Hospice Skill Checklist

SKILLS CHECKLIST

Hospice
Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below. 
 
No Experience
Need Training
Perform with Supervision
Perform Independently
WORK SETTINGS
Home Hospice
Inpatient Hospice
Pediatric Hospice
Home Health/Hospice Setting
ASSESSMENT
Intake Assessment
Assessment Interview
Physical Exam
Coping Status
Environmental Status
PLAN OF CARE
Set Goals with Pt/Family
Collaborate with Other Team Members
Ensure Continuity of Care
SYMPTOM MANAGEMENT
Urgent Assessment of Symptoms
Reduce Symptoms to Level Acceptable to Pt
Report Symptoms/Management to Provider
Treat Underlying Cause
Severity Scale
Management of Nausea
Management of Constipation
Management of Fatigue
Anorexia/Cachexia
Restlessness
Educate Family on Symptom Management
PAIN MANAGEMENT
Identify Source of Pain
 
No Experience
Need Training
Perform with Supervision
Perform Independently
Pain Severity
PAINAD Scale for Non Verbal Patient
Reduce Pain to Level Acceptable to Patient
WHO 3 Step Ladder
Non-Pharmacologic Management of Pain
Pharmacologic Management of Pain
Effects of Pharmacologic Treatment
Nociceptive/Neuropathic/Mixed Pain
Management of Nocicep
Management of Neuropathic Pain
Educate Family on Pain Management
WOUND CARE
Positioning Techniques
Bed/Support Surface Select
Pressure Ulcer Staging/Management
Response to Treatment
Evaluate Factors that Impede Healing
Educate Family on Positioning/Shearing
PEDIATRICS
Developmentally Appropriate Assessment
Parental/Sibling Support
Pediatric Support Team Collaboration
MEDICATION ADMIN
Equianalgesic Conversion Formula
Titration of opioids
IV Pump Management
Evaluate Effectiveness of Medication
 
No Experience
Need Training
Perform with Supervision
Perform Independently
Family Management of Medications
Disposal of Medications
AFTER DEATH
Facility Family/Cultural Rituals/Rites
Patient Care after Death
Coordinate Mortuary Services
Bereavement Services
COMPLIANCE
Scope and Frequency of Services
Medicare/State Regulations of Hospice
Document Progression of Decline
DME Authorization & Documentation of Need/Ord
OASIS-C
PROFESSIONAL KNOWLEDGE AND SKILLS
Identify Source of Suffering
Palliative Care Philosophy
Patient/Family Directs Goals of Care
Maximize Quality of Life
Cultural Diversity
Supervision of Ancillary Staff
National Patient Safety Goals/Core Measures
Fall Risk Assessment/Prevention
Infection Prevention
Isolation Precautions
Interpretation and Communication of lab Values
 
No Experience
Need Training
Perform with Supervision
Perform Independently
EMR
Epic
Cerner
Eclipsys
Allscripts
McKesson
Meditech
Other Computerized System
Computerized Physician Order Entry
Bar Coding for Medication Administration
Do you speak any languages other than English?
Age Specific Skills
Check the box under EACH age group that you have experience with and are comfortable with for each skill below.
Understands the different communication needs for the age group & changes communication methods and terminology accordingly
Understands the different medications, dosages and possible side effects for the age group and administers medications appropriately
Understands the different safety risks for the age group and alters the environment accordingly
Understands the normal growth and development for the age group and adapts care accordingly
 
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