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Oncology Skills Checklist

My responses in this checklist represent a true reflection of my experience and comfort level. Please self-rate your comfort level in performing tasks in connection with the below checklist. Rate your level of comfort for each line item by following the below ranking system. Simply fill in the appropriate option immediately following the rating number.

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Level of Comfort/Experience

N/A=Non-applicable
1=Inexperienced in this area
2=Limited comfort/experience in this area
3=Comfortable/experienced in this area
4=Very comfortable/highly experienced in this area

MEDICATIONS / IV THERAPY	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Administer PO Medications	N/A	1	2	3	4
Administer IM / SQ Medications	N/A	1	2	3	4
Administer IV Medications	N/A	1	2	3	4
Needle-less Systems	N/A	1	2	3	4
Infusion Pumps	N/A	1	2	3	4
Establish Peripheral IVs	N/A	1	2	3	4
Discontinue Peripheral IVs	N/A	1	2	3	4
Pain Assessment / Management	N/A	1	2	3	4
Draw Blood for Lab Studies	N/A	1	2	3	4
Admin Blood / Blood Products	N/A	1	2	3	4
Central Venous Lines (CVL)	N/A	1	2	3	4
Hickman / Broviac Catheters	N/A	1	2	3	4
PCA / CADD	N/A	1	2	3	4
Port-A-Cath	N/A	1	2	3	4
Infusaid	N/A	1	2	3	4
Infuse-A-Port	N/A	1	2	3	4
CARE OF ONCOLOGICAL PATIENT	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Head, Neck, Chest	N/A	1	2	3	4
Hematologic System	N/A	1	2	3	4
Gastrointestinal Tract	N/A	1	2	3	4
Reproductive System	N/A	1	2	3	4
Skin (Melanomas / Nonmelanomas)	N/A	1	2	3	4
Urinary Tract	N/A	1	2	3	4
Emergencies	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Cardiac Tamponade	N/A	1	2	3	4
Dissesminated Intravascular Coagulation	N/A	1	2	3	4
Hypercalcemia	N/A	1	2	3	4
Organ Obstruction	N/A	1	2	3	4
Sepsis	N/A	1	2	3	4
Spinal Cord Compression	N/A	1	2	3	4
Superior Vena Cavae Syndrome	N/A	1	2	3	4
Tumor Lysis Syndrome	N/A	1	2	3	4
Family / Psychosocial Needs	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Patient / Family Education	N/A	1	2	3	4
Advance Directives	N/A	1	2	3	4
Acute Phase	N/A	1	2	3	4
Chronic Phase	N/A	1	2	3	4
Terminal Phase	N/A	1	2	3	4
Bereavement Phase	N/A	1	2	3	4
After Treatment (Survivorship)	N/A	1	2	3	4
ANTINEOPLASTIC AGENTS	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Bleomycin	N/A	1	2	3	4
Dactinomycin (Actinomycin)	N/A	1	2	3	4
Daunorubicin (DaunoXome)	N/A	1	2	3	4
Doxorubicin (Adriamycin)	N/A	1	2	3	4
Routes of Administration	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Oral / SQ / IM	N/A	1	2	3	4
Oral / SQ / IM	N/A	1	2	3	4
Intraarterial	N/A	1	2	3	4
Intrathecal / Intraventricular	N/A	1	2	3	4
Intraperitoneal (Tenckhoff Catheter)	N/A	1	2	3	4
Intrapleural	N/A	1	2	3	4
Intravesicular	N/A	1	2	3	4
Alkylating Agents	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Bulsulfan (Myleran)	N/A	1	2	3	4
Chlorambucil (Leukeran)	N/A	1	2	3	4
Cisplatin (Platinol)	N/A	1	2	3	4
Cyclophosphamide (Cytoxan)	N/A	1	2	3	4
Mechlorethamine (Mustargen)	N/A	1	2	3	4
Antimetabolites	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Cytarabine (Ara-C)	N/A	1	2	3	4
Fluorouracil (5-FU)	N/A	1	2	3	4
Mercaptopurine (6-MP)	N/A	1	2	3	4
Methotrexate	N/A	1	2	3	4
Leucovorin Rescue Protocol	N/A	1	2	3	4
Antineoplastic Antibiotics	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Bleomycin	N/A	1	2	3	4
Dactinomycin (Actinomycin)	N/A	1	2	3	4
Daunorubicin (DaunoXome)	N/A	1	2	3	4
Doxorubicin (Adriamycin)	N/A	1	2	3	4
Plant Alkaloids	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Paclitaxel (Taxol)	N/A	1	2	3	4
Vinblastine (Velban)	N/A	1	2	3	4
Vincristine (Oncovin)	N/A	1	2	3	4
Hormonal Antineoplastics	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Leuprolide (Lupron)	N/A	1	2	3	4
Megestrol (Megace)	N/A	1	2	3	4
Tamoxifen (Nolvadex)	N/A	1	2	3	4
Testolactone (Teslac)	N/A	1	2	3	4
