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Competency/Skills Self-Appraisal: EKG Technician

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Name

3= Very Competent > 1yr Exp.

_________________________________ Date

Please check the column that applies to your skill level: 2=Some Help needed <1 yr. Exp. 1=Need Direction <6 months Exp. 0=Never Done

SKILLS

BCLS EKG Technician Expires: Date certified:

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SKILLS

5. CARDIOVASCULAR SYSTEM KNOWLEDGE: Coronary circulation Vascular system Conduction system CHF Ischemia Pulmonary Hypertension Systemic hypertension Diseases of the aorta 6. ELECTROCARDIOGRAM: Application of leads Interpretation Monitoring Arrhythmias 7. CARDIOVASCULAR ELECTROPHYSIOLOGY: Cardiac cycle

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Other Certification (specify): ____________________________ Computerized Charting System (specify) __________________ 1. AGE SPECIFIC PRACTICE CRITERIA: Newborn/Neonate (birth to 30 days) Infant ( 30 days to 1 year) Toddler (1 -3 years) Preschooler (3-5 years) School Age Children ( 5-12 years) Adolescent (12-18 years) Young Adults (18-39 years) Middle Adults (39-64 years) Geriatric (64 +) 2. EXPERIENCE WITH AGE GROUPS: Able to adapt care to incorporate normal growth and development Able to adapt method and terminology of patient instructions to their age, comprehension and maturity level Ensures safe environment reflecting specific needs of various age groups 3. EXPERIENCE IN SETTINGS: Acute care hospital Regional/Large hospital Outpatient Physician's office 4. GENERAL SKILLS: Charting/Documentation/Consents/Care Plans Confidentiality of Information/HIPAA Ordering Supplies Universal Precautions/Infection Control Procedures Advance Directives JCAHO ­ National Patient Safety Guidelines Vital Signs Use of transfer/lift devices Pain management Caregiver/Patient Education Emergency Procedures Normal lab values Pulse oximetry Equipment QC

Electrical conduction system

Refractory

Transmembrane potential Polarization Depolarization Action Potential Phase 0 - Phase 4 8. EKG INTERPRETATION: Ventricular tachycardia Ventricular fibrillation Atrial tachycardia Atrial fibrillation Atrial flutter Junctional escape rhythms Asystole PEA ­ (pulseless electrical activity) Normal sinus rhythm Sinus tachycardia Sinus brachycardia Acute myocardial infarction patterns Cardiac pacemakers Wolff-Parkinson-White

Competency/Skills Self-Appraisal: EKG Technician

Please check the column that applies to your skill level: 3= Very Competent > 1yr Exp. 2=Some Help needed <1 yr. Exp. 1=Need Direction <6 months Exp. 0=Never Done

SKILLS

8. EKG INTERPRETATION CONTINUED: First degree heart block Second degree heart block Type I Type II 9. EKG TECHNIQUES AND RECOGNITION: P,Q, R, S and T waves ECG measurement Baseline values Time heart rate Voltage Axis/hexaxial system Intervals Segments Complexes Normal and abnormal ST segment 10. RECOGNITON OF RECORDING ERRORS/ARTIFACTS: Incorrect standardization Incorrect paper speed Lead reversals Incorrect lead placement Electrical; interference Somatic tremor Wandering baseline 11. ECG, HOLTER AND STRESS TESTING INSTRUMENTATION: ECG Calibration methods Single channel Three channel 12. STRESS TEST TECHNIQUES AND CONTAINDICATIONS: Protocols Bruce Modified Bruce Naught on Prep techniques Test interpretation Calculation Double product Bicycle procedure Ergometers Arms Legs Treadmill Pharmacologic Dipryridamole

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Dobutamine Thallium Cardiolyte 13. HOLTER MONITORING: Preparation techniques Lead placement Interpretation Recognition of artifact 14. OTHER: Temporary pacemakers Permanent pacemakers Defibrillators Event monitors 15. CARDIAC MEDICATIONS: Antihypertensives Nitrates Calcium channel blockers Beta blockers Cardiac glycosides Antiarrythmics Emergency medications Epinephrine Atropine Verapamil Lidocaine Oxygen Isuprel 16. ECG LEADS: Bipolar leads Unipolar leads Precordial leads Einthoven's triangle and law 17. SKIN PREP: Shaving Alcohol prep Diaphoretic patients 18. PHLEBOTOMY: Butterfly stick Vacutainer method 19. VITAL SIGNS: T/P/R Pulse oximetry Auscultation Noninvasive blood pressure

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Revised: 6/2007 HCS/HCS Travelers

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