Work will be performed within a prescribed range of functions involving routine and non-routine methods and procedures which require the exercise of some discretion and judgement
Polysomnographic recordings are commonly conducted in hospitals, private sleep laboratories and some neurologists' rooms who specialize in sleep disorders
All activities are carried out in accordance with organisation policies, procedures and infection control guidelines
This unit of competency describes the skills and knowledge required to prepare a client for and to perform a polysomnographic recording.
You may want to include more information here about the target group and the purpose of the assessments (eg formative, summative, recognition)
Prerequisites
Pre-requisite unit
This unit must be assessed after successful achievement of pre-requisite:
HLTNE401D Perform electroencephalography (EEG)
Employability Skills
This unit contains Employability Skills
Evidence Required
List the assessment methods to be used and the context and resources required for assessment. Copy and paste the relevant sections from the evidence guide below and then re-write these in plain English.
The evidence guide provides advice on assessment and must be read in conjunction with the Performance Criteria, Required Skills and Knowledge, the Range Statement and the Assessment Guidelines for this Training Package.
Critical aspects for assessment and evidence required to demonstrate this competency unit:
The individual being assessed must provide evidence of specified essential knowledge as well as skills
Where, for reasons of safety, space, or access to equipment and resources, assessment takes place away from the workplace, the assessment environment should represent workplace conditions as closely as possible
Consistency of performance should be demonstrated over the required range of situations relevant to the workplace
Context of and specific resources for assessment:
Relevant organisation policy, guidelines, procedures and protocols
Method of assessment:
Clinical skills involving direct client care are to be assessed initially in a simulated clinical setting (laboratory). If successful, a second assessment is to be conducted during workplace application under direct supervision.
Observation of work activities when performing polysomnographic recordings
Observation of simulation and/or role play when performing polysomnographic recordings
Discussion of physical and/or behavioural contingency scenarios involving duty of care
Authenticated transcripts of relevant education/training courses
Recognition of relevant life/work experience
Questioning, written assessments/projects, e-learning can be used to assess knowledge
Authenticated reports of experience in performing polysomnographic recordings (Documentation associated with performance reviews, supervisor/co-ordinator evaluations of work performance)
Training records associated with First Aid, OH Safety training, Orientation/Induction Training, Safe Manual Handing, Universal infection control procedures
Case study and scenario as a basis for discussion of issues and strategies to contribute to best practice
Access and equity considerations:
All workers in the health industry should be aware of access and equity issues in relation to their own area of work
All workers should develop their ability to work in a culturally diverse environment
In recognition of particular health issues facing Aboriginal and Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on health of Aboriginal and Torres Strait Islander people
Assessors and trainers must take into account relevant access and equity issues, in particular relating to factors impacting on health of Aboriginal and/or Torres Strait Islander clients and communities
Submission Requirements
List each assessment task's title, type (eg project, observation/demonstration, essay, assingnment, checklist) and due date here
Assessment task 1: [title] Due date:
(add new lines for each of the assessment tasks)
Assessment Tasks
Copy and paste from the following data to produce each assessment task. Write these in plain English and spell out how, when and where the task is to be carried out, under what conditions, and what resources are needed. Include guidelines about how well the candidate has to perform a task for it to be judged satisfactory.
This describes the essential skills and knowledge and their level required for this unit.
Essential knowledge:
The candidate must be able to demonstrate essential knowledge required to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role
This includes knowledge of:
Anatomy and physiology relevant for EEG interpretation, including neurological sleep disorders
Basic pharmacology related to neurological function
Complications and contraindications for clients undergoing polysomnographic procedure
Concepts of electronics and physics relevant to the performance of a polysomnograph and the machine
Confidentiality requirements of client information
Derivations, montage design and type, and machine settings, including understanding of when and how to change them
Electrical safety requirements
Emergency procedures in the event of complications relevant in the performance of polysomnographic procedures
Infection control policies, including standard and additional precautions, in relation to neurophysiology testing procedures
International 10/20 system as standard for electrode placement, and modified systems and other polygraphic placements
Medical terminology relevant to performance of polysomnographic recording
Normal and abnormal rhythms in recordings for EEG, ECG, EMG and respiration and appropriate test alterations
Protocols for polysomnographic procedure
Purpose of polysomnographic tests eg: diagnostic, prognostic, classification of events
Routine maintenance policy and procedures for equipment
Sleep staging
Units of measurement
Essential skills:
It is critical that the candidate demonstrate the ability to:
Apply knowledge of boundaries of responsibilities and refer problems to supervisor, neurologist, respiratory specialists, or other appropriate health professional
Communicate effectively with clients and carers in relation to the procedure and manage clients' and/or carers' anxiety level
Comply with policies and procedures including those of WHS and infection control
Identify results which may require immediate action for client management or infection control
Identify steps that must be taken to ensure equipment is safe for use
Safely produce a diagnostic polysomnographic result
In addition, the candidate must be able to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role
This includes the ability to:
Attach electrodes and leads and other polygraphic variables correctly
Correctly identify and validate abnormal findings
Correctly operate polysomnograph and associated monitoring equipment
Correctly prepare skin
Deal with conflict
Demonstrate basic cardiopulmonary resuscitation
Demonstrate computer skills relevant to workers' role
Identify a polysomnographic recording result that is unsatisfactory for diagnostic purposes
Identify a polysomnographic recording result which may require immediate medical attention
Manage the known common interferences in the production of a polysomnographic recording
Measure for the placement of electrodes to achieve a polysomnographic recording of diagnostic quality
Produce a polysomnographic recording satisfactory for diagnostic purposes including ability to design montages and select machine parameters appropriately
Solve problems including an ability to use available resources
Take into account opportunities to address waste minimisation, environmental responsibility and sustainable practice issues
Use numeracy skills including the ability to complete basic arithmetic calculations, recording stock levels, statistical information and skills related to technical equipment
continued ...
