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Competency/Skills Self-Appraisal: Patient Care Technician

_________________________________________________________________

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 CNA PCT Expires: Expires: Expires:

3

2

1

0

SKILLS

Puree Diet Mechanical Soft Regular NPO Aspiration Risk Positioning for feeding Proper feeding and swallowing technique AM, PM and HS Snacks Water pitchers Deliver dietary supplements Record intake on I&O Chart Use of adaptive equipment for feeding Stocking/ordering of supplies for unit kitchen 5. ELIMINATION: Urinary Catheter care Empty drainage bag

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2

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0

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/Inpatient Hospital Nursing Home Assisted Living Facility Psychiatric Facility Clinic Physician Office Home Health Private Duty Sitter 4. NUTRITION: Assist with menu selection Assist with tray set up Assist with feeding Passing and pick up of trays Diets ­ NAS CCD Low Cholesterol Clear Liquid Full Liquid

Obtain urine specimen ­ routine

Catheter port

Mid stream Clean catch 24 hour specimen collection C and S Catheters ­ External (Texas) Catheters ­ Internal (Foley) Emptying of leg bag Use of urinal Use of bedside commode Bedpan ­ regular Bedpan ­ fracture Tube positioning Insertion of Foley catheter D/C Foley Urine: Sugar, Acetone, and Specific Gravity Raised toilets Bowel Diapers Weighing diapers for amounts

Competency/Skills Self-Appraisal: Patient Care 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

5. ELIMINATION CONTINUED: Rectal tubes Enemas Collecting stool sample Testing stool for occult blood Ostomy care Empty Ostomy Bowel - Frequency Consistency Guaic Ova and parasite Recording output on I&O Hygiene Incontinence Care 6. VITAL SIGNS: Blood pressure ­ cuff/manual Blood pressure- Dynamap/Rover Pulse ­ apical Pulse ­ radial Respirations Temperature ­ auxiliary Temperature - oral Temperature ­ rectal Temperature ­ Tympanic/Digital/Electronic Weight ­ bed scale Weight ­ standing scale Weight ­ Chair scale Pediatric scale Hoyer lift scale Use of pulse oximetry to measure O2 saturation Assist with use of oxygen/nebulizer Height by tape measure Height ­ pediatric tape measure Blood Sugar ­ daily QC Perform finger stick Use of glucose strips Use of glucose monitor Charting vital signs 7. BATHING AND PERSONAL CARE: Tub/Shower Partial Bed bath Complete Bed Bath Back Rub Hair care ­ comb Hair care ­ dry wash

3

2

1

0

SKILLS

Oral/Mouth care ­Brushing Swabbing Dentures Perineal Care Catheter Care Eyeglass care/Contact care Hearing Aids Shaving Sitz bath Linen change ­ occupied Linen change ­ unoccupied Shave and prep surgical site Putting on/Removal of TED Hose/Ace Wraps Application of eggcrate/geomat Post mortem care 8. ACTIVITY: Ambulation ­ Contact guard One person assist Two person assist Gait belt Proper use of cane Proper use of walker Proper use of crutches Proper use of Trapeze Transfers Bed to chair Bed to wheelchair Chair to BSC Bed to stretcher Hoyer Lift One person Two person Exercise Range of motion PT/OT Guidelines Positioning/Repositioning Schedule Body alignment Mealtime Equipment aids Pillows Draw sheet Foot cradle Dangling Instruct patients to cough and deep breathe

3

2

1

0

Revised: 6/2007 HCS/HCS Travelers

Competency/Skills Self-Appraisal: Patient Care 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

9. DOCUMENTATION: Electronic Health Record I&O Sheet Calorie Counts Nutrition ordering form Growth chart Documentation of care checklist 10. INFECTION CONTROL: Standard Precautions Hand washing Gloves ­ application and removal Latex Allergy Disposal of Infectious Material Clean Used Equipment Employee Illness Linen Handling ­ clean and soiled Specimen collection Double Bag Isolation Technique Isolation/Reverse Isolation Precautions Airborne/contact/droplet precautions 11. SAFETY: Chemotherapy precautions Radiation precautions Environmental hazards Bedrails/side rails/padded side rails Call lights Airway maintenance Bed alarm Proper use of restraints ­ application, protocol Nurse call system Door alarms Behavioral health checks Patient falls Incident reports 12. COMMUNICATION BARRIERS: Confusion Disorientation Hearing Impairment Visual Impairment Agitation

3

2

1

0

SKILLS

13. ABILITY TO ASSIST WITH: Pap Colposcopy Colonoscopy Endoscopy IV Starts Casting Rectal exam Lumbar puncture 14. OTHER SKILLS: Sputum specimen collection Set up and complete 12 lead EKG Set up and complete EEG Phlebotomy Finger stick Visual acuity exams NG tubes Hemovacs Jackson-Pratt T-tubes Tube feedings Use of incentive spirometer Decubitus care Application and Maintenance of ice packs Application and Maintenance of K-pads IV site care Non sterile dressing changes 15. GENERAL SKILLS: Recognizing and reporting emergencies Patient/Family teaching Set up post op/admission patient room Patient rights Charting/Documentation/Consents/Care Plans Confidentiality of Information/HIPAA DNR Advance Directives JCAHO ­ National Patient Safety Guidelines Ordering Supplies Lab work ­ ordering Changes to report to RN (Abnormal VS, falls, behavior change, pain, skin problems, bleeding, dizziness, nausea, vomiting, etc) End of life care Assist with admission, transfer and discharge of patient Conducting home care visit Use of transfer/lift devices

3

2

1

0

Aphasia Body Language ­ verbal/nonverbal Foreign Language Cultural

Revised: 6/2007 HCS/HCS Travelers

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