Healthcare Science Practitioner Training Programme: Cardiovascular, Respiratory and Sleep Sciences Training Manual

Healthcare Science Practitioner Training Programme: Cardiovascular, Respiratory and Sleep Sciences Training Manual 220100929 PTP training Manual Cardio Version 2 GMCB

CONTENTS Page No Section 1.0 Healthcare Practitioner (Practitioner Training Programme) In Cardiovascular, Respiratory and Sleep Sciences 1.1 Introduction 3 1.2 Role of a Healthcare Science Practitioner 4 1.3 Good Technical Practice 4 1.4 Overall Aim of the Training Programme 4 Section 2.0 Programme Overview 2.1 Generic Modules 6 2.2 Division Modules 6 2.3 Specialist Modules 6 Section 3.0 Work-Base Curriculum 3.1 Introduction 8 3.2 Year 1 8 3.3 Year 2 and 3 for Cardiac Physiology 12 3.4 Year 2 and 3 for Respiratory and Sleep Physiology 16 Section 4.0 Student Portfolio, Assessment and Competency Strategy 4.1 Assessment 19 4.2 Competency Log Book 20 4.3 Generic Modules 21 4.4 Division/Theme Modules 22 4.5 Cardiac Physiology 23 4.6 Respiratory and Sleep Physiology 40 Appendices Appendix 1 Direct Observation of Practical/Procedural Skills Template 51 Appendix 2 Case Based Discussion Template 53 2

Section 1 Healthcare Science Practitioner Training Programme (PTP) in Cardiovascular, Respiratory and Sleep Sciences 1.1 Introduction This training manual provides an overview of the integrated 3-year BSc [Hons] in Healthcare Science and a more detailed description of the work-base learning outcomes that form an integral part of the training programme for Healthcare Science Practitioners (HCSP) in Physiological Science specifically Cardiovascular, Respiratory and Sleep Sciences. This training manual must be used in conjunction with the Course Handbook provided by the Higher Education Institute with whom each student is registered. The BSc [Hons] programme has been developed to provide the knowledge, skills and experience that underpin the role and function a Healthcare Science Practitioner is expected to successfully perform at the end the programme. The concept underpinning this programme is shown in the diagram below 1. Integrated BSc (Hons) in Healthcare Science with a Certificate of Competence Academic Workplace-based Year 3 Application to Practice Core Specialism: one of: Radiotherapy Technology Radiation Physics Technology Nuclear Medicine Technology Core Specialism and Project Year 2 Techniques & Methodologies Increasing specialisation & supporting science Academic learning to support workplace skills development Clinical experience Year 1 Scientific Basics Divisional Focus Medical Physics Introductory Block across Healthcare Science Wide but brief exposure to workplace based experience Increasing Experiential Learning 1 Modernising Scientific Careers. The UK Way Forward Gateway Reference: 13494. February 2010. Access at: www.dh.gov.uk/cso 3

1.2 Role of a Healthcare Science Practitioner A Healthcare Science Practitioner (HCSP) will have the necessary expertise in applied scientific techniques underpinned by theoretical knowledge within a division or related specialism and will work in a range of healthcare settings: with a defined technologically based role in the delivery and technical reporting of quality assured tests, investigations and interventions on patients, samples or equipment; in a number of specialisms, HCSP will provide therapeutic interventions, some of which may be specialist. 1.3 Good Technical Practice Good Technical Practice sets out, for the profession and the public, the standards of behaviour and practice that must be achieved and maintained as a Healthcare Science Practitioner. Good Technical Practice also contextualises and makes more explicit the standards of practice and proficiency set down by the Health Professions Council (HPC) in a way that is accessible to the profession and the public. It uses as its basis the HPC Standards of Proficiency and HPC Standards of Conduct, Performance and Ethics, but elaborates these within the context of the divisions of Healthcare Science. The Domains of Good Technical Practice are; 1. Professional 2. Scientific 3. Clinical 4. Technical 5. Investigation and Reporting 6. Quality 7. Working with colleagues 8. Research and development 9. Probity 10. Leadership 11. Training and Developing Others 1.4 Overall Aim of the Training Programme The overall aim of this HCSP training and education programme is to prepare the student to fulfil the function of a HCSP working in a clinical healthcare setting in Cardiovascular, Respiratory and Sleep Sciences. The programme combines and integrates both academic and work-base learning and has a strong patient and clinical focus. Within the first year it is expected that 4

