Competency Verification Records

To make a Competency Verification Record (CVR), use the following template:

CVR Template

CVR Repository

• 12 Lead EKG: Lead Placement
• Ambulatory Vaccine Administration
• Anticoagulation Management- RN (Primary Care)
• Aquadex - RN
• Belmont Rapid Blood Infuser
• Bladder Scan
• Blood Administration - RN
• EtCO2/Capnography Monitoring - RN, RT, CNA, PCT
• Capnography - End Tidal Carbon Dioxide (etCO2)
• Capnography - PCA/PCT 
• Charge Nurse Role
• Chest Tube Management - Peds
• Catheter-Associated Urinary Tract Infection (CAUTI) Prevention - RN
• Central Line Dressing Change in Pediatrics – RN
• Central Line - Removal 
• Clubfoot Cast Removal
• Continuous / Intermittent Ultrafiltration Therapy RN - Aquadex
• Continuous Renal Replacement Therapy (CRRT) - NxStage- Experienced Travel RN
• Continuous Renal Replacement Therapy (CRRT) NxStage- Novice RN
• Doppler for Peripheral Pulses
• Dialysate: Adding Medication to Bag
• Enteral Tube Feeding Preparation
• Epidural Catheter Removal - RN
• Epidural Positioning Device (EPD) - RN
• Fetal Pillow - RN
• Hovermat
• Implanted Ports
• Indwelling Urinary Catheter (IUC) - Removal
• Infant Antibiotic Administration Via Syringe Pump 
• Lower Extremity Toenail and Foot Care
• Manual Blood Pressure Measurement
• Mechanical Cardiopulmonary Resuscitation Device (MCPR) - LUCAS Compression Device (Medical Emergency Team only)
• Nitrous Oxide Preparation and Monitoring - RN
• Ostomy Bag Change
• Obtaining an EKG on an Infant
• Obtaining Respiratory Rate
• Offsite Anesthesia MRI (Perianesthesia/PACU Nurses only)
• Peripheral IV Insertion
• Peripheral IV Insertion - Ultrasound Guided
• Peripheral IV - Removal
• Phlebotomy
• PICC Insertion- VAT only
• Procedural Sedation-RN
• Repositioning an Endotracheal Tube
• Removal of Peripheral IV Competency Form
• Small Bore Feeding Tube (Blind) Insertion
• Subcutaneous Anchor Securement Device - Removal
• Subcutaneous Anchor Securement System (SASS) – Insertion (Vascular Access & LIP only)
• TCV: Assisting LIP "MAC" insertion
• TCV: Lumbar Drainage Device Post Thoracoabdominal Aortic Surgery - RN
• TCV: Sterile Blake Drain-Atrium to Bulb Suction
• Transcutaneous Bilirubin (TCB) Level
• TR Band (Need name of TR)
• Tube Feed for NICU RN float
• Zoll Defibrillator CVR

PCT Competency Verification Records

• PCT Wound Dressing Change Competency form
• PCT Ostomy Bag Change Competency form
• Enteral tube Feeding Preparation Competency Form
• Removal of Foley Catheter Competency Form
• 12 Lead EKG for PCT Competency Form
• Doppler Competency Form
• Syringe Feeding Pumps Competency Form