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/depts/uwhealth/ambulatory-education/checklists/resources/ENT.pdf

20170367

page

100

UWMF,

Learning and Development,

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

ENT

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


1

ENT - 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 relevant data & able to appropriately care for
patient with the following:

Signs and symptoms of
EAR:
Otitis Media
Otitis Externa
Eustachian Tube Dysfunction
Mastoiditis
Cholesteatoma
Cerumen Impaction
Tinnitis
Vertigo/Meniere’s Disease
TM Perforation
Auricular Hematoma
Foreign Body in Ear
Hearing Loss- Conductive, Sensorineuro, Sudden
Employee is able to gather data on the & able to appropriately care for
patient with the following:

NOSE/SINUS:
Epistaxis

2
AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Deviated Septum
Nasal Fracture
Foreign Body-Nose
Rhinitis
Sinusitis Acute/Chronic
Nasal Congestion
Snoring/Sleep Apnea

MOUTH/THROAT:
Sialoadenitis
Salivary Stone
Tonsillitis
Peritonsillar abscess
Pharyngitis Acute/Chronic
Adenoid Hypertrophy
Laryngitis
Dysphagia
Hoarseness
Reflux Esophagitis
Thyroid- Nodule, Malignant
Neck Mass

SKIN LESIONS
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

Patient Education- Employee participates in patient/family teaching



3
AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Health Education - Employee demonstrates knowledge & can discuss with
patient:

SURGICAL PROCEDURES:
EAR:
Myringotomy
Tympanotomy Tube Placement
Tube removal
Tympanoplasy
Mastiodectomy

NOSE/SINUS:
Septoplasty
Endoscopic Sinus Surgery
Nasal Reduction
Somnoplasty
Nasal Button Insertion
Adenoidectomy
Rhinoplasty

THROAT/MOUTH/NECK:
Laryngoscopy
Tracheostomy
Neck Mass excision
Thyroglossal Duct Cyst Excision
Parotid Tumor Excision
Submandibular Gland Excision
Brachial Cleft Cyst Excision
Tonsillectomy
Thyroidectomy
Snoring/Sleep Apnea Procedures
Frenuletomy

4
AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
COSMETIC PROCEDURES
Employee is able to Administration of Medications
Understands the following drug compatibility’s
Verbalize appropriate dose, mechanism, and side effects of the following
medications:

Antihistamines
Decongestants
Antibiotics
Analgesics
Anesthetics- General-Local
Antitussives/Expectorants
Antivirals
Benzodiazepines
Diuretics
H2 Antagonists
Thyroid Hormones
Nasal Steroid Sprays*
Ear/Eye Drops*

Employee is able to send a consults/referrals to other departments
PT, OT, Speech, Vestibular Rehab
Allergy, GI, Radiation Oncology
Be able to refer to appropriate “other” clinics and physicians as needed

Demonstrate competence in counseling and provide appropriate resources
Refer to specialty support groups
Obtain prior authorization for medications
Fill out forms for ordering medications for those who need financial assistance

Employee is able to set up and/or use all equipment/ Supplies
Assure all equipment/supplies are available based on patient needs
Assure all equipment functions before use

5
AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Assure all emergency equipment/supplies are current and available at all times
Assure all equipment/supplies are available based on patient needs
Cautery Machines
Somnoplasty Machine
Harmonic Scalpel

Procedures-Demonstrate competence to assist/set-up/patient care/follow-up
Lesion removals
Proper and complete labeling of specimens and paperwork (in needed)
Fine Needle Aspiration
Somnoplasty
Snoreplasty
LAUP
Nasal cautery
Nasal Fracture reduction
Nasal Packing removals
Trach change
Ear tube insertion/removals
Septal Button Placement
Transnasal Esophogoscopy

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

Hearing Test,ABR,ENG
MRI,CT, X-rays
Cultures
Specimens
Sterilization of Instruments/Autoclaving
Assures instrument cleaning and autoclaving is properly completed
Assures proper wrapping and marking of packs
Assures proper cleaning of autoclave

6
AREA OF ORIENTATION Discussed Observed Preceptor’s Signature Completed date
Employee is able to understand the following regarding surgery
Schedule and Preauthorization
Surgical agreements
Labs, Chest X-rays, EKG*, other Pre-op Testing

Provides URGENT Patient Care – Employee is able to:
Initiates EKG monitoring (when indicted)*
Initiates Defibrillation (if indicted)
Appropriately care for patient requiring an EKG interpretation
Appropriately care for patient requiring anti-arrhythmic medication
Initiate Chest Pain Protocol appropriately (see Emergency Procedures Manual)
Appropriately care for patient requiring anit-anginal medication
Appropriately care for patient with cardiopulmonary arrest (until advanced help
arrives)

Understands and can appropriately set-up the crash cart
Stocks crash cart appropriately
Performs appropriate crash cart ‘checks’

Employee understands the following ENT Policies
Pre-Appointment Management Triage
Administer IM* adult, SQ* adult, ID*, and sublingual* medications
Administer IV medications *
Administration of IN Cocaine
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





7
Status/Recommendations/Comments:

____________________________________________________________________________________________________________________

I, _________________________________________ (employee name) have completed the ENT - CLINICAL 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).

__________________________________________________ ___________________
Preceptor Date

____________________________________________________ ___________________
Supervisor Date

__________________________________________________ ___________________
Provider Date

Additional Preceptor Signatures/initials:
1. _________________________________________________
2. _________________________________________________
3. _________________________________________________
4. _________________________________________________

Initially Completed 05-19-03 – Updated 08/04, 8/05, 8/07, 9/11, 3/12, 2/14, 6/14, 3/17

 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.

REFERENCES:
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.