Approved
Supervised
UAP
Alone*
William Jennings Bryan Dorn VAMC Emergency Room Clinical Privileges and Competencies
Name: _____________________________
Comments
Title: Unlicensed Assistive Personnel
Date
Done
1
Date
Done
2
Date
Done
3
Date
Done
4
Date
Done
5
Basic Skills
Maintains ACLS Certification and utilizes for
appropriate patients
Maintains BLS Certification and utilizes for
appropriate patients
Maintains PALS Certification
Maintains NALS Certification
M
Part of cardiac/respiratory arrest team
M
Performs UAP competencies
M
Assistance with any provider or registered
nurse requested procedure or exam, within
scope of UAP ability
M
Triage
Obtains vital signs
M
Notified RN/Provider to abnormal vital signs
Obtains chief complaint
M
M
Cardiovascular and Hemodynamic
Knowledge of disorders: including but not
limited to:
Continuous and 12 lead cardiac monitoring
Cardiopulmonary resuscitation
Acute myocardial infection, acute coronary syndrome, angina, congestive heart failure, pulmonary embolus,
cardiac tamponade, cardiac contusion, cardiopulmonary arrest, pericarditis, endocarditis, aortic
aneurysm/dissection, great vessel injury, hypertensive crisis
M
M
NIBP monitoring
M
Comments: S-supervised by privileged provider, C-must consult specialist service prior to performing. * denotes ultimate proficiency expected after orientation
to skill
M: Mandatory competency for position (essential function of the job)
M
Approved
12 lead ECG (left and right-sided) acquisition
Supervised
UAP
Alone*
William Jennings Bryan Dorn VAMC Emergency Room Clinical Privileges and Competencies
Name: _____________________________
Comments
Title: Unlicensed Assistive Personnel
Date
Done
1
Date
Done
2
Date
Done
3
Date
Done
4
Date
Done
5
Pulmonary/Respiratory
Knowledge of disorders: including but not
limited to:
Oxygen/nebulizer therapy (BVM, NC, facial
mask, venture, etc)
Airway adjuncts (oral, nasal trumpets)
Airticial airways (endotracheal, orotracheal,
tracheostomy tubes) knowledge
Continuous pulse oximetry
Airway obstruction, asthma/bronchitis, inhalation injuries, pneumonia, pulmonary edema, pulmonary embolus,
hyperventilation, aspiration, pleural effusion, pneumothorax, hemothorax, tension pneumonthorax, flail
chest/ruptured diaphragm, rib fractures, pulmonary contusions, COPD
M
M
M
M
Neurological/Neurosurgical
Knowledge of disorders: including but not
limited to:
Cervical spine stabilization (including
Cervical collar)
Lumbar puncture assistance
Helmet removal
Head injury/trauma-closed and open skull fractures, spinal cord injury, hyper/hypothermia, seizures, increased
intracranial pressure, alzheimers disease/dementia, CVA/ intracranial hemorrhages (epidural, subdural),
subarachnoid hemorrhage/aneurysm rupture, concussion, headache (migraine, cluster, tension), traumatic brain
injury
M
Requires multiple team members
M
M
Requires multiple team members
Gastrointestinal and/or nutrition Disorders
Knowledge of disorders: including but not
limited to:
Nasogastric tube insertion
Orogastric tube insertion
Acute abdomen, GI bleed, hepatic failure, open abdominal wounds, pancreatitis, bowel obstruction, appendicitis,
cholecystitis, splenic injuries, diverticulitis
M
M
Comments: S-supervised by privileged provider, C-must consult specialist service prior to performing. * denotes ultimate proficiency expected after orientation
to skill
M: Mandatory competency for position (essential function of the job)
M
Assist with Focus Abdominal Sonograpy for
Trauma (FAST)
Approved
Colostomy management
Supervised
UAP
Alone*
William Jennings Bryan Dorn VAMC Emergency Room Clinical Privileges and Competencies
Name: _____________________________
Comments
Title: Unlicensed Assistive Personnel
Date
Done
1
Date
Done
2
Date
Done
3
Date
Done
4
Date
Done
5
M
ENT, Maxillofacial/Ocular and/or Dental
