OPERATING ROOM SKILLS CHECKLIST

Level Of Proficiency
Date A = Never Performed. You have never performed the stated
task and have no experience with this type of skill.
Name B = Familiar with. You are familiar with the stated task; but you
would need more experience and practice to feel
Signature comfortable and proficient in this type of skill.
C = Experienced in. You have performed this task several
times; you feel moderately comfortable functioning
independently, but you would require a resource person
to be nearby.
Please select the column that most accurately describes your proficiency level… D = Expert. You have a performed this task frequently; you
feel comfortable and proficient in this skill; you would not
require supervision or practice.

SKILL A B C D SKILL A B C D

BASIC OPERATING ROOM PROTOCOL, INCLUDING: THORACIC:

Aseptic Technique Thoroctomy
Donning of surgical attire Chest Tube Set-Up
Sponge and Lap counts Sternal Splitting:
Care of specimens Power Driver Splitter
Patient charge (billing) capture systems Manual Splitter

EXPERIENCE LEVEL IN THE FOLLOWING: Hiatal Hernias

GENERAL SURGERY: Colon Interpositions
Exploratory Lap CARDIOVASCULAR:
Cholecystectomy Arterial Bypass
Thyroidectomy Aorta – Bifemoral Bypass
Rectal Surgery Mesocaval Shunt

GYNECOLOGY: A – V Shunts
Laparoscopy Knowledge of different types of grafts
Total Abdominal Hysterectomy ORTHOPEDICS:
Vaginal Hysterectomy Emergency Trauma
Suction D & C Irrigation & Debridement of open fracture
Laser Surgery Water Pik

G.U. AND CYSTO: External Compression Devices

Cystoscopy Intermedullary Rods
T.U.R.P. ORIF ankles, tibias, hips, etc.: Endoprosthesis
Nephrolithotomy Closed pinning & reduction of extremities
Nephrectomy Image intensifier
Ileal Loop Water pik
Prostatectomy – Abdominal Chick Table
Peritoneal Laminectomy

PEDIATRICS: Spinal Fusions – Harrington Rods

Hernias Anterior Cervical Fusions
Pylorotomy Protocol for Total Joint Replacements
Thorocotomy Shoulders, Hips, Knees, Ankles

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 OPERATING ROOM SKILLS CHECKLIST
SKILL A B C D SKILL A B C D

ORTHOPEDICS CONTINUED: EQUIPMENT: (CONTINUED)

Arthroscopy Nerve stimulator
Tendon Implants & reanastomosis Nitrous oxide bank
Free Nerves Flaps Ohio suction units
Microscopic instruments Pneumatic tourniquet
Extremity microscope Sterad machine

Application of Halo Ultrasonic cleaner

NEUROSURGERY Vac-pac positioner

Craniotomy Vacuum curettage
V.P. Shunts Washer sanitizer- AMSCO
Types of Shunts Washer sterilizer- AMSCO
Laminectomies IV THERAPY:
Anterior Cervical Fusions Administration of blood and blood products

PLASTIC SURGERY: Starting IV’s

Skin grafts – types of dermatomes Assist with IA/IV therapy
Rhinoplasty ORAL SURGERY:
Mammoplasty: Care of prosthesis Maxillo facial procedures
Mentoplasty Implants
Otoplasty EYE:
Abdominal lipectomy Cataracts
Blepharoplasty Vitrectomies

EQUIPMENT: Scleral Buckel

Argon beam coagulator Fragmetomore
Bair Hugger Cryomachine
Cell saver ENT:
Cry-opthalmic unit Tonsillectomy and Adenoidectomy
Brown Dermatome Insertion of PE Tubes
Padgett Dermatome Tympanomastoidectomy
Zimmer Dermatome Mastoidectomies
Stryker drills Panendoscopies
Electrosurgical unit Facelifts
Emerson thoracic pump ENDOSCOPY:
Eye magnet Bronchoscopy
Fracture tables Gastroscopy
Laser Colonoscopy; Hot Biopsy Forceps

Reviewed by: