Critical Care Intensive Care Checklist

Key To Experience/Proficiency Levels

The following is a list of equipment and/or procedures performed in rendering care to patients. Please indicate your level of experience/proficiency with each area and, where applicable, the types of equipment and/or systems you are familiar with. Use the following key as a guideline:

Theory Only/No Experience - Didactic instruction only, no hands on experience.
Limited Experience - Knows procedure/has used equipment, but has done so infrequently or not within the last six months
Moderate Experience - Able to demonstrate equipment/procedure, performs the task/skill independently with only resource assistance needed.
Proficient/Competent - Able to demonstrate/perform the task/skill proficiently without any assistance and can instruct/teach.

2. Interpretation of Lab Results

a. Arterial blood gases0123

c. Level of consciousness0123

Renal / Genitourinary

Endocrine / Metabolic

4. Medication

a. Insulin pump0123

Phlebotomy / IV Therapy

a. Assessment of pain level/tolerance0123

Age Specific Practice

Able to adapt care to incorporate normal growth and development.A. Newborn/Neonate (birth - 30 days)B. Infant (30 days - 1 year)C. Toddler (1 - 3 years)D. Preschooler (3 - 5 years)E. School age children (5 - 12 years)F. Adolescents (12 - 18 years)G. Young adults (18 - 39 years)H. Middle adults (39 - 64 years)I. Older adults (64+)Please check the box corresponding to each age group for which you have expertise in providing age-appropriate care.

Type of blood glucose measuring device:

Able to adapt method and terminology of patient instructions to their age, comprehension and maturity level.A. Newborn/Neonate (birth - 30 days)B. Infant (30 days - 1 year)C. Toddler (1 - 3 years)D. Preschooler (3 - 5 years)E. School age children (5 - 12 years)F. Adolescents (12 - 18 years)G. Young adults (18 - 39 years)H. Middle adults (39 - 64 years)I. Older adults (64+)Please check the box corresponding to each age group for which you have expertise in providing age-appropriate care.

Can ensure a safe environment reflecting specific needs of various age groups.A. Newborn/Neonate (birth - 30 days)B. Infant (30 days - 1 year)C. Toddler (1 - 3 years)D. Preschooler (3 - 5 years)E. School age children (5 - 12 years)F. Adolescents (12 - 18 years)G. Young adults (18 - 39 years)H. Middle adults (39 - 64 years)I. Older adults (64+)Please check the box corresponding to each age group for which you have expertise in providing age-appropriate care.