Howard Hubbard Memorial Hospital

Managed by Mt. Matutum Health Care Foundation, Inc.

Polomolok, South Cotabato
NURSING DEPARTMENT

SKILLS INVENTORY

NAME:
LIGTAS, ROY
BUSGANO

DATE OF
HIRE:
SEPTEMBER
30, 2016

SKILLS

AREA OF
ASSIGNMENT:
INTENSIVE
CARE
UNIT/HIGH
RISK
PREGNANCY
UNIT

SUPERVISOR/HEAD NURSE INCHARGE:

MS. CYNTHIA J. BRAZA
RATE THE
PERFORMAN
CE OF STAFF.
(1= Poor, 2 = Needs
Improvement, 3 =
Satisfactory)
Dates and
Signatures of
Supervisor/Head
Nurse

PHYSICAL
ASSESSMENT

Breast

Chest and
Lungs

POSITION:
ICU NURSE

General
Survey
Vital Signs

Skin

Head

Neck

TOTAL

REMARKS

Heart

Abdomen

GenitoUrinary
Extremities

OTHERS
NVS

COMMUNICAT
ION SKILLS

RATE THE
PERFORMAN
CE OF STAFF.
(1= Poor, 2 = Needs
Improvement, 3 =
Satisfactory)

TOTAL

Dates and
Signatures of
Supervisor/Head
Nurse

REMARKS

Ward
Endorseme
nt
Doctors
Order
(Carry Out)
Referral of
Findings
and
Diagnostics
Administrati
on of
Medication/
Treatment
Health
Teachings

DOCUMENTAT
ION SKILLS

RATE THE
PERFORMAN
CE OF STAFF.
(1= Poor, 2 = Needs
Improvement, 3 =
Satisfactory)

TOTAL

REMARKS

Dates and
Signatures of
Supervisor/Head
Nurse

Kardex

Vital
Sign
/Graphic
Sheet
IV Flow
Sheet
Medication/
Treatment
Record
Nurses
Record
Home
Instruction
Form
NVS Form

I and O
Sheet
OTHERS

FUNCTIONAL
NURSING

RATE THE
PERFORMAN
CE OF STAFF.
(1= Poor, 2 = Needs
Improvement, 3 =
Satisfactory

TOTAL

Dates and
Signatures of
Supervisor/Head
Nurse

Charge
Nurse
Medication
Nurse
Bedside
Nurse

PROCEDURES
3

REMARKS

RATE THE
PERFORMAN

TOTAL

REMARKS

CE OF STAFF.
(1= Poor, 2 = Needs
Improvement, 3 =
Satisfactory
Dates and
Signatures of
Supervisor/Head
Nurse

Bed Bath/Bed
Shampoo
Body Mechanics
Providing Perenial
Care
Administering
Oxygen
Catheterization
NGT insertion
Assist Intubation
Cutdown (Assist)
Tracheostomy
(Assist)
CTT Insertion
(Assist)
Thoracentesis
(Assist)
Suctioning:
nasopharyngeal
oropharyngeal
tracheostomy
ET tube
Preparation for CT
scan
Preparation for
surgical procedure
Post Mortem Care

DRUG
ADMINISTRATI
ON
Dates and
Signatures of
Supervisor/Head
Nurse

Activated
4

RATE THE
PERFORMAN
CE OF STAFF.
(1= Poor, 2 = Needs
Improvement, 3 =
Satisfactory

TOTAL

REMARKS

Charcoal
Aldactone
Aminophylline
Amniodarone
(Cordarone)
Atropine Sulfate
Blood Transfusion
Calcium
Gluconate
Citicholine
Digoxin (Lanoxin)
Dobutamine
Dopamine HCl
Ephedrine
Epinephrine
Diazepam
(Valium)
Furosemide
Isorsorbide
Dinitrate (Isoket
Drip)
Kyaxelate
Levophed
Magnesium
Sulfate
Mannitol
Methyl-Pred
(Depo-Medrol)
Nalbuphine HCl
INubain)
Nicardipine Drip
Nicardipine Drip
Nor-epinephrine
(Levoped)
Phenytoin (Dilatin)
Potassium
Cholride
Sodium
Bicarbonate
5

Sodium Luminal
(Phenobarbital)
Terbutaline Sulfate
(Bricanyl)
Verapamil
(Isoptin)
Blood Product
Administration
FWB
PRBC

OPERATION
OF
EQUIPMENT

RATE THE
PERFORMAN
CE OF STAFF.
(1= Poor, 2 = Needs
Improvement, 3 =
Satisfactory

TOTAL

REMARKS

Dates and
Signatures of
Supervisor/Head
Nurse

AED Defibrillator
Cardiac Monitor
Central Monitor
CPAP

ECG Machine 12
leads
Glucometer
Incubator
Infusion/Syringe
Pump
Mechanical
Ventilator
Nebulizer
Peak Flow Meter
Suction Machine

HOSPITAL
COMMITTES
AND
PROGRAMS

Safety
Programs

WRITE THE
DATE OF
PARTICIPATIO
N

REMARKS

Infection
Control
Program
Waste
Manageme
nt Program
HIV
Committee
TB
Committee
Breastfeedi
ng
Committee
Computer
Information
System
CustomerService
Improveme
nt
Workshop
Teambuildi
ng
Workshop
OTHERS

Orientation
on
MMHCFI
Benefits for
Dole
Employees
and
Dependent
s

REMARKS
7

REMARKS

REMARKS