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/depts/uwhealth/ambulatory-education/ambulatory-orientation/checklists/resources/Transformations-Clinical-Staff-Checklist-1-24-2018.pdf

20180125

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UWMF,

Learning and Development,

Departments & Programs,UW Health,Ambulatory Education,Ambulatory Orientation,Checklists - Core and Department Specific,Resources

Transformations Clinical Staff

Transformations Clinical Staff - Departments & Programs, UW Health, Ambulatory Education, Ambulatory Orientation, Checklists - Core and Department Specific, Resources



Transformations Clinical Staff Training Checklist

Name: ___________________________ ID: _________ Clinic: ______________ Start Date: ________ Due Date: ________
Area of Orientation

Discussed/
Observed
(D/O)
Preceptor’s
Initials
Date
Completed
PATIENT TEACHING – ALL PATIENTS
Employee participates in patient/family teaching and is able to:
ξ Elicit patient’s expectations in medical care
ξ Determine patient’s knowledge level/deficit and ability to understand
ξ Identify cultural practices related to care
ξ Counsel and provide appropriate resources
ξ Gather information regarding relationships with significant others (when
appropriate)


SURGICAL AND NON-SURGICAL PROCEDURES
Employee is able to appropriately:
ξ Complete Pre-Op Forms for surgical procedures
ξ Perform blood draws/phlebotomy
ξ Perform sterile setup and technique for office based surgery
ξ Dress surgical site at end of procedure using appropriate technique
ξ Provide dressing instructions to patients prior to going home

Employee demonstrates ability to clean and care for equipment:
ξ Laser equipment
ξ All appropriate equipment/supplies are available based on patient
needs/procedure

ξ All equipment functions before use
ξ All emergency equipment/supplies are current and available at all times

CONSULTS/REFERRALS
Employee is able to place consults/referrals for:

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Area of Orientation

Discussed/
Observed
(D/O)
Preceptor’s
Initials
Date
Completed
ξ Other clinics, physicians
ξ Dietitians/Nutrition, Diabetes Education
ξ Cornea, Retina Surgeries
ξ Plastic Surgeries Referred to UWHC, or Davis, Duehr, Dean
ξ Mohs Surgery, Cosmetic/Laser Consults

EAR/NOSE/THROAT (ENT)
Employee is knowledgeable regarding ENT Policies:
ξ Pre-Appointment Management Triage (RN, LPN Only)
ξ Photography

Employee is able to gather relevant data & appropriately care for patients
with the following:

ξ Signs/symptoms of nose/sinus problems:
o Deviated Septum
o Nasal Fracture
o Sinusitis Acute/Chronic
o Nasal Congestion
o Snoring/Sleep Apnea

ENT-SURGICAL PROCEDURES
Employee is able to set-up/assist/follow-up for the following surgical
procedures:

ξ Ear:
o Otoplasty
o Ear Piercing, Earlobe repair

ξ Nose/Sinus:
o Septoplasty
o Endoscopic Sinus Surgery
o Nasal Reduction

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Area of Orientation

Discussed/
Observed
(D/O)
Preceptor’s
Initials
Date
Completed
o Nasal Button Insertion
o Rhinoplasty

ξ Cosmetic procedures:
o Sciton Laser
o Fat Transfer
o Sinus Scope
o Chemical peels

ξ Post-surgical procedures:
o Mohs Procedure
o Dermal Fillers
o Botox

ENT-PROCEDURES
Employee demonstrate competence to assist/set-up/patient care/follow-up for
the following procedures:

ξ Lesion removals*
ξ Snoreplasty
ξ Nasal Fracture reduction
ξ Nasal Packing removals
ξ Septal Button Placement
ξ Electro Cautery
ξ Phlebotomy

Employee demonstrates ability to clean and care for the following
equipment:

ξ Cautery machines, Sciton, Chiller, Plume evacuator




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Area of Orientation

Discussed/
Observed
(D/O)
Preceptor’s
Initials
Date
Completed
MEDICATIONS
Employee is able to verbalize appropriate dose, mechanism of action, side
effects and drug compatibilities for the following:

ξ Anti-histamines
ξ Decongestants
ξ Antibiotics
ξ Analgesics
ξ Anesthetics- General-Local
ξ Antivirals
ξ Nasal Steroid Sprays *
ξ Ear/Eye Drops *
Employee is able to obtain prior authorization for medications when needed

OPHTHALMOLOGY
Employee is knowledgeable regarding Ophthalmology Policies:
ξ Triage Protocol

Employee is able to gather data relevant to the following:
ξ Assess and record visual acuities
ξ History, medical care of eye
ξ Photography/Add to computer
ξ Visual Fields/Goldman
ξ Blood pressure

OPHTHALMOLOGY-PROCEDURES
Employee demonstrates competence to set-up/ assist/patient care/follow-up:
ξ Trays for in-office procedures: chalazion, stitch removal, lesions, cysts
ξ Contacts lens insertion and removal
ξ Appropriate care for biopsy specimens
ξ Lacrimal duct probing and tube insertion
ξ Botox administration set up

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Area of Orientation

Discussed/
Observed
(D/O)
Preceptor’s
Initials
Date
Completed
ξ Dermal Fillers
ξ Laser procedures
ξ Visual fields Goldmans