the experiential component will start broad with short tasters across Cardiac, Vascular, Respiratory and Sleep Physiology with some exposure to other aspects of the patient pathways for example a clinic, patient education programme, medical records and other areas of healthcare science. This will give the student a wide appreciation of the many specialisms and a more holistic view of the areas which contribute to high-quality care. At successful completion of the programme the student should be able to fulfil the role of a Healthcare Science Practitioner. The diagram below depicts the broad framework around which all BSc [Hons] degree programmes in Healthcare Science being implemented as part of the Modernising Scientific Careers (MSC) Programme are structured. Each of the three divisions within the MSC Programme (Medical Physics and Clinical Engineering, Life Sciences and Physiological Sciences) have interpreted and adapted this framework. Further refinement has been undertaken by each Higher Education Institute to develop and deliver BSc [Hons] programmes that enable students to meet the learning outcomes of the course. HIGH LEVEL FRAMEWORK INTEGRATED BSc [Hons] IN HEALTHCARE SCIENCE Year 3 Application to Practice Year 2 Techniques & Methods Year 1 Scientific Basics Professional Practice [10] Generic Curriculum Professional Practice [10] Generic Curriculum Professional Practice [10] Scientific Basis of Healthcare Science Specialism Research Methods [10] [60] Scientific Basis of Healthcare Science - Integrated Module across Body Systems will usually include informatics, maths and statistics [60] Generic Curriculum Specialism Specific Curriculum Scientific Basis of Healthcare Science [60] Practice Based Project [30] Division/Theme Specific Curriculum Principles of Scientific Measurement [30] Scientific Basis of Healthcare Science [50] Work-base Training 25 weeks [20] Work-base Training 15 weeks [10] Specialism Work-base Training 10 weeks Division/Theme Specific Curriculum *46 wks *40 wks *36 wks Generic Modules: Common to all divisions of Healthcare Science Division/Theme Specific Modules: Life Sciences; Medical Physics and Clinical Engineering; Physiological Sciences (Cardiovascular, Respiratory and Sleep Sciences and Neurosensory Sciences) Specialist Modules: Specific to a specialism Section 2 provides an overview of the structure of the Generic, Division and Specialist modules for students following the Cardiovascular, Respiratory and Sleep theme. 5

Section 2.0 Programme Overview 2.1 Generic Modules The 3-year degree has been designed with three key curriculum strands. The Generic Curriculum depicted in blue will be followed by all students undertaking the Healthcare Science Practitioner BSc [Hons] degree and has three modules: Professional Practice Scientific Basis of Healthcare Science Research Methods The professional practice module is a vertical theme running from Year 1 to Year 3. In Year 1 all students will study the Scientific Basis of Healthcare science with integrated work-base learning and in Year 2 research methods. 2.2 Division/Theme Modules The Division specific curriculum, depicted in yellow, will be followed by all students undertaking the programme in Cardiovascular, Respiratory and Sleep Science and this part of the programme has three modules: Scientific Basis of Cardiovascular, Respiratory and Sleep Science including work-base training Instrumentation, signal processing and imaging Pathophysiology of Common Cardiovascular and Respiratory Conditions 2.3 Specialist Modules The specialism specific curriculum, depicted in orange, will be followed by students specialising in Cardiac Physiology and has four modules: Cardiac Physiology Applying Cardiac Physiology in Practice Work-base training Research Project in Cardiac Physiology The specialism specific curriculum, depicted in orange, will be followed by students specialising in Respiratory and Sleep Science has four modules: 6

Respiratory and Sleep Physiology Applying Respiratory and Sleep Physiology in Practice Work-base training Research Project in Respiratory and Sleep Physiology Further details of the indicative content and high level learning outcomes for each module of the BSc in Healthcare Science (Cardiovascular, Respiratory and Sleep Sciences), including the work-base training, will be provided by the Higher Education Institute in the Student Handbook. 7

