ADEX Medical Staffing - GI Endoscopy Skills Checklist

GI Endoscopy 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

Frequency Scale:

1 = Never Observed

2 = Less than 6 times a year

3 = 1 or 2 Times a Month

4 = Daily or Weekly

Personal Information
Name:
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	Proficiency				Frequency
Procedures	1	2	3	4	1	2	3	4
Assist with EGD's
Assist with Endoscopic Ultrasound
Assist with Active GI Bleed
Cautery Devices
Assist with Manometry Studies
Assist with Variceal Banding
Asist with Esophageal Dilatations
Assist with Sclerotherapy
Assist with TEE
Assist with Bronchoscopy
Assist with Colonscopy
Assist with Polypectomy
Assist with ERCP's
Assist with PEG placements
Assist with Collection of Hot & Cold Bx's
Specimen Collection & Labeling
Apply External Abdominal Pressure to assist with Scope Movement
Monitoring of Conscious Sedation

	Proficiency				Frequency
Pre/Post Procedure	1	2	3	4	1	2	3	4
Knowledge of Sedation Reversal Agents
O2 Administration
Pulse Oximetry
Scope Cleaning
Set-up of Scopes & Video Equipment
Obtain IV Access
Pre-procedure Checklist
Pre-procedure Teaching
Monitor EKG
Monitor O2 stats
Monitor VS
Use of Sedation Recovery Scale
Airway Management
Assess GI Statue Post-procedure
Assess for Gag Reflex Post EGD
Perform Post Procedure Teaching

	Proficiency				Frequency
Medications	1	2	3	4	1	2	3	4
Antibiotics
Insulin
Conscious Sedations Medications
Sedation Reversal Agents

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

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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 - 11/16/2010