OPERATING ROOM SKILLS CHECKLIST
Registered Nurse Technician CTS
Name:
When completing this ckecklist, please indicate your level of proficiency in each area according to the scale below. Place a check mark in box which best describes your expertiese with each skill.

The scale is as follows:
1. Not performed   2. Intermitten experience   3. Very experienced.
CARDIOVASCULAR
  1. Aortic Femoral Bypass graft   1 2 3
  2. Femoral-Popliteal Bypass   1 2 3
  3. Pacemaker Implantation   1 2 3
  4. Care of patients with pacemaker   1 2 3
  5. Cardiac cath lab  
    1. Intra-Aortic Balloon Pump   1 2 3
  6. Septal defects   1 2 3
  7. Shunts   1 2 3
  8. Coronary Artery Bypass Graft   1 2 3
  9. Pediatric procedures   1 2 3
  10. Valve replacement   1 2 3
  11. Aortic aneurysm   1 2 3
ENT
  1. Adenoidectomy/Tonsillectomy   1 2 3
  2. Caldwell - Luc   1 2 3
  3. Cleft lip/palate repair   1 2 3
  4. Mastoidectomy   1 2 3
  5. Middle ear procedure   1 2 3
  6. Radical neck dissection   1 2 3
  7. Rhinoplasty/septoplasty   1 2 3
  8. Tracheotomy   1 2 3
EQUIPMENT
  1. Camera/video systems   1 2 3
  2. Cell saver   1 2 3
  3. Cidex soak   1 2 3
  4. Cryo-ophthalmic unit   1 2 3
  5. CUSA   1 2 3
  6. Vac-Pac/ Bean Bag   1 2 3
  7. Hypo/Hyperthermia Unit   1 2 3
  8. Drills and saws   1 2 3
  9. Electrosurgical unit   1 2 3
  10. Fiber optic luminator   1 2 3
  11. Cavitron   1 2 3
  12. Autoclave   1 2 3
  13. Fracture tables   1 2 3
  14. Stapling devices   1 2 3
  15. Mesh graft/Dermatome   1 2 3
  16. Microscopes   1 2 3
  17. Nitrogen tank   1 2 3
  18. Pneumatic tourniquet   1 2 3
  19. Steris unit   1 2 3
  20. Pulsevac Irrigation   1 2 3
  21. Autotransfusion Drain   1 2 3
  22. Ligasure machine   1 2 3
GENERAL SURGERY
  1. Abdominal peritoneal resection   1 2 3
  2. Breast biopsy   1 2 3
  3. Bowel resection   1 2 3
  4. Gastric procedures   1 2 3
  5. Hernia: open repair   1 2 3
  6. Colostomy/Ileostomy   1 2 3
  7. Appendectomy - open   1 2 3
  8. Appendectomy - Laparoscopic   1 2 3
  9. Cholecystectomy/Laparoscopic   1 2 3
  10. Cholecystectomy/colongiogram-open   1 2 3
  11. Hiatal herniorraphy   1 2 3
  12. Hepatic resection   1 2 3
  13. Hickman/Groshong/Portacath insertion   1 2 3
  14. Rectal procedures   1 2 3
  15. Pancreatectomy/pancreatogram   1 2 3
  16. Splenectomy   1 2 3
  17. Thyroidectomy   1 2 3
  18. Colonoscopy/Sigmoidoscopy   1 2 3
  19. Gastroscopy/ Esophagoscopy   1 2 3
  20. Nissen fundoplication laparoscopic   1 2 3
GYNECOLOGY
  1. Cesarean section   1 2 3
  2. Dilation and Curettage (D&C)   1 2 3
  3. TAH/BSO   1 2 3
  4. Vaginal Hysterectomy   1 2 3
  5. Marshall-Marchetti   1 2 3
  6. Ovarian cystectomy   1 2 3
  7. AP Repair   1 2 3
  8. Laparoscopic procedures   1 2 3
  9. Hysteroscopy   1 2 3
NEUROLOGY
  1. Discectomy/laminectomy   1 2 3