Section 3.0 Work-base Training Modules 3.1 Introduction The BSc [Hons] programme integrates knowledge, skills and experience and a series of work placements enables students to gain the skills and attitudes to practice as a Healthcare Science Practitioner. This section describes the learning outcomes across knowledge, skills, experience and professionalism that a student should gain during work-base training. The professional practice module runs vertically throughout the programme and many of the learning outcomes will be achieved in the workplace. Work-base learning should equate to a minimum of 10 weeks in Year 1 and a minimum of a further 40 weeks across Year 2 and 3. The work-base placement in Year 1 exposes the student to the clinical environments across Physiological Sciences and specifically within the Cardiovascular, Respiratory and Sleep Science Physiology pathway. It is expected that the student will gain an understanding of how departments function, the range of investigations undertaken, the professional and interprofessional relationships which exist and a wider understanding of the NHS. Section 3.2 Division: Year 1: Cardiovascular, Respiratory and Sleep Sciences Work-base Training Learning Outcomes: Knowledge and Understanding On successful completion of this module the student will understand the: 1. Roles undertaken by a Healthcare Science Practitioner relevant to Cardiovascular, Respiratory and Sleep Science. 2. Range of technologies and procedures relevant to Cardiovascular, Respiratory and Sleep Science. 3. Work of the healthcare science workforce and how it contributes to the patient pathways relevant to Cardiovascular, Respiratory and Sleep Science. 4. Need to ensure that the needs and wishes of the patient are central to their care. 5. Importance of developing and maintaining the patient-professional partnership. 6. Procedures relevant to the use of chaperones. 7. Impact of adverse incidents on patients, carers and healthcare professionals. 8. Procedures and need for evaluation of adverse incidents. 9. Relevance of a Dress Code policy in the modern clinical environment. 10. Standards of professional behaviour expected of a Healthcare Science Practitioner. 11. Shared responsibility for infection control. 8

12. Organisation and inter-relationship of primary care, outpatient and inpatient services in their placement. Learning Outcomes: Practical Skills On successful completion of this module the student will: 1. Be able to work safely in the clinical environment relevant to the specialism of Cardiovascular, Respiratory and Sleep Science. 2. Demonstrate the six stage hand-washing technique. 3. Demonstrate Basic Life Support in accordance with current Resuscitation Council (UK) guidelines. 4. Demonstrate the ability to treat patients with respect. 5. Communicate effectively within the health care environment and clinical team. 6. Demonstrate the ability to perform, under direct supervision, basic investigations in accordance with local health and safety regulations, including: Routine electrocardiogram in an adult patient Measurement of blood pressure using an automatic device Dynamic Lung Volumes (Spirometry) in an adult patient Measurement of oxygen saturation (SpO 2 ) Learning Outcomes: Associated Personal Qualities and Behaviours (Professionalism) On successful completion of this module the student will: 1. Behave in a professional manner in matters of attendance, appearance, maintaining confidentiality and infection control. 2. Respect and understand individuals beliefs and ways of coping with illness. 3. Value social diversity and its relationship to service provision in health care. 4. Demonstrate the ability to work safely within each environment. 5. Demonstrate the ability to treat patients with respect. 6. Communicate effectively with the health care environment and clinical team and develop appropriate interpersonal skills. 7. Seek to adapt their communication style to meet the varying needs of different peers, colleagues and patients in different contexts. 8. Adopt a range of techniques to overcome barriers to communication. 9. Develop and maintain professional relationships and effective team working. 10. Discuss and demonstrate safe and effective practice in a health care environment. 11. Begin to develop a balance between reflective practice and active exploration in personal learning. 12. Take responsibility for personal learning. 9

