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Respiratory Therapy 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.

 

Typed Name (Typing your name below serves as an electronic signature) *      Date*

                                                         

 

Phone*

              

 

Recruiter

 

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

 

Area

Not Applicable

Inexperienced

Limited

Experienced

Highly Experienced

RESPIRATORY TREATMENTS

Endotracheal tubes

N/A  

1

2

3

4

Tracheostomy tubes

N/A  

1

2

3

4

IPPB

N/A  

1

2

3

4

Incentive spirometry

N/A  

1

2

3

4

Metered dose inhalers

N/A  

1

2

3

4

Oxygen masks, cannula

N/A  

1

2

3

4

Pnuematic aerosols

N/A  

1

2

3

4

Nasopharyngeal suction

N/A  

1

2

3

4

Oralpharyngeal suction

N/A  

1

2

3

4

Ultrasonic nebulizer

N/A  

1

2

3

4

Oximetry/O2 Analyze

N/A  

1

2

3

4

Chest physiotherapy

N/A  

1

2

3

4

 

AIRWAY MANGEMENT

Check intracuff pressure

N/A  

1

2

3

4

Endotracheal tubes

N/A  

1

2

3

4

Nasal airway treatment

N/A  

1

2

3

4

Nasal airway suctioning

N/A  

1

2

3

4

Oral airway placement

N/A  

1

2

3

4

Intubation assistance

N/A  

1

2

3

4

Extubation

N/A  

1

2

3

4

Extubation assistance

N/A  

1

2

3

4

 

ASSESSMENT

Breath sounds

N/A  

1

2

3

4

Peak flow rate

N/A  

1

2

3

4

Pulmonary function testing

N/A  

1

2

3

4

Rate and work of breathing

N/A  

1

2

3

4

Transcutaneous monitoring

N/A  

1

2

3

4

Basic EKG

N/A  

1

2

3

4

Care of the patient with chest tubes

N/A  

1

2

3

4

Assessment and placement of chest tube

N/A  

1

2

3

4

Placement assistance

N/A  

1

2

3

4

Infection control practices

N/A  

1

2

3

4

Sputum collection

N/A  

1

2

3

4

Drawing and assisting with blood gases

N/A  

1

2

3

4

Arterial line

N/A  

1

2

3

4

Brachial artery

N/A  

1

2

3

4

Femoral artery

N/A  

1

2

3

4

Radial artery/Allen tests

N/A  

1

2

3

4

Hemodynamic monitoring

N/A  

1

2

3

4

 

PEDIATRICS

NICU

N/A  

1

2

3

4

Infant resuscitation

N/A  

1

2

3

4

PICU

N/A  

1

2

3

4

Pediatric vents/equipment

N/A  

1

2

3

4

Pediatric resuscitation

N/A  

1

2

3

4

C- Sections/high risk

N/A  

1

2