The Operating Room Competency Checklist Form is a valuable tool for assessing the competency of medical professionals in the operating room. The form can be used to evaluate the capabilities of surgeons, anesthesiologists, and nurses. The checklist includes a variety of topics such as patient safety, team work, and surgical procedures. By using the form, hospitals can ensure that their staff is fully competent in all areas of the operating room.
Below is the information about the PDF you were in search of to fill out. It will show you just how long it will need to complete operating room competency checklist, what fields you will need to fill in and some further specific facts.
| Question | Answer |
|---|---|
| Form Name | Operating Room Competency Checklist |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | aorn operating room competency checklist, nurse competencies checklist operating room, orientation to the operating room, operating room nurse orientation checklist |
Skills Self Assessment
OPERATING ROOM
Name: _________________________________ |
Date: ___________________ |
Please indicate your level of experience (1, 2, or 3.) |
One year experience in profiled specialty required. |
1. Limited - Less than one year 2. Experienced - One to Two years 3. Independent - Two or more years
Indicate Specialty: |
RN |
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SCRUB TECH |
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Endoscopy |
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Colonoscopy / Sigmoidoscopy |
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Cystoscopy / Uteroscopy |
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Gastroscopy/ Esophagoscopy/ Bronchoscopy |
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Laparoscopic Surgery |
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Specimen Management |
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Suctioning (Oral, nasal, trach) |
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Cardiac_Open Heart _Vascular |
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Abdominal Aortic Aneurysm |
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Aortic Resection |
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Aorto_Iliac Femoral Graft |
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AV Shunt |
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Endarterectomy Carotid/Femoral w/ graft |
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Femoral Popliteal Bypass Graft |
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Open Heart_Atrial/Ventricle Septal Defect |
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Open Heart_CoronaryArteryBypassGraft |
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Open Heart_PDA |
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Open Heart_Tetrology of Fallot |
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Open Heart_Valve Replacement, Repair |
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Pacemaker Implantation or Repair |
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Pericardial Window |
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Ventricular Assist Devices |
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General (see Endoscopy) |
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Appendectomy / ruptured |
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Breast Biopsy |
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Catheters_Hickman, Groshong, Portacath |
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Cholecystectomy / cholangiogram |
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Colon / Ileum resection |
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Colostomy / Ileostomy |
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Gastrectomy or Gastroplasty |
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Hemorrhoidectomy |
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Hepatic resection |
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Hernia repair |
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Laparotomy exploratory |
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Pediatric procedures |
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Pilonida cystectomy |
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Pyloric stenosis |
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Saphenous vein stripping |
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Sentinel node biopsy |
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Splenectomy |
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Tenchkoff catheter |
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Thyroidectomy |
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Vagotomy |
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Whipple |
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Gynecology |
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Circulate |
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AP Repair |
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3 |
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Cesarean section / Tubal Ligation |
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Cystectomy (ovarian etc) |
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(D&C) Dilation & Curettage |
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Gynecology (cont.) |
Circulate |
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MMR (Marshall Marchetti Krantz) |
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Radiological insertion |
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TAH / BSO_Vaginal & Abdominal |
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Vaginal Reconstruction |
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Vaginectomy / Vulvectomy |
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Neurological |
Circulate |
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Scrub |
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Burr Holes (Sub Dural Hematoma) |
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Crainotomy_Aneurysm |
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Crainotomy_Decompression fracture |
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Crainotomy_Tumor |
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Instrumentation_Spinal fusion |
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Kyphoplasty Spinal |
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Laminectomy / Discectomy Anterior_Posterior |
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Pediatric procedures |
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Spinal Fusion_Anterior / Posterior |
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Steriotactics |
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Tongs_Crutchfied & Mayfield |
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VP/VA Shunt |
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Ophthalmology |
Circulate |
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Scrub |
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Cataract extraction with IOL |
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Corneal Transplant |
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Enucleation |
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Iridectomy |
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Phaco Emulsification |
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Sceral Buckle |
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Vitrectomy |
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Orthopedics |
Circulate |
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Scrub |
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ACL (Anterior Cruciate Ligament) |
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Amputation limb |
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Arthroscopy (leg, shoulder, elbow) |
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Didget Reimplantation |
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External fixation application |
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Hand procedures |
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Hip Compression nails / pinning / screws |
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IM Rods (Intramedullary) |
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ORIF (Open Reduction Internal Fixation) |
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Pediatric procedures |
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Segmental Spinal Fixation |
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Tendon transplant |
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Total joint knee / hip / shoulder replacement |
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Oral_ENT |
Circulate |
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Scrub |