Staff Minimize Risk of Exposure	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
During Preparation	N/A	1	2	3	4
During Administration	N/A	1	2	3	4
During Disposal	N/A	1	2	3	4
CLASSIFICATION OF NEOPLASMS	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Staging - TNM System	N/A	1	2	3	4
Tissue of Origin	N/A	1	2	3	4
Biologic Behavior	N/A	1	2	3	4
Degree of Cell Differentiation	N/A	1	2	3	4
Anatomic Site	N/A	1	2	3	4
Radiation Therapy (RT)	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Electromagnetic (Xrays, Gamma Rays)	N/A	1	2	3	4
Particulate (Alpha, Beta)	N/A	1	2	3	4
External Beam Therapy	N/A	1	2	3	4
Knowledge of Early Effects of RT	N/A	1	2	3	4
Knowledge of Interim. Effects of RT	N/A	1	2	3	4
Knowledge of Late Effects of RT	N/A	1	2	3	4
Brachytherapy (Sealed Sources)	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Interstitial Radiation Therapy	N/A	1	2	3	4
Intracavitary Radiation Therapy	N/A	1	2	3	4
Radiopharmaceutical (Unsealed Sources)	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Tracer Dose	N/A	1	2	3	4
Therapeutic Dose	N/A	1	2	3	4
Surgical Intervention	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Curative Surgery	N/A	1	2	3	4
Diagnostic Surgery	N/A	1	2	3	4
Mechanical Device Insertion	N/A	1	2	3	4
Palliative Surgery	N/A	1	2	3	4
Prophylactic Surgery	N/A	1	2	3	4
Reconstructive Surgery	N/A	1	2	3	4
Rehabilitative Surgery	N/A	1	2	3	4
Bone Marrow Transplant - Allogenic	N/A	1	2	3	4
Bone Marrow Transplant - Syngenic	N/A	1	2	3	4
ONCOLOGY HEALTH CARE SETTINGS	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Adult	N/A	1	2	3	4
Pediatrics	N/A	1	2	3	4
Cancer Center	N/A	1	2	3	4
Radiation Oncology	N/A	1	2	3	4
Surgical Oncology	N/A	1	2	3	4
Bone Marrow Unit	N/A	1	2	3	4
Research / Clinical Trials	N/A	1	2	3	4
Subacute / Skilled Nursing	N/A	1	2	3	4
Home Health Care	N/A	1	2	3	4
Hospice	N/A	1	2	3	4
Clinic - Risk Assess / Screening / Diagnosis	N/A	1	2	3	4
Clinic - Surgery / Gyn	N/A	1	2	3	4
Clinic - Medical / Hematology	N/A	1	2	3	4
Clinic - Immunology / Infectious	N/A	1	2	3	4
Recognition & Management of	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Anxiety / Depression	N/A	1	2	3	4
Metabolic Alterations	N/A	1	2	3	4
Hypersensitivity	N/A	1	2	3	4
Fatigue	N/A	1	2	3	4
Hematopoietic	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Anemia	N/A	1	2	3	4
Leukopenia	N/A	1	2	3	4
Thrombocytopenia	N/A	1	2	3	4
Gastrointestinal	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Anorexia / Dehydration	N/A	1	2	3	4
Nausea / Vomiting	N/A	1	2	3	4
Constipation / Diarrhea	N/A	1	2	3	4
Muscositis / Ulceration	N/A	1	2	3	4
Hepatic Toxicity	N/A	1	2	3	4
Integumentary	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Alopecia	N/A	1	2	3	4
Dermatitis	N/A	1	2	3	4
Hyperpigmentation	N/A	1	2	3	4
Genitourinary	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Cystitis	N/A	1	2	3	4
Renal Toxicity	N/A	1	2	3	4
Cardiovascular	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Cardiac Toxicity	N/A	1	2	3	4
Phlebitis	N/A	1	2	3	4
Extravasation	N/A	1	2	3	4
Neurologic	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Neurotoxicity	N/A	1	2	3	4
Ototoxicity	N/A	1	2	3	4
Metabolic Encephalopathy	N/A	1	2	3	4
Peripheral Neuropathy	N/A	1	2	3	4
Pulmonary	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Fibrosis	N/A	1	2	3	4
Pneumonitis	N/A	1	2	3	4
Edema	N/A	1	2	3	4
Reproductive	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Infertility	N/A	1	2	3	4
Changes in Libido	N/A	1	2	3	4
Erectile Dysfunction	N/A	1	2	3	4
NUTRITION	Not Applicable	Inexperienced	Limited Experience	Experienced	Highly Experienced
Assess Nutritional Status	N/A	1	2	3	4
Assess / Manage Nutritional Impairment	N/A	1	2	3	4
Interpretation of Lab Values	N/A	1	2	3	4
Oral Feedings	N/A	1	2	3	4
Enteral Tube Feeding	N/A	1	2	3	4
Peripheral Parenteral Nutrition (PPN)	N/A	1	2	3	4
Central TPN	N/A	1	2	3	4