Employee demonstrates ability to clean and care for the following
equipment:

ξ Slitlamps, ophthalmoscopes

DERMATOLOGY
Employee is knowledgeable regarding Dermatology Policies:
ξ Hyfracator, Liq. Nitrogen
ξ Vectus Laser Hair Removal/Sciton Laser
ξ Photography and Transfer to computer or PACS

Employee is able to gather data regarding the following conditions (including
visual descriptions, family history, sun exposure, risk factors of multiple
nevi):

ξ Skin lesions
o Basal cell and Squamous cell carcinoma
o Melanoma
o Seborrheic keratosis
o A/K and Nevi
o Telangiectasias / hemangiomas
o Skin Tags
o Cysts/lypoma, dermatofibroma, other skins lesions
ξ Acne / Rosacea
ξ Auto Immune Diseases - Alopecia

Employee demonstrates knowledge of & can discuss the following topics with
patient:

ξ Appropriate follow-up by diagnosis and provider protocol

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Area of Orientation

Discussed/
Observed
(D/O)
Preceptor’s
Initials
Date
Completed
ξ Sunscreen
o Importance of use
o What products to use
o When /How to use

ξ Over the counter treatment options for:
o Hyperpigmentation
o Acne
o Rosacea

ξ Wound Care including:
o Signs and symptoms of infection
o Topical antibiotics
o Liquid nitrogen
o Post-op laser care
o Post-op bleeding

Employee demonstrates ability to clean and care for the following
equipment:

ξ Laser equipment
ξ Liquid Nitrogen
ξ Hyfracator

DERMATOLOGICAL PROCEDURES
Employee demonstrates competence to assist/set-up/patient care/follow-up:
ξ Lesion removal: shave biopsy*, punch, surgical excision ECD, Mohs
ξ Injection of local anesthesia, including proper dilution
ξ Suture removal *, Steri strip
ξ Photofacial, Resurfacing and Vein Laser assist including laser safety and
use of appropriate goggles, prep of laser patient, post laser care and
instructions


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Area of Orientation

Discussed/
Observed
(D/O)
Preceptor’s
Initials
Date
Completed
Employee is able to process specimens appropriately to:
ξ Dermatology Lab
ξ UWMF Lab

MEDICATIONS
Employee is able to verbalize appropriate dose, mechanism of action, side
effects and drug compatibilities for the following:

ξ Acne: oral antibiotic: minocycline, tetracycline, sulfa, erythromycin,
doxycycline, accutane

ξ Acne: topical antibiotics, retinoids, benzoyl peroxide
ξ Rosacea: metro-gel, lotion, cream, oral antibiotics, erythro, minocycline,
tetracycline, noritiate

ξ Actinic keratosis: Liquid Nitrogen, Efudex
ξ Viral Infections: Valtrex, Zovirax, Famvir
Employee is able to obtain prior authorization for medications: Retin-A

BREAST, VARICOSE VEINS, COSMETIC SURGICAL PROCEDURES
Employee is able to gather data relevant to the following:
ξ Signs and symptoms of Breast Disease: As relates to Breast Reduction,
Augmentation, Reconstruction

ξ Pre-operative evaluation
ξ Post operative assessment
ξ Signs and symptoms of Varicose Veins/Spider Veins
ξ Pre-operative evaluation
ξ Post operative assessment

Patient Education - Employee demonstrates knowledge & can discuss with
patient:

ξ Breast diagnosis
ξ Wound care
ξ Drain care

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Area of Orientation

Discussed/
Observed
(D/O)
Preceptor’s
Initials
Date
Completed
ξ Pre op teaching related to specific surgery
ξ Varicose vein prevention

Employee demonstrates competence in counseling/providing appropriate
resources:

ξ UWHC Breast Center
ξ Tattoo Artist

Employee is able to appropriately care for a patient with the following:
ξ JP Drains
ξ Wound Packing
ξ Sutures/Staples *

Diagnostic/therapeutic tests- Demonstrate competence to assist/set-up/patient
care/follow-up

ξ Breast Ultrasound and Pre-op mammogram
ξ Cultures
ξ Specimens
ξ Set up vein studies (Pre and Post op)

Vein Procedures- Demonstrate competence to set-up/assist/patient
care/follow-up and clean up: (Vein injection and Lasering)

ξ Assure that instrument trays are set up correctly
ξ Assure that vein light is set up correctly
Employee demonstrates ability to clean and care for the following
equipment:

ξ Vein laser
ξ Electrocautery
ξ Liposuction equipment



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Area of Orientation

Discussed/
Observed
(D/O)
Preceptor’s
Initials
Date
Completed
MEDICATIONS
Employee is able to verbalize appropriate dose, mechanism of action, side
effects and drug compatibilities for the following:

ξ Lidocaine 1% with and without epinephrine
ξ Vicodin/Hydrocodone and Oxycodone
ξ Silver Nitate
ξ Ibuprofen
ξ Sodium Tetratecyl

Employee demonstrates ability to:
ξ Photograph varicosities or other areas of interest
ξ Download and send photos to appropriate people

Employee demonstrates competence regarding general surgery policies
related to:

ξ Triage calls
ξ Documentation of patient phone calls