ADEX Medical Staffing - OR Skills Checklist

OR Skills Checklist

This assessment is for determining your experience in the below outlined clinical areas. This checklist will not be used as a determining factor in accepting your application for employment with ADEX Medical Staffing, LLC.

Proficency Scale:

1 = No Experience - Theory only

2 = Limited Experience - Infrequent

3 = Moderate Experience - Able to perform independently

4 = Proficient - Able to perform proficiently and instruct

Personal Information
Name:
Email:
City:
Country:
State/Region:

General Skills	1	2	3	4
Cardiac Arrest/ Adult CPR
Cardiac Arrest/ Infant-Child CPR
Care of the patient in restraints
Universal Precautions
Care of the patient in isolation
Organ Donor Protocols
Lift/Transfer Devices
Electronic Documentation

	Scrub				Circulate
General Surgery	1	2	3	4	1	2	3	4
Abdominal Perineal Resection
Adrenalectomy
Bariatric Surgery (gastric bypass)
Bowel Resection
Cholecystectomy/Cholangiogram
Colostomy/Ileostomy
Gastrectomy
Hemicolectomy
Hepatic Resection
Herniorrhaphy-Femoral/Inguinal
Hiatal Herniorrhaphy-Transabdominal
Pancreatectomy
Organ Procurement
Radical Mastectomy
Saphenous Vein Ligation/Stripping
Splenectomy
Thyroidectomy
Tracheostomy
Vagotomy
Familiarity with Pediatric Procedures

	Scrub				Circulate
Cardiovascular / Thoracic	1	2	3	4	1	2	3	4
Aortic Femoral Bypass graft
Femoral Popliteal Bypass
Pacemaker Implantation/ Explantation
Care of patients with pacemaker
Cardiac Cath Lab- IABP
Carotid Endoscopy
Septal Defects, ASV, VSD
Coronary Artery Bypass Graft
Maze Procedure
Valve Replacement
Aortic Aneurysm
Thoracotomy
Lobectomy
Rib Resection
Endoscopic Vein Harvesting
Off Pump Bypass
Endoluminal AAA
Angiography
A-V access graft
Aortic aneurysm Endarterectomy
Peripheral Vascular Bypass Procedures
Resection Carotid Aneurysm/ Graft
Thrombectomy
Embolectomy
Vena Cava Ligation
Arterial Switch
Atrial Septectomy
Bidirectional Glenn
Fontan Procedure
Norwood Procedure
Ross Procedure
Tetralogy of Fallot Repair
VSD Repair
Valve Repair/Replacement
BT Shunt
PDA Ligation
Repair of Coarctation of Aorta
ECMO Insertion/Decannulation (Cardiac)
Pacemaker
Chest Exploration/Closure

	Scrub				Circulate
Eyes, Ears, Nose & Throat	1	2	3	4	1	2	3	4
Cataract extraction
IOL Implants
Corneal transplant
Orbital Implant
Enucleation
Repair Orbital Blowout Fracture
Repair of Retinal Detachment
Scleral Buckle
Caldwell-Luc
Cleft lip/Palate Repair
Larynegectomy
Radical Neck
Tonsillectomy & Adenoidectomy
Mandibulectomy
Mastoidectomy
Rhinoplasty/ Septoplasty
Sinusotomy
Tracheostomy

	Scrub				Circulate
Endoscopic / Laparoscopic Procedures	1	2	3	4	1	2	3	4
Bronchoscopy
Culdoscopy
Cystoscopy
Esophagoscopy
Gastroscopy
Hysteroscopy
Appendectomy
Cholecystectomy
Colon Resection
Hernia Repair
Salpingo-oophorectomy
Tubal Ligation
Vaginal Hysterectomy
Laryngoscopy
Mediastinoscopy
Pelviscopy
Sigmoidoscopy
Thoracoscopy
Whipple
Nissen Fundalplication

	Scrub				Circulate
Gynecology	1	2	3	4	1	2	3	4
Caesarean Section
Dilation & Curettage
Hysterectomy-Vaginal
Hysterectomy-Abdominal
Laser Surgery
Radium Insertion
Salpingo-Oopherectomy
Shirodkar Procedure
Termination of Pregnancy
Tubal Ligation
Vaginectomy

	Scrub				Circulate
Neurology	1	2	3	4	1	2	3	4
Kyphoplasty
A-V malformation
Laparoscopic spine procedures
Burr Holes for Subdural Hematoma
Carotid ligation
Cervical Sympathectomy
Cranioplasty
Craniotomy
Disectomy/laminectomy
Halo Traction application
Insertion of nerve stimulus device
Myelomeningocele repair
Shunt procedure VP/ VA/LP
Spinal Fusions
Ventriculostomy

	Scrub				Circulate
Orthopedic	1	2	3	4	1	2	3	4
Achilles Tendon Repair
Amputation
Arthroscopy/Arthrotomy
Closed Pinning & Reduction of Extremities
External Compression Devices
Hip compression nails and lag screws
Total Joint Replacement-knee, hip, shoulder
Spica Cast
ORIF- shoulder, hip, humerus
Repair of Dislocation
Patellectomy
Tendon Implants and Reanastomosis
Antegrade/Retrograde Roddings
Humoral fracture
Tibial fracture
Femoral fracture
Carpal Tunnel release

	Scrub				Circulate
Plastics	1	2	3	4	1	2	3	4
Abdominal lipectomy
Blepharoplasty
Face Lift
Mammoplasty
Augmentation
Reduction
Reconstructive
Liposuction
Otoplasty
Scar Revisions
Skin Grafting
Craniofacial Reconstruction
Repair of Cleft Lip, Nose, Palete
Rhinoplasty/ Septoplasty

	Scrub				Circulate
Transplant	1	2	3	4	1	2	3	4
Bone
Corneal
Harvesting
Heart/Lung
Kidney
Liver
Multi Organ
Pancreas
Skin

	Scrub				Circulate
Trauma	1	2	3	4	1	2	3	4
Burns
Gunshot/ Stab wounds
Motor Vehicle Accidents
Traumatic amputations
Open Fractures
Hematoma: Subdural/Epidural

	Scrub				Circulate
Urology	1	2	3	4	1	2	3	4
Circumcision
Cystoscopy/ Ureteroscopy
Cystectomy
Hypospadius Repair
Implants
Lithotripsy
Nephrectomy
Orchiectomy
Prostatectomy
Ureterolithotomy
TURP
PVP- photo vaporization of prostate
Vasectomy

Equipment	1	2	3	4
Transfer/Lift Devices
Computerized Documentation
Medication Pumps
Abinmed Machine
Camera/Video systems
Cell Saver
Cidex Soak
Cryo-ophthalmic unit
CUSA
Hypo/Hyperthermia Unit
Drills and Saws
Electrosurgical unit
Fiber optic laminator
Cavitron
Autoclave
Fracture Tables
Stapling Devices
Mesh Graft/Dermatone
Microscopes
Nitrogen Tank
Pneumatic tourniquet
Steris unit
Pulsevac Irrigation
Autotransfusion Device
Laser Equipment
Care of Scopes and Fiberoptic Equipment
Venodyne

Age Specific Skills	1	2	3	4
Newborn birth-30 days
Infant 30 days-1 year
Toddler 1-3 years
Preschooler 3-5 years
School Age 5-12 years
Adolescents 12-18 years
Young Adults 18-39 years
Middle Adults 39-64 years
Older Adults 64+ years

Signature
The information represented above is true and correct to the best of my knowledge. I authorize ADEX Medical Staffing, LLC to share this skills checklist with its clients.
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Form Reviewed by ADEX Clinician - 10/14/2009