Indicative Content and Suggested Experience: Observe the work of a range of Healthcare Science departments, technologies and procedures Observe the process for handling work requests from the receipt of the request to completion Observe the patient journey from admission to discharge Gain an understanding of the skills required to work safely in the clinical/laboratory/workshop/radiation environment Gain an understanding of record keeping, data protection and confidentiality Gain an appreciation of how the NHS is structured Gain an understanding of team working and the role of multi-disciplinary team meetings Gain an understanding of the meaning and role of professionalism and professions in healthcare Gain an understanding of the roles of different professional groupings in Healthcare Science Gain an understanding of human and social diversity and its implications for relationships, behaviours and service provision in healthcare Gain an understanding of types of effective communication in the context of healthcare, including barriers to effective communication and strategies to overcome them Gain an understanding of the interpersonal skills related to dealing with patients, carers and health care professionals Gain an understanding of the skills needed to work as part of a team Gain an understanding of the management and evaluation of adverse incidents Gain an understanding of data management (paper and electronic) Gain an understanding of Infection control Gain an understanding of Basic Life Support Gain an understanding of Reflective practice and its application to: the roles undertaken by a healthcare science practitioner relevant to each area of the placements a range of technologies and procedures relevant to the placements how the work of the healthcare science workforce contributes to the patient pathways and screening programmes relevant to the placements the need to ensure that the needs and wishes of patients are central to their care the importance of developing and maintaining the patient-professional partnership the procedures relevant to the use of chaperones the impact of adverse incidents on patients, carers and healthcare professionals the procedures and need for evaluation of adverse incidents the relevance of a dress code policy in the modern clinical environment 10

the standards of professional behaviour expected of a healthcare practitioner the shared responsibility for infection control the organisation and inter-relationship of primary care, out-patient and in-patient services in the placements 11

Section 3.3 Division: Physiological Sciences Theme: Cardiovascular, Respiratory and Sleep Sciences Specialism: Cardiac Physiology Years 2 and 3: Work-base Training [20 Credits] The indicative content for the work-base training modules in Year 2 are defined in the Year 3 module content. This is to be achieved across Year 2 and 3. Important Note: Work-base training does not have to be confined only to the work-base but elements may be taught in other environments for example a clinical skills laboratory, simulation centre or science laboratory. The overall aim of this module is to give the student experience of Cardiac Physiology that ensures that the student can undertake the full breadth of practice expected of a newly qualified Healthcare Science Practitioner in Cardiac Physiology. This is delivered through work placements in years 2 and 3 of the BSc. Further work developing the framework for the accompanying Professional Portfolio across healthcare science and in the specialisms will define the levels of competency. Learning Outcomes: Knowledge and Understanding On successful completion of this module the student will: 1. Critically review and evaluate departmental protocols in relation to the core skills in health and safety, human rights, patient identification, communication skills and management and quality assurance. 2. Understand the underpinning principles of routine cardiac investigations integrating knowledge of basic and clinical science. 3. Critically review and evaluate routine tasks in relation to cardiac physiology. 4. Understand the test selection process. 5. Produce a Professional Portfolio which cumulatively records/provides evidence of the skills, knowledge and attitudes gained. Learning Outcomes: Practical Skills On successful completion of this module the student will: 1. Demonstrate increased knowledge, understanding and confidence in application of the core skills in clinical practice, patient identification, communication skills, self management and quality assurance. 12

2. Demonstrate competence for routine tasks / situations in Cardiology including: Electrocardiography Blood pressure measurement Ambulatory Electrocardiographic monitoring Ambulatory blood pressure monitoring Assisting with cardiac exercise stress testing 3. Provide technical assistance during implantation of simple pacemaker systems for the treatment of bradycardia (NB: Not follow-up). 4. Undertake haemodynamic monitoring during coronary angiography and percutaneous coronary intervention (PCI procedures). 5. Critically apply the scientific principles covered in the academic module within their own practice. 6. Make the appropriate choice of equipment for the procedure. 7. Use the equipment to produce the highest quality results. 8. Perform patient investigations in a safe manner whilst undertaking appropriate infection control techniques. 9. Undertake and document measurements and assist in the production of a factual report. 10. Produce a Professional Portfolio which cumulatively records/provides evidence of the skills, knowledge and attitudes gained. Learning Outcomes: Associated Personal Qualities and Behaviours (Professionalism) On successful completion of this module the student will: 1. Present complex ideas in simple terms in both oral and written formats. 2. Challenge discriminatory behaviour and language. 3. Adapt communication style and language to meet the needs of each listener. 4. Respect and uphold the rights, dignity and privacy of patients. 5. Establish patient-centred rapport. 6. Consistently focus on their professional duty of care. 7. Reflect and review their own practice to continuously improve personal performance. 8. Consistently operate within a sphere of personal competence and level of authority. 9. Manage their personal workload and objectives to achieve quality of care. 10. Actively seek accurate and validated information from all available sources. 11. Select and apply appropriate analysis or assessment techniques and tools. 12. Evaluate a wide range of data to assist with judgements and decision making. 13. Contribute to and co-operate with the work of multidisciplinary teams. 13