Essential skills:
Use reading and writing skills required to fulfil job roles in a safe manner and as specified by the organisation at a level of skill that involves reading and documenting clinical information and understanding complex policy and procedure manuals
Use oral communication skills required to fulfil job roles in a safe manner and as specified by the organisation, including skills in:
asking questions
providing clear information
listening to and understanding workplace instructions
clarifying workplace instructions when necessary
using effective verbal and non verbal communication skills with a range of internal and external persons
literacy in English or a community language, depending on client group and organisation requirements
Work with others and display empathy with client and relatives
The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Add any essential operating conditions that may be present with training and assessment depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts.
Equipment and material may include:
EEG machine; digital, analogue, portable, standard, video and audio
Polygraphic equipment; ECG, EMG, EOG machines, respiration, movement and tremor monitors
Electrodes eg caps, disc, mushroom
Head box
Chair
Bed
Additional - accessories, toys, other stimuli
Gels and Electrode pastes
Tape measure
Video cassette recorder and camera with audio
Resuscitation equipment
CPAP machine
Monitoring equipment including monitors for TCO2, SaO2, sound, body position
Environment may include:
Neurophysiology department
Wards
Sleep Laboratories
Private Neurologist's rooms
Intensive care units
Client details may include:
Referral letter/request
Reason for study/referral
Medical history
Address and telephone number
Date of birth and age
Medications
Client's presenting condition
Sleep patterns
Date of test
Date of previous test
In care client/out of care client
Clients' expectations
Test requested
Referring doctor address and telephone number
Clients may include:
Adults
Children
Neonates
Adolescents
Elderly
Client medical history may include:
Event/s leading to referral
Sleep disorder
Current sleep patterns
Cardiac disorder
Respiratory disorder
Vascular disorder
Neurological disorder
Infectious diseases
Epilepsy type and frequency, and date of last seizure
Psychiatric and behavioural disorders
Developmental disorder
Metabolic disorder
Medications
Action in response to client's medical history may include:
Use of various additional recording devices including: CPAP machine, TCO2 monitors, etc.
Varied activation procedure or disturbances
Alteration of Test procedure time
Waking the client
Personal protective equipment may include:
Gloves
Mask
Goggles
Gown
Positioning of monitoring equipment for other physiological measurement may include:
Respiratory i.e. diaphragm, nasal, oral
EMG
Other monitoring equipment may include:
ECG monitor
Respiration
Actogram
EMG
Oximetry
Movement sensors
CPAP machine
TCO2 monitor
Integrity of electrodes must include:
Ground
Reference
Active
Respiration thermistors or equivalent
Respiration straps
Oximetry
Movement Sensors
CPAP machine
TCO2 monitor
Additional validation techniques must include:
Touch test (of electrodes)
Exchange electrodes
Replace electrodes
Low, and of similar value, impedances
Amplifier calibration for DC and AC
Continuous monitoring of CPAP
Continuous viewing of the sleep study in progress
Techniques applied must include:
Montages
Derivations
Sensitivity
Filter
Display speed
Activations
Sleep states and staging must include:
Wake
REM and REM onset
Non-REM, including stages I, II, III, IV
Sleep onset
Physiological parameters may include:
Respiration
ECG
Oxygen saturation
Actogram
EMG
Causes of changes throughout procedure must include:
EEG findings
ECG findings
Respiration findings
SaO2 findings
TCO2 findings
EMG findings
Clinical events
Equipment
Environmental
Client's physiological and psychological state
Abnormal patterns which require immediate medical attention must include:
Continuous spiking or spike and wave
Hypsarrhythmic EEG
Frequent sub clinical seizure pattern
Status epilepticus
EEG finding consistent with infectious or reportable diseases/conditions eg Herpes Encephalitis, Creutzfeldt Jakob Disease (CJD) or CJD variant
Burst suppression and /or isoelectric EEG
Unilateral abnormality
Any other conditions which may endanger the health and well being of the client, particularly if not expected prior to recording or indicated on the referral letter
Other abnormalities that may be identified on the ECG, respiration or SaO2 channels or other recording devices
Complications and severe reactions may include:
Seizure
Cardio-respiratory arrest
Information provided to client's and carer's may include:
Appropriate follow up period with referring doctor to obtain results
Risks of injury to client following procedure ie. if overtired, or if have ceased medication for test etc.
