PD CHECKLIST

Medical Staffing Group
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PEDIATRIC CHECKLIST

Your first name:

Your last name:

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Attach your critical care checklist:
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1=Done Frequently; well skilled 2=Occasionally done; moderately skilled
3=Rarely done; skill limited 4=Observed only; never done

Blood/blood product administration/precautions
Calculation of rates :Mcg/min, Mcg/kg/min, Mg/min

Hang IV Piggyback
Heparin Lock
Hyperalimentation
Peripheral/Central Line
Knowledge of solution

Insertion of Central line
Use of Broviac/Hickman/Groshong Catheters
Blood/blood product administration/precautions
Lab Assessment
Implanted venous access ports

Dressing changes
Insertion of peripheral line:
Dressing change
d/c line
Universal precautions

Isolation procedures
Airborne isolations
Contact Isolation/Universal Precautions
SPECIMEN COLLECTION
Arterial line blood draw

Blood culture
Capillary blood draw
Central line blood draw
PICC line blood draw
Sputum

Stool
Urine Culture
Urinalysis
Venipuncture
Wound Culture

CARDIOVASCULAR:

Assess heart sounds

ASSIST IN:
Obtain 12 lead EKG
Normal Anatomy of the Heart

Left Side
Right Side
Normal Physiology of CV system

Resuscitation

Team Member
Perform defibrillation
Perform/set up emergent cardioversion
Prepare and administer meds
Set up and interpret 12 lead EKG

Proper lead placement
Use of Doppler

Interpretation of labs
Ambu bag techniques

Administer oxygen
Use of apnea monitor
Assess lung sounds

Incentive spirometer
Nebulizer

Normal physiology of pulmonary vascular system
Obtain arterial blood gas Result interpretation
Pavulonized patient
Pulse oximetry
Suctioning: Oral, NT, ETT Use of emergency equipment

Skin care
Dressing changes

Administer med via NG/gastrostomy tube
Catheter insertion
Female
Male

Insulin preparation and administration blood glucose monitoring
Equipment used
Jejunostomy care
NG tube insertion/lavage
Normal physiology of renal and GI system

Ostomy/stoma care
Peritoneal lavage
Poison control
Wound care irrigations

Procedure for patient signing AMA
Disaster protocols
Assist with peritoneal lavage
MISC. TRAYS/INSTRUMENTS, CHECK YES IF YOU EVER HAD EXPERIENCE WITH:
Cut down tray

Pelvic tray
Procto tray
CVP tray
Culdocentesis tray
Thoracentesis tray

PEDIATRICS
Administration of Medication
Oral
Subcutaneous
Intramuscular

Pediatric Nursing
Anorexic patient care
Assist with lumbar puncture
Respiratory distress syndrome
Broncho-pulmonary dysplasia

Croup
Epiglotitis
Asthma
Cystic fibrosis
Pneumonia

Near drowning
Near SIDS
Chest tubes
Reye’s syndrome
Meningitis

Hydrocephalus
Spina bifida
Lead play therapy
Care of the child with seizures
Sickle cell

EQUIPMENT
Apnea monitor
Cardiac monitor
Ventilator
ECMO

Care of the child with

Child abuse

Failure to thrive

Cleft palate

Post tonsillectomy

Dying infant/child
Diabetes mellitus
Psych patients
Skin care

Nasopharyngeal airway
Chest physiotherapy
Complications of Chest tube insertion (assist in)
Incentive spirometer
Nebulizer

Normal physiology of pulmonary vascular system
Obtain arterial blood gas Result interpretation
Pavulonized patient
Pulse oximetry
Suctioning: Oral, NT, ETT Use of emergency equipment

Thoracentesis
Tracheostomy
Trach tray set up
Assist with emergency trach
Changing of the trach or tube


NEUROLOGICAL SYSTEM
Assessing sensory-motor function extremities
Assist with lumbar puncture
Cervical traction

Seizure precautions
Cranial nerve assessment
Use of Glascow coma scale
Monitoring of ICP: Appropriate interventions for changes in Pressure
LOC assessment

Multiple trauma patient
Overdose patient
Seizure disorder
Spinal cord injury

Newborn/Neonate(birth - 30 days)
Infant (30days- 1 year)
Toddler (1-3 year )
Prescholer (3-5 years )
School age children (6-12 years)

Employment Application consent form

I authorize the investigation of my background including all information contained in this application and information provided in the interview. I understand that misrepresentation or omission of information in connection with my application and interview will be sufficient cause, in and of itself, for rejection or dismissal whenever discovered. I understand and agree that any offer of employment is contingent upon satisfactory completion of MSG pre-employment investigation which includes but is not limited to health assessment, criminal history check, educational and work verification, reference checks, consumer report and any investigation required by local, state, or federal laws. I understand that if I am hired by MSG, my employment will be for an indefinite period of time and will be “at will” which means that either MSG or I may terminate the employment relationship at anytime and for any reason or no reason.

I further understand that, if hired, my at-will employment status my only be changed in written contract signed by the management of
MSG, and that no representative of MSG has the authority to make oral promise to me concerning my employment. Finally, I also understand that MSG may adopt, from time to time, policies or handbooks dealing with benefits and other terms or conditions of employment. These policies or handbooks do not constitute a contract of employment between MSG and me. MSG reserves the right to change or discontinue these policies and/or handbooks at any time with or without notice to me.

MSG strives to provide a safe, healthy and productive work environment and supports a smoke free, alcohol-free work environment.

By signing your name below, means your signing the employement application consent form.

Signature: Date:

E-mail:info@msgstaffing.net