GENERAL INFORMATION

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This profile is for use by healthcare professionals in the Home Health discipline and specialty. It will not be a determining factor for the program.

CHECKLIST INSTRUCTIONS

Please mark your level of experience      1. No theory and/or experience      2. Limited experience/need supervision and/or support      3. Experienced/minimal support needed to perform      4. Proficient/can perform independently

CARDIOVASCULAR

1

2

3

4

ACS/Post MI

Heart Failure

Post Cardiac Surgery

Cardiac Auscultation (Rate/Rhythm)

Peripheral Pulse/Circulation Checks

PULMONARY

1

2

3

4

Asthma

COPD

Pneumonia

Lung Cancer

Pulmonary Emboli

Auscultate Lung Sounds

Oxygen Administration

Oxygen Safety

Oro/Nasotracheal Suctioning

CPAP/BiPAP

Ventilator Management (Specify):

NEUROLOGICAL

1

2

3

4

CVA

Alzheimer's Disease/Dementia

Parkinson's

Degenerative Neurologic Disorders (ALS, MS, etc.)

Brain Tumor

Brain Injury

Para/Quadriplegia

Seizure Disorder

Level of Consciousness/Neuro Changes

ORTHOPEDICS

1

2

3

4

Joint Replacement

DVT Prophylaxis/Recognition

Incision Checks

Staple Removal

Fractures

Cast/Brace

Amputation

Arthritis

Assistive Equipment/Lift Devices

In Home PT/INR

GASTROINTESTINAL

1

2

3

4

Nutritional Assessment

Colostomy/Ileostomy Management

Fecal Incontinence/Diarrhea

Bowel Obstruction

GI Bleed

Post GI Surgery

Hepatitis Liver Failure

NG Tubes

Feeding Tubes

Feeding Pumps

Drainage Devices

RENAL/GENITOURINARY

1

2

3

4

Hemodialysis

AV Fistula/Shunt

Peritoneal Dialysis

Post Bladder Surgery

Post Prostate Surgery

Urostomy

Urinary Incontinence

Bladder Catheter Insertion/Maintenance

Suprapubic Catheter Insertion/Maintenance

ENDOCRINE/METABOLIC

1

2

3

4

Diabetes

Hyper/Hypoglycemia

Diabetic Skin Assessment

Cushing's / Addison's Disease

Thyroid Disease

Insulin Pumps

Glucometers

WOUND/SKIN CARE

1

2

3

4

Braden Scale

Pressure Ulcer Prevention

Pressure Ulcer Staging

Pressure Ulcer Management

Burns

Wound Care

Wound Cultures

Wound Vac

ONCOLOGY

1

2

3

4

Risk for Infection

Symptom Management

Side Effects of Treatment

Terminal Disease

INFECTIOUS DISEASE

1

2

3

4

MRSA

VRE

C. Difficile

HIV

Tuberculosis

Isolation Precautions

PHLEBOTOMY/IV THERAPY

1

2

3

4

Peripheral Venipuncture for Labs

Start IVs

Peripheral IVs

PICC/CVP Lines

Venous Access Ports

Infusion Pump Set up and Management

Specify Infusion Pump Type:

PSYCHIATRIC

1

2

3

4

Cognitive Disorders

Mood Disorders

Schizophrenia/Psychotic Disorders

Medication Compliance

WOMEN'S HEALTH/MATERNAL-INFANT CARE

1

2

3

4

Pregnancy Related Complications

Fetal Heart Tones

Contractions

Post Partum Mother/Baby Visit

Newborn Care

Phototherapy

Breast Feeding Support

PEDIATRICS

1

2

3

4

Growth and Development

Respiratory Distress Syndrome

Bronchopulmonary Dysplasia

Cystic Fibrosis

Muscular Dystrophy

Spina Bifida

Spinal Surgery

Sickle Cell Disease

Trach Care/Suctioning

Ventilator Management

Ventilator Type (Specify):

PAIN MANAGEMENT

1

2

3

4

Verbal/Nonverbal Pain Scales

Response to Pain Management Interventions

PCA Pump

Epidural Cath/Site Monitoring/Pump

Non-Pharmacologic Pain Measures

PALLIATIVE AND END OF LIFE CARE

1

2

3

4

Palliative Symptom Management

Pain Management/Response

Family Support/Teaching

After Death Protocols

MEDICATIONS

1

2

3

4

Alzheimer's Medications

Antiarrhythmics

Antibiotics/Antivirals

Anti-Depressants

Anti-Hypertensives

Anti-Psychotics

Anti-Seizure Medications

Benzodiazepines

Calculation of Pediatric Dosages

Coumadin

Diuretics

Enoxaparin

Inhaled Medications

Nebulizer Medications

Insulin

Opioid and Non-Opioid Analgesics

Oral Chemotherapy

Oral Hypoglycemics

Oral & Topics Nitrates

Rivaroxaban

Sedative/Hypnotics

Steroids

HOME HEALTH

1

2

3

4

Intake/Admissions

Case Manager

Case Load - Pts/Day(specify)

Supervise LVNs/HHAs

Medicare/Medicaid

Long/Short Term Disability

Private Insurance

Telephonic Assessments

Management of Complaints

APS Reports

OASIS

Diagnosis Coding

Document Plan of Care

Clinical Assessment Documentation

PROFESSIONAL KNOWLEDGE AND SKILLS

1

2

3

4

National Patient Safety Goals/Core Measures

Safety Assessment

Fall Assessment and Prevention

Patient/Family Teaching

Age Specific/Population Based Care

EMR

1

2

3

4

Allscripts

Cerner

EPIC

HomeCare Home Base

McKesson

Meditech

Other Computerized Documentation System

1

2

3

4

EMR Conversion

Yes

No

Certifications

1

2

3

4

BLS

ACLS

PALS

OASIS Training

Coding Training

IV Certification

Wound Care

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