How to clean the hair etc. appropriately to remove all glues/pastes.
Copy and paste from the following performance criteria to create an observation checklist for each task. When you have finished writing your assessment tool every one of these must have been addressed, preferably several times in a variety of contexts. To ensure this occurs download the assessment matrix for the unit; enter each assessment task as a column header and place check marks against each performance criteria that task addresses.
Observation Checklist
Tasks to be observed according to workplace/college/TAFE policy and procedures, relevant legislation and Codes of Practice
Yes
No
Comments/feedback
Review client booking list for client details
Identify special needs of clients
Select equipment, materials and location for test
Ensure equipment and materials selected are clean and dry, in working order, and, where applicable, calibrated
Review relevant, current literature and protocols
Arrange client bookings according to organisation procedures, clients' needs, and reason for study
Confirm receipt of information by client
Receive and process request for polysomnographic recording
Correctly identify client, reassure and inform client regarding the procedure
Give opportunities for client/carer to ask questions and discuss areas of concern
Check client consent has been obtained
Review client's medical history, seek clarification on specific details and take actioned, as required
Utilise personal protective equipment in accordance with standard and additional precautions
Select type and number of electrodes according to client needs, including multiple polygraphic recording electrodes
Conduct head measurement to verify sites for cerebral electrode placement according to current standards and organisation policies and procedures
Identify positioning of monitoring equipment for other physiological measurements
Complete skin preparation according to infection control guidelines and client's needs
Attach other monitoring equipment as required
Correctly connect required leads between interface/head box and machine
Perform pre-test electrode impedance and establish integrity of electrodes and other recording devices, and application
Adjust equipment, electrodes, and other recording devices as required
Enter client details on testing equipment or on paper traces, as required
Perform pre test on machine and biological calibration, including calibration of all polygraphic variables and AC/DC amplifiers
Perform additional validation techniques performed
Apply techniques according to client details and annotate concurrent results on record
Validate electrode impedance throughout test as required
Use troubleshooting methods to isolate problems with any recording device used in the study.
Recognise artefacts are recognised, annotate on the record, and eliminate or reduce on all polygraphic channels
Identify expected waveforms related to clinical conditions and age groups
Identify sleep states and staging
Identify changes in physiological parameters are identified, correlate to client's record and action as required
Identify and action abnormal EEG patterns and waveforms which require immediate attention
Use derivations and machine settings according to test requirements, polygraphic variables, concurrent results and client needs
Add/attach further monitoring equipment and/or electrodes in response to concurrent findings
Annotate on recording any changes throughout the procedure
Determine appropriate length of recording according to standards, medical referral and concurrent polysomnographic results.
Identify and meet client needs during the polysomnographic recording
Identify and respond to severe reactions and complications to in accordance with organisation emergency procedures
Perform post test electrode impedance and verify integrity of electrode and contact
Perform post test machine and biological calibration
Validate existence of the computerised file on hard drive, if required
Identify and action abnormal test patterns which require immediate medical attention
Remove EEG leads and electrodes and other recording devices from client and wash paste/gel off client
Provide client with assistance as required, on completion of the procedure
Confirm timely follow up with referring doctor for results
Record test details for retrieval and statistical purposes according to department procedures
Provide information to client and carer according to duty of care
Clean, dry and store equipment in accordance with manufacturer's guidelines and infection control guidelines
Dispose of disposable EEG electrodes and other materials in accordance with waste management procedures and infection control guidelines
Review and correct client details reviewed and corrected
Review annotations reviewed and correct to provide accurate and concise information including sleep staging
Forward technical report/results with accompanying documentation to neurologist or respiratory specialist for review or assessment and reporting
Forms
Assessment Cover Sheet
HLTNE608D - Perform polysomnographic recording
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Assessment Record Sheet
HLTNE608D - Perform polysomnographic recording
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Feedback to student:
Overall assessment result: Competent Not yet competent