"SELF EVALUATION"
RESPIRATORY SKILLS PROFICIENCY CHECKLIST

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     Last Name: 
    First Name: 
Middle Initial:  
CRTT Years Experience: 
RRT  Years Experience:

DIRECTIONS: Place an x in the box that best describes your level of proficiency for each of the skills presented.

LEVELS OF PROFICIENCY KEY:

HP = Highly Proficient; Extensively experienced; able to supervise and/or train others.

VE = Very Experienced; can perform well, without assistance or supervision.

EX = Experienced; competent; can perform independently; may need initial review or supervision.

SE = Some Experience; need review and assistance or supervision.

NE = No Experience.
PROFICIENCY LEVEL
WORK SUMMARY: HP VE EX SE NE
Intensive Care Unit
Coronary Care Unit
Burn ICU
Transplant
Pediatrics
Pediatric ICU
Neonatal ICU Level II
Neonatal ICU Level III
Emergency Room
Pulmonary Rehabilitation
Sleep Lab
Home Care
Transports
 Other:
CARE OF PATIENTS WITH: HP VE EX SE NE
Asthma
Status Asthmaticus
Acute/Chronic Bronchitis
Broncho-Pulmonary Dysplasia (BPD)
Cardiac Surgery
Cystic Fibrosis
Epiglottitis
Failure to Thrive
Respiratory Distress Syndrome
Tracheo-Esophageal Fistula
Hyaline Membrane Disease 
 (HMD/IRDS)
Meconium Aspiration
Neonatal Pneumonia
Persistent Fetal Circulation
Pulmonary Interstitial Emphysema (PIE)
Transient Tachypnea
Croup
Myesthenia Gravis
Guillian Barre
Open Hearts
Thoracotomies
Fem-pop Bypass
Pacer
BASIC TREATMENTS: HP VE EX SE NE
Incentive Spirometry
IPPB Treatments
Hand Held Nebulizers
Ultrasound Nebulizers
Chest Physical Therapy Postural Drainage
Medihalers
 Other:
BASIC RESPIRATORY THERAPY: HP VE EX SE NE
Patient Assessment and Monitoring
O2 Set-up
* Nasal Canula
* Mask
* Trach
* Aerosol
Change O2 Tank
Calculate Time Left in O2 Tank
Change Regulator, Empty to Full Tank
Differentiate Hi Flow - Low Flow O2 Delivery
Determine Proper FiO2 On Flow Rates
Know Difference in Various O2 Masks
Analyze Oxygen - FiO2
Interpretation of ABG's
Determination of Acid-Base States
Placement of Oral Airway
Placement of Nasal Airway
Nasotracheal Suctioning
Endotracheal Suctioning
Check Intracuff Pressure
Ventilate Patient with Manual Resuscitator
Heated and Cool Nebulizers
 Other:
 Other:

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