Able to assess, identify, care for, manage, evaluate and troubleshoot potential or actual life-threatening ENT, Maxillofacial/Ocular and/or Dental
and associated equipment
Knowledge of disorders: including but not
limited to:
Ocular irrigation (Morgan Lens)
Dental emergencies, otitis (externa/media), foreign bodies, Ludqig’s angina, Nasal fracture, epistaxis, Pharngitis,
peritonsillar abscess, epiglottitis, soft tissue injuries to neck, maxillary and zygomatic fractures, sinusitis,
temporo-mandibular joint (TMJ) dislocation, facial nerve disorders, conjunctivitis, iritis, corneal abrasion/ulcer,
central retinal artery occlusion, orbit fracture, periorbital/ortibal cellulitis, hyphema, globe rupture, eyelid
laceration
M
Ear irrigation
M
Visual acuity exam
M
Ocular bandaging
M
Hematologic/Immunocompromised/Oncologic Disorders
Knowledge of disorders: including but not
limited to:
Neutropenic precautions
DIC, Thrombocytopenia, sickle cell crisis, oncological emergencies, immunocompromised states
M
Integumentary and/or Orthopedic/Musculoskeletal
Knowledge of disorders: including but not
limited to:
Traction splints (application/discontinuation)
Inflammatory conditions (bursitis, tendonitis, gout, arthritis), lacerations, amputations, abrasions, contusions,
wound-related infections, punctures, ballistic injuries, rhabdomyolysis, peripheral vascular trauma,
fractures/dislocations, low back pain, costochrondritis, compartment syndrome
M
Comments: S-supervised by privileged provider, C-must consult specialist service prior to performing. * denotes ultimate proficiency expected after orientation
to skill
M: Mandatory competency for position (essential function of the job)
Wound care management (dressing,
irrigation)
Splinting, sling application
M
Crutch fitting and instruction
M
Ankle brachial index calculation
Suturing assistance
M
Compression dressing application
M
Approved
Supervised
UAP
Alone*
William Jennings Bryan Dorn VAMC Emergency Room Clinical Privileges and Competencies
Name: _____________________________
Comments
Title: Unlicensed Assistive Personnel
Date
Done
1
Date
Done
2
Date
Done
3
Date
Done
4
Date
Done
5
M
M
Doppler US (pulses)
M
Burns, Multi-System disorders/shock
Knowledge of disorders: including but not
limited to:
Direct pressure for bleeding wound
Burns, septic shock, hypovolemic shock, cardiogenic shock, neurogenic shock, anaphylactic shock, polytrauma
M
Body Warmers
Bandages, including hemostatic dressings
Burn care management
M
M
M
Obstetrical, Gynecological/Genitourinary or Renal
Knowledge of disorders: including but not
limited to:
Infant warming
Vaginal bleeding, sponteanou/threatened/incomplete/inevitable/complete abortions, placenta previa, placenta
abruption, pre-eclampsia, ectopic pregnancy, precipitous delivery, trauma in pregnancy, newborn resuscitation,
hyperemesis gravidum, ovarin cysts, ovarian torsion, bladder rupture, genital trauma, UTI, pyelonephritis, renal
calculi, epidymitis, PID, foreign bodies, bartholin cyst, testicular torsion, STIs, sexual assault, renal trauma, renal
insufficiencies/acute renal failure, acid-base imbalances, altered renal function, electrolyte imbalances
M
Fetal heart tone monitoring/doppler
M
Resuscitation of infant/mother
M
STI cultures obtaining
M
Comments: S-supervised by privileged provider, C-must consult specialist service prior to performing. * denotes ultimate proficiency expected after orientation
to skill
M: Mandatory competency for position (essential function of the job)
M
Urinary catheterization
Approved
Urine collection (clean catch, texas catheter)
Supervised
UAP
Alone*
William Jennings Bryan Dorn VAMC Emergency Room Clinical Privileges and Competencies
Name: _____________________________
Comments
Title: Unlicensed Assistive Personnel
Date
Done
