Department - Nursing Nursing Competency Check - ICU

Name of the Staff Nurse: Unit:

Emp No. : D. O. J:

S.N Check proficiency 3 months 1 Year

1  Keeps the bed and equipments ready
 Receives the patients
 Assesses the patient
 Connects monitor
 Resuscitates the patients
 Assists in Endotracheal intubation & extubation
 Cannulates peripheral veins or assists for central lines
 Checks CVP/ABP/PA pressure
 Performs ABG
 Ensures Xray is done after intubation and central lines
 Inserts Foleys catheter and Ryles tube
 Does ryles tube feeding and other tube feedings
 Administers total parenteral nutrition and monitors hydration status of the patients
 Collects and despatches sample for investigation and collects report and informs
the duty doctor
 Handles emergency situations and complications during the course of treatment.
2 Does hourly Assessment of
 CVP
 I/O chart
 Vitals signs
 Pain
 Restraint
 Performs back care and changes position every 2nd hourly
 Department - Nursing Nursing Competency Check - ICU

S.N Check proficiency 3 months 1 Year

 Ensures patient is on special mattress
 Ensures indents ( Medication) are received within ½ an hour
3 Assists / Cares the patient in the following procedure
 Dialysis
 ICD insertion
 Tracheostomy
 Bed side echo and other bedside procedures
 Paracentesis
 Thoracentesis
 Lumbar puncture
4 Cares for patient with
 Intra Aortic Balloon
 Myocardial infarction
 Congestive heart failure
 PTCA
 CAG
 Permanent & Temporary Pace Maker Insertion
5 IV Cannulation, Blood & Blood products administration
 Assesses for the vein
 Cannulates the patient
 Secures the IV site
 Monitors the IV site for swelling, infection etc…
 Ensures consent is signed before blood transfusion
 Administers and monitors transfusion of blood component
 Packed RBC
 Platelet concentrate
 Fresh Frozen plasma
 Cryoprecipitate
 Department - Nursing Nursing Competency Check - ICU

S.N Check proficiency 3 months 1 Year

6 Isolation & Infection prevention techniques
 Practices barrier and isolation protocols as applicable.
 Ensures the usage of PPE whenever necessary
 Restricts attenders
 Disposes all biomedical waste as per protocols
 Ensures patient is prevented from all healthcare associated infections
 Ensures the practice of universal precautions.
7 Pain management
 Assesses Pain
 Intervenes & documents
 Follows safety of the following
 Continuous narcotics infusion
 IV push narcotics
 Transdermal agents
 Oral timed release agents
 Epidural medications
8 Death care
 Removes all the invasive lines and plugs all the orifices
 Packs the body
 Practices all infection control protocol for an infected patients
 Transports the body to mortuary and hands over the reports security
9 Equipment
Knowledge and safety in handling
 Ventilator
 Ambu bag
 Department - Nursing Nursing Competency Check - ICU

S.N Check proficiency 3 months 1 Year

 Crash cart
 Defibrillator
 Glucometer
 Infusion Pump
 Laryngoscope
 Pulse Oximeter
 Suction Apparatus Wall/Portable
 Syringe Pump
 Nebulizer
 Special mattress
 ECG Machine

Designation Remarks & Signature Remarks & Signature

3 months 1 Year
Staff Nurse

Incharge Nurse

Nursing Superintendent

Band Score:
1-Needs Training
2-Can work under supervision
3-Independent