Indicative Content Students are expected to gain knowledge, skills and experience of routine Cardiology investigations across the range of conditions referred for investigation. Common content across investigations: Indications and contra-indications for testing Health and Safety including safe handling of reagents Graphical representation of results and interpretation Safe decontamination of equipment Quality standards, control and assurance for all activities Care Pathways for patients with cardiovascular disease Investigations: Electrocardiography including recognition of the changes related to o Age, gender, ethnic origin and pregnancy o Atrial arrhythmias o Ventricular arrhythmias o Conditions affecting the left side of the heart Left atrial abnormalities Left ventricular hypertrophy o Conditions affecting the right side of the heart Right atrial enlargement Right ventricular hypertrophy o Conditions not primarily affecting the heart Hyperkalaemia Hypokalaemia Thyrotoxicosis Hyperthyroidism Hypocalcaemia o Conduction Defects Bundle branch blocks Hemi-blocks o Blood pressure measurement o Intermediate life support o Ambulatory electrocardiography o Ambulatory blood pressure monitoring o Assisting in cardiac exercise stress testing o Haemodynamic monitoring during coronary angiography and percutaneous coronary intervention (PCI) procedures o Providing technical assistance during implantation of simple pacemaker systems for the treatment of bradycardia Gains an awareness of: Principles and practice of: o Echocardiography 14

o Cardiac rhythm management 15

Section 3.4 Division: Specialism: Years 2 and 3: Cardiovascular, Respiratory and Sleep Sciences Respiratory and Sleep Physiology Work-base training [20 Credits] The indicative content for the work-base training modules in Year 2 are defined in the Year 3 module content. This is to be achieved across Year 2 and 3. Important Note: Work-base training does not have to be confined only to the work-base but elements may be taught in other environments for example a clinical skills laboratory, simulation centre or science laboratory. The overall aim of this module is to give the student experience of Respiratory and Sleep Physiology that ensures that the student can undertake the full breadth of practice expected of a newly qualified Healthcare Science Practitioner in Respiratory and Sleep Physiology. This is delivered through work placements in Years 2 and 3 of the degree course. Further work developing the framework for the accompanying Professional Portfolio across healthcare science and in the specialisms will define the levels of competency. Learning Outcomes: Knowledge and Understanding On successful completion of this module the student will: 1. Understand the underpinning principles of routine respiratory and sleep physiology investigations integrating knowledge of basic and clinical science. 2. Understand the inter-relationships of ventilation, diffusion and perfusion in respiration. 3. Understand the basic concepts of breathlessness and the relationship between the physiological events and the patient s perception of breathlessness. 4. Understand the test selection process. 5. Understand the difference between obstructive, restrictive and mixed respiratory disorders, and different disorders that affect lung function. 6. Critically review and evaluate departmental protocols in relation to the core skills in health and safety, human rights, patient identification, communication skills and management and quality assurance. 7. Critically review and evaluate routine tasks in relation to respiratory measurement and sleep science. 8. Produce a Professional Portfolio which cumulatively records/provides evidence of the skills, knowledge and attitudes gained. 16

