CENTRAL VERMONT HOSPITAL - VNIP



MANIILAQ HEALTH CENTER

DEPARTMENT OF NURSING

Patient Care Technician Orientation and Skills Checklist

This record is to be completed by the employee (orientee) and their preceptor / supervisor. Your (orientee) initials and date instructed are to be placed in the first column. If you work in an area where the listed skill is not part of your job description; check the N/A column. The preceptor / supervisor will initial and date the other column when competency is demonstrated.

PCT Name: ___________________________ Date of Hire: ______________ Unit: _________________

|Performance Criteria |Instructed |Return Demonstration |N/A |

| |Initial and date |Initial and Date | |

| |(Orientee) |(Preceptor) | |

|Activity: (Physical Therapist can assist with teaching in| | | |

|this section) | | | |

| Ambulation | | | |

| Type: | | | |

| Contact Guard | | | |

| One Person Assist | | | |

| Two Person Assist | | | |

| Proper Use Of: | | | |

| Cane | | | |

| Walker | | | |

| Gait Belt | | | |

| Trapeze | | | |

| Transfers: | | | |

| Bed to Chair | | | |

| Bed to Wheelchair | | | |

| Chair to BSC | | | |

| Bed to Stretcher | | | |

| One Person | | | |

| Two Person | | | |

| Hoyer Lift | | | |

| Exercise | | | |

| Range of Motion | | | |

| PT/ OT Guidelines | | | |

| Positioning/Repositioning | | | |

| Schedule | | | |

| Body Alignment | | | |

| Mealtime | | | |

| Equipment/ Aids | | | |

| Pillows | | | |

| Draw-sheet | | | |

| Foot Cradle | | | |

|Communication | | | |

| Shift start report | | | |

| Daily Checklist | | | |

| Other | | | |

|Vital Signs: | | | |

| Temperature: | | | |

| Axillary | | | |

| Oral | | | |

| Rectal | | | |

| Electronic Thermometer | | | |

| Pulse: Radial/Apical | | | |

| Respirations | | | |

| Blood Pressure | | | |

| Dynamap/Rover | | | |

| Manual | | | |

| O2 Saturation | | | |

| Pulse Oximetry | | | |

| Oxygen /Nebulizer (assisting with or | | | |

|maintaining therapy) | | | |

| Weight | | | |

| Standup Electronic | | | |

| Hoyer Lift / Scale | | | |

| Bed Scale | | | |

| Pediatric Scale | | | |

| Height / Length | | | |

| Standing tape measure | | | |

| Pediatric tape measure | | | |

| Blood Sugar | | | |

| Glucose Monitor Test on Patient | | | |

| Daily Quality Control | | | |

|Assisting with procedures: | | | |

| Pap’s | | | |

| Colposcopy | | | |

| D & C | | | |

| Upper Endoscopy | | | |

| Colonoscopy | | | |

| IV Starts | | | |

| Casting | | | |

| Rectal | | | |

| Lumbar Puncture | | | |

| Other | | | |

|Eye Exams | | | |

| Performing exams | | | |

| Special considerations | | | |

|Documentation: | | | |

| Electronic Health Record (EHR) | | | |

| (I&O) Sheet | | | |

| Calorie Counts | | | |

| Daily Assignment Sheet | | | |

| Nutrition ordering form | | | |

| Growth Charts | | | |

| Patient Information form (HIPAA) | | | |

|Infection Control: | | | |

| Standard Precautions | | | |

| Hand-washing | | | |

| Gloves | | | |

| Carry Soiled Items | | | |

| Clean Used Equipment | | | |

| Disposal of Infectious Material | | | |

| Precaution Cart (Setting up and | | | |

|maintaining isolation room) | | | |

| Employee Illness | | | |

| Linen Handling: Clean | | | |

| | | | |

|Soiled | | | |

| Specimen Collection: Urine | | | |

| | | | |

|Sputum | | | |

| | | | |

|Stool | | | |

| | | | |

|Pap’s | | | |

| | | | |

|Blood | | | |

| Application and Removal of gloves and PPE | | | |

|Medication Refrigerator Temperature Check | | | |

|Elimination: | | | |

| Diapers (weighing for amounts) | | | |

| Bedpan | | | |

| Regular | | | |

| Fracture | | | |

| Bedside Commode | | | |