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Adenoidectomy / Tonsillectomy |
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Cleft lip/palate repair |
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Dental procedures |
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Fracture Reduction facial / wiring |
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Frontal Flap Sinus procedure |
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Radical neck dissection |
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Rhinopasty / Septoplasty / Tympanoplasty |
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TMJ exploration or arthroplasty |
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Tracheostomy |
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OR_HSGS |
1 |
5_07_LKP |
Skills Self Assessment
OPERATING ROOM
Plastics |
Circulate |
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Scrub |
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Abdominoplasty |
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3 |
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Blepharoplasty |
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Face Lift |
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Flaps_Free / Rotational |
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Liposuction |
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Mammoplasty_Augmentation |
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Mammoplasty_Reduction |
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Mammoplasty_TRAM flap / Reconstruction |
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Radical Mastectomy |
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Split Thickness Skin Graft |
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Thoracic |
Circulate |
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Scrub |
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Chest Tube/Drains |
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Mediastinoscopy |
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Pneumonectomy_Lobectomy |
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Rib Resection |
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Thoracotomy |
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Thrombectomy_Embolectomy |
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VATS (Video Assisted Thoracoscopy) |
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Transplant_Procurment |
Circulate |
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Scrub |
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Bone / Marrow |
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Corneal |
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Heart_Lung |
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Kidney |
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Liver |
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Pancreas |
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Trauma |
Circulate |
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Scrub |
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Burns |
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1 |
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Gunshot Stab Wounds_Abdomen |
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Gunshot Stab Wounds_Chest |
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Gunshot Stab Wounds_Head |
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MVA with Multiple injuries |
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Traumatic Amputations |
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Urological (see Endoscopy) |
Circulate |
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Scrub |
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Bladder Suspension |
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Cysto Retrograde |
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Hypospadias repair |
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Implant_Prosthesis insertion/removal |
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Lithotripsy |
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Nephrectomy |
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Radical Node Dissection |
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Radical Prostatectomy |
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Radium Seed Implants |
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Stent placement |
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TURP |
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Vasectomy |
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I attest the information submitted is true and accurate to the best of my knowledge.
Name (print) ____________________________________________
EQUIPMENT (Use and Care of) |
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Scrub |
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Argon Coagulator |
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Autoclave - Flash |
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Cell Saver |
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Cidex Soak |
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CUSA |
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Dermatome (Brown, Zimmer, Padgett) |
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Drill assembly / usage (cordless & air/gas) |
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Drills_Codman Cranitome |
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Drills_Midas Rex |
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Drills_Neurotome |
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Drills_Surgairtome |
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Electrical surgical unit & grounding pads |
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Endoscopic equipment (camera, video, etc) |
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Endoscopic Fiber optic luminator |
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Harmonic Scaple |
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Hypo/Hyperthermia Unit |
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Intestinal Stapling |
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Microscope |
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Nitrous Oxide |
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Pneumatic tourniquet |
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Robotics |
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Seris unit |
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Sterad machine |
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Table_OR, Fracture, Jackson |
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TPS |
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Ultrasonic cleaner |
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Vac Pack (Bean Bag) |
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Vacuum Curettage |
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Washer Sanitizer |
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Wilson Frame |
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OTHER |
Circulate |
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Scrub |
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Blood / Blood Products Administration |
1 |
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3 |
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3 |
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Catheter Care/Insertion |
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Conscious Sedation |
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Diseases Infectious/Communicable |
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Hemodynamic Monitoring |
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IV Care/Therapy |
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Lab Obtain / Interpret |
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Latex Allergy Guidelines/Procedure |
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O2 Saturations / Oxygen Therapy |
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Pain Assess / Manage |
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Restraints |
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System Assessment |
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Teaching Pt/Others |
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Wound / Dressing Care |
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CERTIFICATIONS |
Expires RN |
Expires ST |
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Certified Scrub Tech |
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CNOR Certification |
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Laser Certification |
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Signature:______________________________ |
Date: ________________________________ |
OR_HSGS |
2 |
5_07_LKP |