Learning Outcomes: Practical Skills On successful completion of this module the student will: 1. Demonstrate increased knowledge, understanding and confidence in the application of the core skills in clinical practice, patient identification, communication skills, management, and quality assurance. 2. Demonstrate competence for routine tasks/situations in Respiratory and Sleep Science including: Dynamic lung volumes and flows Assessment for bronchodilator response Static lung volumes Measurement of Transfer Factor for Carbon Monoxide Overnight pulse oximetry CPAP machine function Calibration and quality control of equipment 3. Critically apply the scientific principles covered in the academic module within their own practice. 4. Make the appropriate choice of equipment/procedure. 5. Use equipment to produce the highest quality results. 6. Perform patient investigations in safe manner whilst undertaking the appropriate infection control techniques. 7. Undertake and document measurements and assist in the production of a factual report. 8. Produce a Professional Portfolio which cumulatively records/provides evidence of the skills, knowledge and attitudes gained. Learning Outcomes: Associated Personal Qualities and Behaviours (Professionalism) On successful completion of this module the student will: 1. Present complex ideas in simple terms in both oral and written formats. 2. Challenge discriminatory behaviour and language. 3. Adapt their communication style and language to meet the needs of each listener. 4. Respect and uphold the rights, dignity and privacy of patients. 5. Establish patient-centred rapport. 6. Consistently focus on their professional duty of care. 7. Reflect and review their own practice to continuously improve their personal performance. 8. Consistently operate within a sphere of personal competence and level of authority. 9. Manage their personal workload and objectives to achieve quality patient care. 17

10. Actively seek accurate and validated information from all available sources. 11. Select and apply an appropriate analysis or use of assessment techniques and tools. 12. Evaluate a wide range of data to assist with judgements and decision making. 13. Contribute to and co-operate with the work of multidisciplinary teams. Indicative Content Students are expected to gain knowledge, skills and experience of routine respiratory and sleep investigations across the range of conditions referred for investigation. Common content across investigations Indications and contra-indications for testing Health and Safety including safe handling of reagents Graphical representation of results and interpretation Safe decontamination of equipment Quality standards, control and assurance for all activities Care Pathways for patients with diseases of the respiratory system and sleep disorders Investigations Dynamic and static lung volumes Assessment of gas transfer Assessment and response to bronchodilator therapy Blood gas analysis Pulse oximetry Overnight pulse oximetry 18

Section 4.0 Assessment, Student Portfolio and Competency Strategy 4.1 Assessment The responsibility for designing and assessing student learning lies with the Higher Education Institute and will be explained in the Course Handbook. However, there will also be continuous assessment across the 3-year training period in the workplace, using a series of Directly Observed Procedures / Direct Observation of Practical Skills (DOPs), Case Based Discussions (CbDs) and Mini Clinical Examinations (mini-cex). Examples of CbDs, DOPS and mini-cex can be found in Appendix 1 and 2. Direct Observation of Practical Skills (DOPS) is the observation and evaluation of a procedural/technical or practical skill performed by a student in a live environment. Case Based Discussions (CbDs) are designed to provide structured teaching and feedback in a particular area of clinical or technical practice by evaluating decision making and the interpretation and application of evidence. They also enable the discussion of the context, professional, ethical and governance framework of practice, and in all instances, they allow students to discuss why they acted as they did. CbDs are used throughout training and should encourage a reflective approach to learning. Mini Clinical Examinations (mini-cex) are a short snapshot of practitioner/patient interaction. They are designed to assess the clinical skills, attitudes and behaviours of students essential to providing high quality care. All DOPS, CbDs and mini-cex have the potential to be completed electronically and analysed on a central database. Each student will be required to complete a portfolio in which a record of these will be kept, further detail can be found overleaf. The table below indicates the suggested number of formal work-based assessments that should be completed by the student in Year 1, Year 2 and Year 3. Year 1 Year 2 Year 3 2 DOPS 1 CBD Competencies 4 DOPS 1 CBD 1 Mini-Cex Competencies 4 DOPS 2 CBD 2 Mini-Cex Competencies 19

It is the responsibility of the student to maintain their own portfolio and ensure all assessments are completed on time. There will be a national progress review after 2 years and a final assessment the detail of which will be sent to the student during the course. 4.2 Competency Log Book The competencies form the foundation of the work-base training programme and are an important part of the portfolio and the student s record of competence. Competencies are transferable across learning outcomes and do not need to be undertaken twice where they are repeated in the programme. Where they are repeated reference should be made to the point at which this competency has been previously completed. Competencies are cumulative and as such not all competencies have to be completed within the relevant module. All competencies should be completed by the end of the programme. This manual provides examples of areas of application or evidence required to demonstrate competence. Students are expected to utilise different tools, resource and media within the local laboratory to demonstrate each area of competence. Some competencies are exit competencies. These are described as such in the recognition that they require a longer time and experience to acquire and therefore cannot be limited to one specific module or individual learning outcome. Where possible the incremental competencies have been given as a guide. 20

