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HOME HEALTH CARE Skills Checklist
Experience Level
1 = No Experience - Theory / Observed Only 3 = Experienced - Does Frequently / Competent 2 = Limited Experience - Have Done / May Need Review GENERAL SKILLS
Monitoring
End of life care/ Palliative care
Documentation of skilled Care (Electronic) Identification and Reporting of Abuse Victims Recognizing failure to thrive across the lifespan CARDIOVASCULAR
Assessment Skills
Care of Patients with
_______________________________________
Page 9 of 17
HOME HEALTH CARE Skills Checklist
Experience Level
1 = No Experience - Theory / Observed Only 3 = Experienced - Does Frequently / Competent 2 = Limited Experience - Have Done / May Need Review CARDIOVASCULAR, con't.
Post Coronary Artery Bypass Graft (CABG)/valve
Medication Administration/Patient Teaching of
Antidysrhythmics
Antihypertensives
PULMONARY
Assessment
Identification of adventitious breath sounds (IE: rales, rhonci) Care of Patients with:
Medication Administration/Patient Teaching of
Inhaled medications (proventil/anticholinergics/steroids/mucolytics) _______________________________________
Page 10 of 17
HOME HEALTH CARE Skills Checklist
Experience Level
1 = No Experience - Theory / Observed Only 3 = Experienced - Does Frequently / Competent 2 = Limited Experience - Have Done / May Need Review NEUROLOGY
Assessment of Neuro Status
Care of Patients with:
Medication Administration/Patient Teaching of
ORTHOPEDIC
Total Joint Replacements (knee/hip/ shoulder)
Care of Patients with:
_________________________________________
Page 11 of 17
HOME HEALTH CARE Skills Checklist
Experience Level
1 = No Experience - Theory / Observed Only 3 = Experienced - Does Frequently / Competent 2 = Limited Experience - Have Done / May Need Review GASTROINTESTINAL
NG Tube
Care of Patients with:
GENITOURINARY
Foley catheter insertion
Care of Patients with:
GYNECOLOGY
Endometriosis
MATERNAL - CHILD CARE
Assessment and Care of Complicated Pregnancy
_________________________________________
Page 12 of 17
HOME HEALTH CARE Skills Checklist
Experience Level
1 = No Experience - Theory / Observed Only 3 = Experienced - Does Frequently / Competent 2 = Limited Experience - Have Done / May Need Review MATERNAL - CHILD CARE , con't.
Breast Feeding
Care of Patients with:
NEONATAL/NEWBORN CARE
Neonatal Care Level I, II & III
PEDIATRICS
Assessment
Use of Oxygen
________________________________________
Page 13 of 17
HOME HEALTH CARE Skills Checklist
Experience Level
1 = No Experience - Theory / Observed Only 3 = Experienced - Does Frequently / Competent 2 = Limited Experience - Have Done / May Need Review PEDIATRICS, cont.
Use of Ventilators
Care of Patients with:
ONCOLOGY
Assessment
Care of Patients with:
________________________________________
Page 14 of 17
HOME HEALTH CARE Skills Checklist
Experience Level
1 = No Experience - Theory / Observed Only 3 = Experienced - Does Frequently / Competent 2 = Limited Experience - Have Done / May Need Review ONCOLOGY, cont.
Post Oncology surgery
Medication Administration/Patient Teaching of
INFECTIOUS DISEASE
Assessment
Culture & Sensitivity Interpretation Care of Patients with:
WOUND/SKIN CARE
Wound Assessment Scale
Special Mattresses & positioning devices Care of Patients with:
_________________________________________
Page 15 of 17
HOME HEALTH CARE Skills Checklist
Experience Level
1 = No Experience - Theory / Observed Only 3 = Experienced - Does Frequently / Competent 2 = Limited Experience - Have Done / May Need Review IV THERAPY
Assessment of Vascular System
Starting & Maintaining Peripheral IV's Administration of Blood & blood products Care of Patients with:
PAIN MANAGEMENT
Pain Scale
Response to Pain Management Interventions Non-pharmacological Pain Relief measures Care and Management of nonvascular devices (epidural, intrathecal) CASE MANAGEMENT
Experience as a Case Manager
Familiar with InterQual criteria & computer software Familiar with Medicare/Medicaid guidelines ________________________________________
Page 16 of 17
HOME HEALTH CARE Skills Checklist
Experience Level
1 = No Experience - Theory / Observed Only 3 = Experienced - Does Frequently / Competent 2 = Limited Experience - Have Done / May Need Review CASE MANAGEMENT, cont.
Private Insurance
Collaboration with Client/Family & Members of the Healthcare Team Regulating Agencies
CMS: Centers for Medicare & Medicaid Services OSHA: Occupational Safety & Health Agency HIPAA: Health Insurance Portability & Accountability Act Computer and Software Programs
WORK SETTINGS/ EXPERIENCE
Hospital
Health Maintenance Organization Review Department ________________________________________
Page 17 of 17
HOME HEALTH CARE Skills Checklist
Experience Level
1 = No Experience - Theory / Observed Only 3 = Experienced - Does Frequently / Competent 2 = Limited Experience - Have Done / May Need Review LEGEND FOR AGE SPECIFIC CRITERIA
[A] = Newborn (Birth to 30 days)
AGE SPECIFIC CRITERIA
Able to adapt care to incorporate normal growth and development
A B C D E F G H I
Able to adapt method and terminology of patient instructions to their age comprehension and maturity level.
A B C D E F G H I
Can ensure a safe environment reflecting specific needs of various age groups.
A B C D E F G H I
CERTIFICATIONS / COURSES / SKILLS
ACLS
I verify that the representation of my skills and associated proficiency levels in this document is a true and accurate reflection of my abilities based on my work experience over the prior 24 months.

Source: http://www.americantraveler.com/pdf/skill_home_health.pdf