GeauxCareStaffing Respiratory Therapy Competency Checklist PERSONAL INFORMATION Name: Date: Signature: KEY TO COMPETENCY LEVELS 0 - No Experience 1 - Minimal experience, need review and supervision, have performed at least once 2 - Comfortable performing with resource available 3 - Competent to perform independently and safely 4 - Expert, able to act as resource to others BASIC RESPIRATORY THERAPY & TREATMENTS 0 1 2 3 4 Aerosol for Medication Acom Nebulizers Handheld Nebulizers Twin Jet Nebulizers Aerosol Set-up for Trach Patients Briggs T-Pierce Trach Masks Chest Physical Therapy Flutter Incentive Spirometry IPV Percussion, Vibration & Postural Drainage Therapy Vest IPPB Treatments AP5: Bird TV2P Nebulizers Cold Heated Heated Aerosols Ultrasonic Nebulizers Oxygen Therapy Analyze Oxygen Fi02 Calculating Remaining Time in Individualized 02 Tank Change Regulator from Empty Tank to Full Talk (any size) Oxygen Set-Up Aerosol Mask BASIC RESPIRATORY THERAPY & TREATMENTS Nasal Airway Nasal Cannula Oral Airway Peak Flow Regulation Trach Venturi Masks RESPIRATORY THERAPY MEDICATIONS 0 1 2 3 4 Albuterol (Proventil, Ventolin) Anti-Asthmatics IV (aminophylline) Inhalers (Azmacort) Atropine Sulfate Coli-Mycin Combivent Cromolyn Sodium (Intal) Decadron D-Nase Gentamycin Intal Isoetharine (Bronkosol) Isoprotereonol (Isuprel) Medihalers/Metered Dose Inhalers Metraproterenal (Alupent) Mucomyst Petsmidine Racemic Epinephrine (Vaponefrin) Spacers (InsperEase, Aerochamber TM) Steroids Surfadant Terbutaline Sulfate (Brickanyl) Tobramycin Vanceril SPECIFIC SKILLS 0 1 2 3 4 Complete Lab Work Flow Volume Loop Stress Testing Suction Endotracheal Tubes Tracheostomy Suctioning Use 02 Analyzer Ventilate Patient with Manual Resuscitator (BMV) VENTILATOR PROCEDURES 0 1 2 3 4 Assist Control Page 2 Created: 10/6/17 VENTILATOR PROCEDURES Blowby Bi-pap CPAP Flowby IMV Inverse Ratoio Ventilation Mechanics of Ventilators F/VT Negative Inspiratory Force Tidal Volume VE Vital Capacity PEEP Pressure Support Troubleshooting Weaning: Negative Inspiratory Force Tidal Volume Vital Capacity VENTILATORS 0 1 2 3 4 8400 STI Adult Star Bear 1000 Bear 3 BiPAP (Non-Invasive Ventilator) Bird Emmerson Helium/Oxygen (Heliox) Non-Ventilated Ventilated IMT (Inspiratory Muscle Trainer) Nellcor Puritan Bennet 7200 Series Nellcor Puritan Bennet 740 Series Newport E 150 Newport E 200 Passy Muir Valve (Talking Valve) PB 840 PDP’s (Pathways, Protocols) Servo 300 Servo 900C NEONATAL/PEDIATRIC ICU 0 1 2 3 4 Assist in High Risk Delivery ECMO Page 3 Created: 10/6/17 NEONATAL/PEDIATRIC ICU Nasal CPAP Pressure Manometer Transcutaneous Monitoring Umbilical Artery Catheters AGE SPECIFIC PRACTICE CRITERIA Please check the box corresponding to each age group for which you have expertise in providing age-appropriate nursing care. Newborn/Neonate (birth - 30 days) Infant (31 days - 1 year) Toddler (1 - 3 years) Preschooler (3 - 5 years) School age children (5 - 12 years) Adolescents (12 - 18 years) Young adults (18 - 39 years) Middle adults (39 - 64 years) Older adults (65+) EXPERIENCE AREA WITH AGE GROUPS 0 1 2 3 4 Able to adapt care to incorporate growth and development Able to adapt method and terminology to patient instructions to their age, comprehension and maturity level Can ensure a safe environment reflecting specific needs of various ages CERTIFICATIONS Question Yes No Expiration Date Are you BCLS Certified? Are you ACLS Certified? Are you PALS Certified Are you NRP Certified? CERTIFICATIONS Certification Expiration Date Have you had one year of experience in this area within the last three years. Yes No ________________________________________________________ __________________________ Signature Date ________________________________________________________ __________________________ Agency (Name/Title) Date Page 4 Created: 10/6/17 Page 5 Created: 10/6/17 .