APRN - Department of Nursing

INITIAL UMG/JDH AMBULATORY COMPETENCY CHECKLIST 11 of 12
Position Title: Nurse Practitioner
Department: Psychiatry
Employee Name:
Method of Instruction Key:
P = Protocol/Procedure Review
E = Education Session
S = Self Learning Package
C = Clinical Practice
D = Demonstration
Method of Evaluation Key:
O = Observation (in clinical setting)
RD = Return Demonstration
T = Written Test
V = Verbal Review
Method of
Instruction
(Use
Instruction
Key on Left)
Evaluation Summary
Evaluation
Method
(Use
Evaluation
Key on Left)
Comments
Competent Initials Date
Yes No
UNIT SPECIFIC CHECKLIST:
III. EQUIPMENT
“Clinical Database” for Department of Psychiatry
Hippocrates software
IV. DOCUMENTATION/COMMUNICATION
Documents on or reviews documentation/use of:
Charge sheet
Ambulatory Summary List
Complies with approved policies and guidelines regarding
patient Release of Information (use of HCH 551 “Authorization
to Obtain and/or Disclose Health Information”)
Utilizes “Treatment Transfer Form” when referring patients
within Department of Psychiatry. (i.e. referring to addiction clinic
or other Provider)
V. PERFORMANCE IMPROVEMENT
Participates in patient safety and performance improvement
chart audits
VII. PROVISION OF CARE
Utilizes the following forms for patient assessment, formulation
of treatment plan, and evaluation:
“Out Patient Psychiatric Risk Screen” form
“Intake Self Assessment”
PHQ9 (Depression screening scale)
AIMS (Abnormal involuntary movement scale)
Conducts Group Therapy sessions
Initials/Name: ___us/Ute Schroeder___________ Initials/Name: ______________________________ Initials/Name: __________________________
Competency Checklist Updated: 9/05, 7/07, 1/08, 4/08