| Catheters | | | |

| External (Texas) | | | |

| Internal (Foley) | | | |

| Emptying of | | | |

| Drainage Bag | | | |

| Leg Bag | | | |

| Tube Positioning | | | |

| Hygiene | | | |

| Incontinence Care | | | |

| Toilets | | | |

| Raised seat | | | |

| Urinals | | | |

| Ostomy: | | | |

| Care | | | |

| Emptying | | | |

|Personal Care: | | | |

| Complete Bath | | | |

| Partial Bath | | | |

| Back Rub | | | |

| Hair Care (Comb) | | | |

| Mouth Care | | | |

| Brushing | | | |

| Swabbing | | | |

| Dentures | | | |

| Nail Care | | | |

| Perineal Care | | | |

| Catheter Care | | | |

| Eyeglass Care/Contacts/Hearing Aides | | | |

| Shampoo | | | |

| Shaving | | | |

| Bed-making | | | |

| Occupied | | | |

| Unoccupied | | | |

| Stretcher | | | |

| Support Hose – TEDS | | | |

| Post-Mortem Care | | | |

|Nutrition: | | | |

| Passing and Picking Up Trays | | | |

| Diets | | | |

| NAS, CCD, Low Chol., etc| | | |

| Clear Liquid | | | |

| Full Liquid | | | |

| Consistency | | | |

| Puree | | | |

| Mechanical Soft | | | |

| Regular | | | |

| Honey / Nectar | | | |

| NPO | | | |

| Aspiration Risk (1,2,3) | | | |

| Positioning | | | |

| Proper Feeding & | | | |

|Swallowing Technique | | | |

| AM, PM and HS Snacks | | | |

| Water Pitchers | | | |

| Feeding | | | |

| Total | | | |

| Set-up | | | |

| Supervision | | | |

| Verbal Cueing | | | |

| Positioning | | | |

| Adaptive Equip | | | |

|Safety: Patient and Employee | | | |

| Call Bell | | | |

| Light | | | |

| Bed Alarm | | | |

| Nurse Call System | | | |

| Side Rails | | | |

| Padded Side Rails | | | |

| Door Alarms | | | |

| Fire Safety | | | |

| Spills / Wet Floors | | | |

| Restraints | | | |

| Behavioral Health Checks | | | |

| Patient Falls | | | |

| Incident Reports | | | |

| Body Mechanics | | | |

| Skin Protectors | | | |

| Safe and Clean Room/Unit | | | |

|Patient Rights: Pamphlet | | | |

|What to Report to Nurse: | | | |

| Abnormal Vital Signs | | | |

| Falls | | | |

| Behavior Problems | | | |

| Skin Problems | | | |

| Bleeding | | | |

| Eating Problems | | | |

| Complaints of Pain | | | |

| Other Concerns | | | |

| Changes in Body/Mental Functions | | | |

|Communication Barriers: | | | |

| Confusion | | | |

| Disorientation | | | |

| Hearing Impairment | | | |

| Visual Impairment | | | |

| Agitation | | | |

| Aphasia | | | |

| Body Language: Verbal/Nonverbal | | | |

| Language / Cultural | | | |

|Codes: Blue, Red, Pink, Green, Orange, Yellow, Stop | | | |

|Miscellaneous: | | | |

| Cleaning Equipment | | | |

| Telephone System | | | |

| Stocking of rooms | | | |

| Sharps boxes | | | |

| Location of Supplies | | | |

| Review of Job Description | | | |

| DNR | | | |

Verification of CPR Certification: Expiration Date: ___________

Verification of CNA Licensure: Expiration Date: ___________

Comments / plans for further instruction if needed (use back of form if needed and write “continued on back”):

Orientee Signature: _________________________Date: ___________ Initials: _____________

(For orientee, please use the date you started unit orientation)

Preceptor Signature: _________________________ Date: ___________ Initials: _____________

Preceptor Signature: _________________________ Date: ___________ Initials: _____________

Preceptor Signature: _________________________ Date: ___________ Initials: _____________

(For preceptors, please use date that you began working with orientee)

Supervisor Signature: _________________________Date: ___________

(Supervisors, please use date of completion of orientation and completed competency evaluation)

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