Endoscopy Checklist - Welcome to ReligStaffing

Endoscopy Checklist

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Endoscopy Checklist

Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.


No Experience Need Traning Able to perform with Supervision Able to perform Independetly
Assist with EGD’s
Assist with endoscopic ultrasound
Assist with active GI bleed
Cautery devices
Assist with manometry studies
Assist with variceal banding
Assist with esophageal dilatations
Assist with esophageal ballooning
Assist with scelrotherapy
Assist with TEE
Assist with bronchoscopy
Assist with colonoscopy
Assist with polypectomy
Assist with ERCP’s
Assist with PEG placements
Assist with liver BX
Assist with collection of hot & cold BX’s
Specimen collection & labeling
Set up of scopes & video equipment
Apply external abdominal pressure to assist with scope movement
Scope cleaning
Assist with mobile cases, ICU, ER, etc.
Radiation safety
Automated Medication Dispensing System, Pyxis, Omnicell, or other
Takes call for emergency cases
National Patient Safety Goals
Awareness of HCAHPS
Accurate patient identification
Effective communication
Interpretation & communication of lab values
Medication administration
Anticoagulation therapy
Monitoring conscious sedation
Pain assessment & management
Infection control
Universal precautions
Minimize risk for falls
Prevention of pressure ulcers
Use of rapid response teams
Fentanyl( Administer Conscious Sedation )
Propofol( Administer Conscious Sedation )
Demerol( Administer Conscious Sedation )
Presedex( Administer Conscious Sedation )
Versed( Administer Conscious Sedation )
Reversal agents ( Administer Conscious Sedation )
Pre procedure phone calls ( Pre Procedure )
Electronic documentation( Pre Procedure )
Patient assessment( Pre Procedure )
Colon prep or re-prep( Pre Procedure )
Pre procedure checklist/consent( Pre Procedure )
IV start, med admin( Pre Procedure )
Assess for air movement post colonoscopy( Post Procedure )
Assess for pain( Post Procedure )
Assess for bowel sounds( Post Procedure )
Assess for gag reflex post EGD( Post Procedure )
Assess for gag reflex post bronchoscopy( Post Procedure )
Recover from MAC( Post Procedure )
Recover from (moderate) conscious sedation( Post Procedure )
Discharge outpatients to home( Post Procedure )
Post procedure phone calls( Post Procedure )
Age Specific Competencies

No Experience Need Traning Able to perform with Supervision Able to perform Independetly
Newborn/neonate (birth-30 days)
Infant (31 days-1 year)
Toddler (ages 2-3 years)
Preschool (ages 4-5 years)
School age (ages 6-12 years)
Adolescent (ages 13-21 years)
Young adult (ages 22-39 years)
Adult (ages 40-64 years)
Older adult (ages 65-79 years)
Elderly (ages 80+ years)

I hereby certify that ALL information I have provided on this skills checklist, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.