  2. Anterior/posterior cervical fusion   1 2 3
  3. Cranioplasty/craniotomy tumor   1 2 3
  4. Craniotomy for aneruysm   1 2 3
  5. Shunt procedure/VP, VA/LP   1 2 3
  6. Halo traction application   1 2 3
  7. Pediatric procedures   1 2 3
  8. Spinal fusion   1 2 3
  9. Spinal fusion with instrumentation   1 2 3
OPTHALMOLOGY
  1. Cataract extraction with IOL   1 2 3
  2. Corneal transplants   1 2 3
  3. Scleral buckle   1 2 3
  4. Vitrectomy   1 2 3
  5. Anterior procedures   1 2 3
  6. Exterior procedures   1 2 3
  7. Equipment:  
    1. Legacy   1 2 3
    2. Millenium   1 2 3
ORAL
  1. Closed reduction facial fractures and wiring   1 2 3
  2. Dental procedures   1 2 3
  3. LeFort osteotomies   1 2 3
  4. Mandibular osteotomy   1 2 3
  5. TMJ procedures   1 2 3
ORTHOPEDICS
  1. Amputation - leg, arm   1 2 3
  2. Carpel tunnel release   1 2 3
  3. Hand surgery   1 2 3
  4. Hip compression nails, screws and pinning   1 2 3
  5. Bipolar/unipolar hip prosthesis   1 2 3
  6. Iliac crest bone graft   1 2 3
  7. Intramedullary rods   1 2 3
  8. Open reduction internal fixation   1 2 3
  9. Patellectomy   1 2 3
  10. Reimplantation of digits   1 2 3
  11. Rotator cuff repair   1 2 3
  12. Total joint knee/shoulder/wrist   1 2 3
  13. Arthroscopic procedures   1 2 3
  14. Pediatric procedures   1 2 3
PLASTICS
  1. Free Flap/Rotational Flap   1 2 3
  2. Radical Mastectomy   1 2 3
  3. Mastectomy   1 2 3
  4. Adominoplasty   1 2 3
  5. Blepharoplasty   1 2 3
  6. Face lift   1 2 3
  7. Augmentation mammoplasty   1 2 3
  8. Reduction mammoplasty   1 2 3
  9. Reconstructive mammoplasty tram flaps   1 2 3
  10. Skin graft   1 2 3
THORACIC
  1. Thombectomy/Embolectomy   1 2 3
  2. Lobectomy   1 2 3
  3. Thoracotomy   1 2 3
  4. Chest tube   1 2 3
  5. Bronchoscopy   1 2 3
  6. Mediastinoscopy   1 2 3
  7. Thoracoscopy   1 2 3
TRANSPLANTS
  1. Bone marrow   1 2 3
  2. Heart/Lung   1 2 3
  3. Kidney   1 2 3
  4. Corneal   1 2 3
  5. Harvesting   1 2 3
  6. Liver   1 2 3
  7. Pancreas   1 2 3
UROLOGY
  1. Implants; penile, testicular   1 2 3
  2. Lithotripsy   1 2 3
  3. Nephrectomy   1 2 3
  4. Orchiopexy   1 2 3
  5. Prostatectomy   1 2 3
  6. TURP   1 2 3
  7. Vasovasostomy   1 2 3
  8. Cystocopy/Ureteroscopy   1 2 3
PROFESSIONAL EXPERIENCE AND CERTIFICATIONS
  1. Years of experience as: RN  Tech.
  2. Years of experience in:Adult  Pediatric.
  3. Area of most proficiency:
  4. Area of least proficiency:
  5. Are you willing to assist with elective abortions? Yes No
  6. Are you Laser certified? Yes No
The information I have given is true and accurate to the best of my knowledge. Please sign and date below.
SIGNATURE: (Last 4 digits of your SSN)    Reenter your last 4 digits of your SSN:   DATE:

  
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