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


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


GASTROENTEROLOGY - CLINICAL TRAINING CHECKLIST ----- This is due three months from hire date------

Employee Name: __________________________________ Employee Credentials:________ Hire Date: ____________

Clinic Location/ number: _______________________ Employee Number ________________________

*** N/A on checklist indicates that it is not indicated for the employee***
*Refer to appropriate UWMF Policy ***Each area should either be discussed or observed by preceptor***

AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Employee is able to gather data relevant to the following: (
Signs & symptoms of Crohns Disease ie: abd. pain, diarrhea, rectal bleeding, fever,
decreased wt

Signs & symptoms of Ulcerative Colitis ie: abdominal pain, bloody diarrhea, mucus,
frequency, urgency, fever and chills

Signs & symptoms of Diverticulosis/Diverticulitis ie: fever, acute abdominal pain, incr.

Signs & symptoms of Irritable Bowel Syndrome ie: cramps with abdominal pain with
diarrhea alternating with constipation, gas, bloating

Signs & symptoms of Chronic Constipation ie: gas, bloating, abdominal pain
Signs & symptoms of lactose intolerance ie: nausea, cramps, bloating, gas, diarrhea
Signs & symptoms of GERD ie: acid indigestion, heartburn, regurgitation
Signs & symptoms of esophagitis ie: epigastric discomfort, indigestion
Signs & symptoms of gastritis ie: nausea, cramps, bloating, gas
Signs & symptoms of cirrhosis of the liver ie: jaundice, fatigue, nausea, weight loss,
itching, bruising

Signs & symptoms of fatty liver ie: right upper quadrant pain, enlarged liver
Signs & symptoms of hemochromatosis, ie: abdominal pain, swelling, fatigue, nausea,
vomiting, decreased appetite, joint pain, frequent urination

Patient’s history of colon cancer or polyps
Family history of colon cancer or polyps
Family or Patient’s history of Barrett’s Esophagus
Family or Patient’s history of Hepatitis C
Family or Patient’s history of Celiac Disease, Eosinophilis esophagitis
Able to elicit patient’s expectations in medical care
Able to determine patient’s knowledge level/deficit and ability to understand
Able to identify cultural practices related to care
Able to elicits info regarding relationships with significant others

AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Patient Education- Employee participates in patient/family teaching
Instructional preps for:
Sigmoidoscopy, Colonoscopy, Gastroscopy
Manometry for 24 hour monitoring
Liver biopsy *
Manometry *
Rectal Tonometry *
Remicade Protocol *

Hepatitis C injections, adverse reactions and side effects

Employee is able to appropriately care for a patient with the following:
Crohns Disease
Ulcerative Colitis
Diverticulosis or Diverticulitis
Irritable Bowel Syndrome
Chronic Constipation
Lactose Intolerance
Celiac Sprue
Cirrhosis of the liver
Fatty liver
Hepatitis C
Colon Polyps
Colon Cancer

Proper and complete labeling of specimens and paperwork (in needed)

Employee is able to send consults/referrals to other departments (nutrition) or

Oncology, Radiology, Surgery, Swallow Clinics
Defacography, Meriter Endoscopy
Ultrasound, liver biopsy, rectal ultrasound/endoscopic ultrasound
Be able to refer to appropriate “other” clinics and physicians as needed

AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Demonstrate competence in counseling and provide appropriate resources
Hepatitis C support groups (UW), Crohns, Colitis Foundation
Obtain prior authorization for medications
Fill out forms for ordering medications for those who need financial assistance

Demonstrate competence in Equipment/ Supplies
Assure all equipment/supplies are available based on patient needs
Assure all equipment functions before use
Assure all emergency equipment/supplies are current and available at all times
Demonstrate competence in the care of flex sig scopes equipment

Procedures- Demonstrate competence to assist/set-up/patient care/follow-up
GT removal, replacement (assist only)
Sigmoidoscopy biopsy
Proper and complete labeling of specimens and paperwork (in needed)

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

Hemoccult test
MRI Cholongiogram
Hida Scan, Hipatobiliary Scan
CT, Ultra Sound

Demonstrate competence in Sterilization of Instruments/Autoclaving
Assures proper wrapping and marking of packs

Administration of Medications
Verbalize appropriate dose, mechanism, and side effects of the following medications:
Hepatitis A and B vaccinations
Antibodies & Metabolites: Remicade, Asacol
Anti-Crohns/Ulcerative Colitis: Sulfasalazine
Anti-Inflammation: Prednisone, Rawasaeneora/casasa/castiffoam (Topicals)
Anti-Neoplastic: 6-Mercaptopurinel/purinethel
Anti-Reflux/H2 Blocker: Ranitidine, cimetidine, Pepcid, Pleosec, Zantac, Nexium,
Prevacid, Protonix, Acipliex

Immunosuppressants: Imuran or azathioprine
Vitamin Injection: B 12

AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Obtain vital signs* (Wt, Ht, BP, P, & Pulse ox), smoking history
Administer IM adult, SQ adult, and ID *
Administer IV medications *
DEA Procedures/Controlled Substances Log *
Controlled Substances Abuse *
Properly documents administered medications *
Properly disposes of expired medications *
Properly disposes of unused or discarded or refused medications *

Gastroenterology Policies and Procedures
Flexible sigmoidoscopy (pending)


I, _________________________________________ (employee name) have completed the Gastroenterology Training Checklist and attest the information is true
and valid. I have demonstrated or discussed these skills and I am responsible for performing patient care as a Certified Medical Assistant / Licensed Practical
Nurse / Registered Nurse (circle one).

__________________________________________________ ___________________ Additional Preceptor Signatures/initials:
Preceptor Date
____________________________________________________ ___________________
Supervisor Date 2._______________________________

__________________________________________________ ___________________ 3._______________________________
Provider Date

Initially Completely 12-12-02 Updated 8-4-03, 8-3-05, 9-11, 3-2012, 6-2014, 3-2017

 Send the original signed Clinical Training Checklist to Clinical Staff Education – 1035.
 One copy of the signed Clinical Training Checklist should be placed in the clinic’s staff employee’s file, and a copy given to the employee.

Brener, T., Doyle, R.M. (Ed.). (2008). Nursing 2008 drug handbook. Philadelphia, PA: Lippincott Williams & Wilkins.
Perry, A.G. & Potter, P.A. (2002). Clinical nursing skills & techniques. (5th ed.). St. Louis, MO: Mosby.
Perry, A.G. & Potter, P.A. (2009). Fundamentals of nursing. (7th ed.). Hall, A. & Stockert, P.A. (Eds.). St. Louis, MO: Mosby Elsevier.