MATRIX PERSONNEL SERVICE, INC.
LPN PROFICIENCY RECORD ( SKILLS CHECKLIST )
LPN

 


NAME DATE

E -MAIL ADDRESS

 

LEVEL OF PROFICIENCY
Theory - NO Experience
1
Minimal Experience
2
Competent and Experienced
3

SKILLS
1
2
3
MEDICATION ADMINISTRATION
Oral Medications
Subcutaneous Injections
Intramuscular Injections
Z-Track Injections
Heparin Lock
Intradermal
Vaginal Suppositories
Ophthalmic Drops
Topical Ointments
Inhalers
Rectal Suppositories
Emergency Meds-Crash Cart
INTRAVENOUS
Starting an IV
Change IV Tubing
Discontinuing an IV
Chemo-Therapy
Piggyback Admnistration
Plasma Administration
Packed RBC Administration
Regulate Flow Rate
Maintain IV site
Hyperalimentation Administration
CVP Line Maintenance
Medication Addition
Whole Blood Administration
Serum Albumin Administration
Platelet Administration
INFECTION CONTROL 
Knowledge of Universal Precations
Knowledge of Waste Disposal
Proper Disposal of Sharps
Mgmt of Patient in Resp. Isolation
Care of Pt in Reverse Isolation
ASSESSMENT
Perform Neurological Assessment
Mgmt of the Pt with Drug Interaction/Allergis Reaction
Mgmt of the Pt with CPR
Perform Cardiovascular Assessment
Perform GI Assessment
Perform Mucleskeletal Assessment
Perform GI Assessment
Perform Respiratory Assessment
RESTRAINTS
Application of Soft Limb Restraints
Application of Leather Restraints
Depression
Application of Posey Restraints
Observation of Patient in Restraints
Documentation
Knowledge of Safety Guidelines for Patient Restraints
EQUIPMENT
Hemovac/Davol Suction Pump
Use of Wall Suction
Use of Corstavac Suction
Alternate Pressure Mattress
Care of Pt. with PCS Pump
Infusion Devises (Volumetric Pump)
Venturi Mask
Management of Trach Collar
Knowledge of Use of Incentive Spirometer
ABG Kits
Knowledge of Use of Bed Scale
Knowledge of Use of Heating Pad
Use of Hoyer Lift
Assist with Set-up of Water Seal Suction
Pleurovac/Emerson Suction
Knowledge of Use of Egg Crate Mattress
Enteral Pump
Management of Oxygen Mask
Management of Nasal Cannula
Use of Ambu Bag
Humidifiers
Application of TED Hose
Use of Heat Lamp
Use of Blood Glucose Monitor
SPECIMAN COLLECTION
Obtain Urine for Specific Gravity
Obtain Urine for Culture
Obtain Foley Catheter Specimen
Obtain Stool Specimen
Perform Straight Catheterization
Obtain Sputum Specimen
Instruct Patient/Assist with Clean
Catch/Midstream Urine Specimen
Collect 24 Hour Urine Specimen
Obtain Stool Hemeocult
Obtain Stool Ova/Parasite
PROCEDURES
Set-up/Instruct Patient in Sitz Bath
Perform Personal Hygiene/Oral Care
Perform Wound Irrigation
Perform Catheterization
Administer Tap/Saline Enema
Administer Soap Suds Enema
Administer Oil Retention Enema
Administer of Fleets Enema
Administer Post-Mortem Care
Pre-Op Teaching
Post Mortem Care
Perform Wet to Dry Dressing
Perform Sterile Dressing Changes
Perform Bladder Irrigation
Perform Ostomy Care
Perform NG Tube Feeding
Perform Gastrostomy Tube Feeding
Adminster Douches
Management of Levine Tube
Management of Jejunostomy Tube
Management of Chest Tube
Perform Nasal Suctions
Perform Oral Suctioning
COMMUNICATION/DOCUMENTATION
Reporting on Assigned Patients
Performing Team Leader Duties
Giving Oral Report
Giving Taped Report
Making Assignments
Making Rounds



Certification
Expiration Date
Certification
Expiration Date
ACLS
PALS
BLS
TNCC
CEN
Other  
ENPC
Other  


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