1
Date
Done
2
Date
Done
3
Date
Done
4
Date
Done
5
M
Medical/Communicable Disease
Knowledge of disorders: including but not
limited to:
Fever/sepsis, blood dyscrasias, parasite and fungal infestations, thyroid disorders, meningitis, tuberculosis,
allergic reactions, childhood diseases (measles, mumps, pertussis, varicella, etc), heptatitis
Isolation techniques
M
Endocrine
Knowledge of disorders: including but not
limited to:
Serum/fingerstick blood glucose monitoring
Diabetic ketoacidosis, hyperosmolar non-ketotic coma, SIADH, Diabetes insipidus, diabetes mellitus
M
Laboratory Values
Use of ISTAT/POC testing available
M
Knowledge of abnormal interventions
Substance abuse/toxicology/Environmental emergencies
Knowledge of disorders: including but not
limited to:
Heating/cooling blankets and treatments
Heat related illnesses, cold-related emergencies, frostbite, submersion, systemic envenomation emergencies,
systemic infection conditions (lyme disease, cat scratch fever), carbon monoxide, salicylates, acetinophen,
recreational drugs, tricyclic antidepressants, sedative/hypnotics, food poisoining, organophosphates,
insecticides, alcohol abuse (delirium tremens, withdrawal, detoxification), bites/sings
M
Vascular Access/and Drug Administration
Transdermal/topical administration
M
Peripheral IV insertion and management
M
Only lotions, barrier creams, OTCs
Comments: S-supervised by privileged provider, C-must consult specialist service prior to performing. * denotes ultimate proficiency expected after orientation
to skill
M: Mandatory competency for position (essential function of the job)
Venipuncture for blood test acquisition (IV
and straight stick)
Approved
Supervised
UAP
Alone*
William Jennings Bryan Dorn VAMC Emergency Room Clinical Privileges and Competencies
Name: _____________________________
Comments
Title: Unlicensed Assistive Personnel
Date
Done
1
Date
Done
2
Date
Done
3
Date
Done
4
Date
Done
5
M
Behavior, psychosocial, and/or end of life
Knowledge of disorders: including but not
limited to:
Administer psychosocial support
Withholding, refusing, or withdrawing life
support (advanced directives, family
presense)
Identify candidates eligible for organ
donation and procedure
Safely manage patients requiring
restraints/chemical sedation
Depression, anxiety, suicidal attempts/ideation, overdose, left without being seen/elopement, situational
crises/homicidal tendencies, abuse, end of life issues
M
M
M
M
Patient Transport
Provide appropriate handoff communication
(SBAR)
Performs assessment prior, during, and after
M
Anticipates and prepares for needs (meds,
supplies, paperwork)
Secures airway
M
Provides for adequate respiratory function
M
Provides for spinal immobilization
M
Reinforces dressings
M
Use of transport equipment
M
M
M
Emergency Department Operations
Comments: S-supervised by privileged provider, C-must consult specialist service prior to performing. * denotes ultimate proficiency expected after orientation
to skill
M: Mandatory competency for position (essential function of the job)
M
Demonstrates knowledge of patient
valuables protocols
Explains AMA procedure
M
Demonstrates protocols on death, dying,
and organ tissue donation
Utilizes medical information system
computer according to policy
M
Approved
Identifies local policies/procedures
Supervised
UAP
Alone*
William Jennings Bryan Dorn VAMC Emergency Room Clinical Privileges and Competencies
Name: _____________________________
Comments
Title: Unlicensed Assistive Personnel
Date
Done
1
Date
Done
2
Date
Done
3
Date
Done
4
Date
Done
5
M
M
Comments: S-supervised by privileged provider, C-must consult specialist service prior to performing. * denotes ultimate proficiency expected after orientation
to skill
M: Mandatory competency for position (essential function of the job)