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CRT/RRT
CRT/RRT
Name
First
Last
Email
Phone
Date
MM slash DD slash YYYY
Self-Assessment Rating Scale
No Experience
Theory or observation only during the past 12 months
Limited Experience
Performed less than 12 times within the past 12 months and may need a review
Experienced
Performed at least once per month within the past 12 months and may need minimal assistance
Highly Skilled
Performed on at least a weekly basis over the past 12 months; proficient
Age
No Experience
Limited Experience
Experienced
Highly Skilled
Newborn (Birth-30 days)
Infant (30 days-1 yr)
Toddler (1-3 yr)
Preschooler (3-5 yrs)
School age child(5-12 yrs)
Adolescents (12-18 yrs)
Young adults (18-39 yrs)
Middle adults (39-64 yrs)
Older adults (64+ yrs)
General Skills
No Experience
Limited Experience
Experienced
Highly Skilled
Standard precautions
Isolation precautions
Patient head to toe assessment
Infant/neonatal cardiac/respiratory arrest
Adult respiratory/cardiac arrest
Prep and administration of emergency meds
Crash carts
Defibrillators
Care of patient in restraints
Automated med dispensing systems
Electronic documentation
Care planning and discharge planning
Care of Patients With:
No Experience
Limited Experience
Experienced
Highly Skilled
Acute/chronic bronchitis
ARDS (Adult Respiratory Distress Syndrome)
Aspiration asthma
Status asthmaticus
Bronchoscopy
Bronco-pulmonary dysplasia
CHF (Congestive Heart Failure)
COPD
Croup
Cystic fibrosis
Epiglottis
Guillain-Barre syndrome
Hemopneumothorax
Myasthenia Gravis
Pneumonia
Pulmonary edema
Pulmonary embolism
Smoke inhalation
Tuberculosis
Tension pneumothorax
Thoracotomy
Tracheal-esophageal fistula
Tracheotomy
Failure to thrive
Fem-pop bypass
Laryngospasm
Meconium aspiration
Near drowning
Persistent pulmonary hypertension
Pulmonary interstitial emphysema
RSV (Respiratory Syncytial Virus)
Transient tachypnea of newborn
Medication Administration
No Experience
Limited Experience
Experienced
Highly Skilled
Atrovent
Albuterol
Bicarbonate
Breo
Combivent
Incruse
Isuprel
Mucomyst
Pulmicort
Racemic epinephrine
Spiriva
Terbutaline sulfate
Theophylline
Xopenex
Knowledge of Effects Of:
No Experience
Limited Experience
Experienced
Highly Skilled
Alupent
Anectine
Atropine
Azmacort
Bronkosol
Corticosteroids
Cromolyn sodium
Decadron
Diazepam
Digoxin
Dopamine
Flovent
Heliox therapy
Inhaled steroids
Ketamine
Lasix
Lidocaine
Morphine
Nitric oxide
Pavulon
Propofol
Tobramycin
Versed
Medication Delivery
No Experience
Limited Experience
Experienced
Highly Skilled
Nebulizer - Hand held
Nebulizer - Humidification (cool/warm)
Nebulizer - Ultrasonic
MDI - Aero chamber
MDI - Intermittent Positive Pressure (IPPB)
Procedures:
No Experience
Limited Experience
Experienced
Highly Skilled
Postural drainage
Chest percussion therapy
Sputum collection/sampling
ABG's (Arterial Blood Gases)
Allen test
Femoral
Arterial
Set up and calibrate arterial lines
Airway Management and Suctioning
No Experience
Limited Experience
Experienced
Highly Skilled
Tracheal
Endotracheal
Nasotracheal
Oral
In-line suctioning
Adult - Checking cuff pressure
Adult - Extubation
Adult - Intubations
Manual ventilation - Neo-natal
Manual ventilation - Pediatrics
Diagnostics
*
No Experience
Limited Experience
Experienced
Highly Skilled
Pulmonary function testing
Assist with bronchoscopes
Obtain umbilical blood gas
Obtain capillary blood gas
Assist with thoracentesis
Homodynamic monitoring
Teaching
No Experience
Limited Experience
Experienced
Highly Skilled
Incentive spirometer
Peak flow meter
Pursed lip breathing
Segmental breathing
Splinting
Work Settings
No Experience
Limited Experience
Experienced
Highly Skilled
CCU/ICU
Emergency department
Home care
Neonatal ICU
Pediatric
Pediatric ICU
Pulmonary rehabilitation
Transport
Equipment
Ventilator Setup
No Experience
Limited Experience
Experienced
Highly Skilled
Achieva
Siemens
Bi-Pap
PB7200
Sechrist IV 100B
Servo V60
Assist control
CPAP
Flow-by
High frequency ventilator
IMV
Inverse ratio vent
Pressure support
Pressure vents
SIMV
Troubleshooting high and low alarms
Oxygen/Air Delivery Systems
No Experience
Limited Experience
Experienced
Highly Skilled
Ambu bag
Croup tent
E-cylinders
Nasal cannula
Non-rebreather
T-piece
Trach collar
Venturi mask
ABG
Signature
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