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Wound Care

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

Acute Care Adult *

Clinic Adult *

SNF/LTAC/Subacute *

Hospice / Palliative Care *

Acute/Long Term Care Pediatrics *

Clinic Pediatrics *

Pressure Ulcers

Assessment *

Staging *

Prevention/Risk Assessment Tools - Adult *

Prevention/Risk Assessment Tools - Pediatrics *

Support Surface Selection *

Neuropathic Ulcers

Assessment *

Management *

Venous Stasis Ulcers

Assessment *

Management *

Peripheral Arterial Ulcers

Assessment *

Ankle Brachial Index *

Management *

Other Wounds

Fistulae Pouching / Skin Care *

Skin Care / Management of Drains *

Wound Debridement

Autolytic *

Enzymatic *

Mechanical *

Sharp *

Dressings/Treatments

Hydrogels *

Hydrocolloids *

Silver Products *

Foams *

Alginates *

Vacuum Assisted Closure *

Growth Factors *

Skin Substitutes *

Hyperbaric Oxygen Therapy *

Wound Cultures *

Electrical Stimulation *

Enzymatic Debriding Agents *

Mist Therapy *

Colostomy / Ileostomy

Ostomy Equipment Selection *

Continence Skin Care Management *

Loop with Rod Stoma *

End Stoma *

Mucous Fistula *

Double Barrel Stoma *

Irrigation *

Ileal Lavage *

Continent Ileostomy

Knock Pouch *

Pelvic Pouch *

Urostomy / Continent

Catheterization for C&S *

Knock Pouch *

Neobladder *

Continence Therapeutic Devices

Vaginal Cones *

Penile Clamps *

Male External Catheters *

Internal Urethral Inserts *

Catheters Mgmt & Self Care Teaching *

Magnetic Therapy *

Urinary Incontinence Program *

Fecal Incontinence Program *

Burns

Burn Management *

Professional Knowledge and Skills

National Patient Safety Goals / Core Measures *

Patient Family Teaching *

Age Specific / Population Based Care *

Isolation Precautions *

Infection Precautions *

Pain Assessment & Management *

Interpretation & Communication of Lab Values *

EMR *

EPIC *

Cerner *

Eclipsys *

McKesson *

Other Computerized System *

Computerized Physician Order Entry *

Bar Coding for Medication *

Culture *

Other / Misc.

Pain Management Assessment of Pain Levels without Intervention *

Pain Management Response Assessment with Intervention *

Experience: Charge Duty *

Experience: Preceptor *

Age Specific Care

Infant (Birth - 1 year) *

Toddler (1-3 years) *

Pre-school (3-6 years) *

School Age (6-12 years) *

Adolescent (12-18 years) *

Young Adult (18-30 years) *

Mature Adult (30-60 years) *

Elderly (>60 years) *

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