ELECTRO PHYSIOLOGY SKILLS EVALUATION
ELECTRO PHYSIOLOGY SKILLS EVALUATION
Personal Information
Name
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First
Last
Title / Specialty
Email
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Phone
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Competency Skills
Obtaining prodcuts and transport patients
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Knowledge of coronary anatomy
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Patient charges
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Answer MD pages during case
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Knowledge of stimulation protocols
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Venipuncture and troubleshooting
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Application / Maintenance of patient restraints
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Administration / Monitoring patient requiring sedation with analgesia
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Bovie
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Pericardiocentesis
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Arterial pressure monitoring
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Tissue speciment for lead extractions
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Monitoring
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Record / document all procedure cases
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Waveform recognition normal / abnormal
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Lab interpretation
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Calling report post procedure
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Proper tray set-up ablations arterial / ventricular
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
12 lead placement
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Sp02 probe
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
R@ pad placement
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
NBP placement
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Ground Pads
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Between case clean-up
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Room set-up
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
R2 pads / hands free defibrillator
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Isuprel
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Procainimide
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Esmolol
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Adenosine
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Amiodarone
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Ancef
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
IABP
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Additional Information
Equipment use During Ablations
Carto Mapping
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Stereotaxis
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Bloom stimulator
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Diagnosis Catheters-Bi-V
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Temporary Pacing Catheter
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Swan-Ganz Catheters
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Internal Cardioversion Catheters
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
EP Cables / Hook-up
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Temporary Pacemaker wires / pacing box
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Knowledge of types of proper storage
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Role / responsibility during PPM / AICD implantation
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Grounding pad / Bovie
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Unit Specific Requirements
Provides care for patient requiring hemodynamic monitoring
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Quality control of ACT machine
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Provides nursing care for patient requiring removal of femoral arterial / venous sheaths
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Manual pull
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Care for patient w / mechanical ventilation
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Care for patient w / exposure to radiation
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Nips procedures
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Cardioversion Internal / External
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Device Implants
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Groin prep
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Manifold set-up
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
IVUS
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Diagnosis EP Catheters
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Defibrillation
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Arterial line set-up
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Cardiac / Respiratory Arrest
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
Directional Coronary Atherectomy
Perform Well - Two plus years experience
Limited Experience - One - two years experience
Intermittent Experience
Theory - No practice
No Experience
