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Post Partum

Information

Name *

Last 4 digits of SSN *

Phone *

Email *

Proficiency Scale

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

Work Settings

Couplet Care *

Antepartum *

Postpartum *

Newborn Nursery *

LDRP *

Postpartum

Vaginal Delivery *

Cesarean Section *

Anesthesia - General *

Anesthesia - Local *

Anesthesia - Spinal *

Bladder Distention *

Breast Milk Collection and Storage *

Breast Pump *

Breastfeeding - Latch Score *

Breastfeeding - Supplemental Feeding *

Breastfeeding Support *

Contraceptive Education *

Epidural/PCA *

Homan's Sign *

Multiple Births *

Parent/Infant Interaction/Attachment *

Post Partum Hemorrhage *

Pregnancy Induced Hypertension *

Tubal Ligation *

Antepartum

Amniocentesis *

Cardiac Disorders *

Diabetes *

Hyperemesis *

Multiple Gestation *

Non-Stress Test *

PIH/HELLP *

Placenta Previa/Abruptio *

Post-Trauma *

Pre-Term Labor/Premature Rupture of Membranes *

Substance Abuse *

FHM Interpretation and Management *

Fetal Assessment *

Labor Assessment *

Assist with Ultrasound *

Medications

Antibiotics/Antivirals *

Antihypertensives *

Antiseizure *

Cervical Ripening Agents *

Immunizations - Mother *

Insulin *

Magnesium Sulfate *

Methergine *

Opioids and Reversal Agents *

Pitocin *

Terbutaline *

IV Therapy

Starting IVs *

IV Management *

Blood Product Administration *

Newborn Care

Newborn Assessment *

Ballard Scale/Dubowitz *

Car Seat Education *

Circumcision Care/Teach to Parents *

Cord Care/Teach to Parents *

Immunizations - Infant *

Infant Caretaking Skills *

Infant Identification and Security *

Metabolic Screen *

Phototherapy *

Thermoregulation *

Professional Knowledge and Skills

National Patient Safety Goals/Core Measures *

Experience in a Baby Friendly Facility *

Fall Risk Assessment/Prevention *

Pressure Ulcer Risk Assessment/Prevention *

Restraints/Use of Least Restrictive Device *

Parent/Family Teaching *

Age Specific/Population-Based Care *

Isolation Precautions *

Infection Prevention *

Pain Assessment & Management - Adult *

Pain Assessment & Management - Neonate *

Charge Experience *

Interpretation and Communication of Lab Values *

Age Specific Competencies

Infant (Birth - 1 year) *

Preschooler (ages 2-5 years) *

Childhood (ages 6-12 years) *

Adolescents (ages 13-21 years) *

Young Adults (ages 22-39 years) *

Adults (ages 40-64 years) *

Older Adults (ages 65-79 years) *

Elderly (ages 80+ years) *

EMR

Epic *

Cerner *

Eclipsys *

McKesson *

Meditech *

Other Computerized System *

Computerized Physician Order Entry *

Bar Coding for Medication Administration *

EMR Conversion *

Other: Specify *

FHM - Other Specify *

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