCELLANEOUS

Intake Triage
National Patients Safety Goals
AMA procedures
CHECK PROFICIENCY
/ 1 / 2 / 3 / 4
MISCELLANEOUS (Continued)
Disaster Management
EMR
Cerner
Eclipsys
McKessson
Meditech
Allscripts
Other Computerized System
Computerized Physician Order Entry
Bar Coding Medication Administration
Other List:
EMR Conversion Yes No

MCNW-F-007, R3 (8/04) Page 1 of 5

Urgent Care/Clinic Skills Checklist

CHECK PROFICIENCY / 1 / 2 / 3 / 4

AGE SPECIFIC EXPERIENCE Care of patients in these age ranges:

Neonatal (birth to 1 month)
Infant (1 month to 1 year)
Pediatric (1 year to 12 years)
Adolescent (12 years to 18 years)
Adult (18 years to 65 years)
Geriatric (65 years and older)
Experience Areas, Record Years/Months of Previous Experience. (Check all that apply.)

Adults

Yrs.Physician's Office

Yrs.Clinic

Yrs.Urgent Care

Visits/Day:Emergency Dept - Yrs:

Pediatrics

Yrs.Physician's Office

Yrs.Clinic

Yrs.Urgent Care

Visits/Day:Emergency Dept - Yrs:

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 *

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MCNW-F-007, R3 (8/04) Page 1 of 5