Section 4.3 Generic Module Years 1: Work-base Training Learning Outcome 1 Performs the generic skills, demonstrates adherence to health and safety, professional behaviour and the knowledge and understanding defined in the work-base module for Year 1. Competency Reviewer Date Comments/Evidence Demonstrate the six stage handwashing technique. Demonstrate basic life support skills. Demonstrate effective communication skills within the healthcare environment. Demonstrate safe working practice in the workplace. Demonstrate the standards of dress and professional behaviour required in the workplace. 21

Section 4.4 Division: Theme: Years 1: Physiological Sciences Cardiovascular, Respiratory and Sleep Sciences Work-base Training Learning Outcome 2 Demonstrate the ability to perform, under direct supervision, basic investigations in accordance with local health and safety regulations. Competency Reviewer Date Comments/Evidence Routine electrocardiogram in an adult patient. Measurement of blood pressure in an adult patient using an automatic device. Dynamic Lung Volumes (Spirometry) in an adult patient. Measurement of oxygen saturation (SpO 2 ). 22

Section 4.5 Division: Physiological Sciences Theme: Cardiovascular, Respiratory and Sleep Sciences Specialism: Cardiac Physiology Years 2 and 3: Work-base Training [20 Credits] The following outcomes are appropriate to all investigations and must be achieved for ALL investigations. Learning Outcome 3 Demonstrate the ability to prepare the environment, equipment and patient for procedures. Evaluate recordings/results and recognise when these should be brought to the attention of senior staff. Competency Reviewer Date Comments/Evidence Apply knowledge and understanding of the core skills required in clinical practice, patient identification, communication skills, patient management and quality assurance. Critically apply the scientific principles covered in the academic modules within clinical practice. Perform tests in a safe manner whilst undertaking appropriate infection control techniques. Ensure that all equipment being used is safe, in good working order and appropriate to the investigation. Adopt safe working practices relevant to the equipment. Recognise risks and hazards associated with equipment. Prepare equipment and consumables in accordance with both the manufacturer s and local policies. Accurately calibrate equipment where appropriate. Use equipment in line with 23

manufacturer s and local protocols. Perform appropriate care and routine maintenance of equipment. Identify and rectify where possible, any equipment defects. Evaluate the technical quality of recordings, identify sub-optimal recordings and re-record where necessary. 24

Learning Outcome 4 Demonstrate the ability to record the resting electrocardiogram (ECG) on patients in a range of clinical settings including adults and children. This competency must be completed in Year 2 Competency Reviewer Date Comments/Evidence Obtain a suitably completed request form, greet patient, check patient ID and recent clinical history. Treat patient in a way which respects their dignity, rights, privacy and confidentiality. Explain the procedure to the patient and gain consent. Identify electrode sites on the patient according to current AHA/SCST * guidelines. Prepare the patients skin in order to ensure adequate electrode contact. Apply suitable electrodes firmly to the patient to minimise artefact. Choose machine settings appropriate to the ECG recording requested/ required. Make an ECG recording ensuring that an accurate, artefact-free tracing is obtained. Take steps to modify the procedure if a suitable recording cannot be made and re-record if necessary. Remove electrodes and ensure that the patient and/or carer are informed of next steps. Check the ECG recording for abnormalities and inform a senior staff member if necessary. Demonstrate that ECG recordings are accurate, complete, legible and 25

forwarded to the correct person in an appropriate timescale. Annotate all ECG recordings with the correct patient details and store safely. * AHA American Heart Association/SCST - Society for Cardiological Science and Technology 26

Learning Outcome 5 Demonstrate the ability to interpret the resting electrocardiogram (ECG). Competency: Reviewer Date Comments/ Evidence Demonstrate an understanding of the derivation of the ECG. Demonstrate an understanding of the relationship between the ECG and the cardiac cycle. Identify and measure all amplitudes and intervals from the ECG. Recognise normal findings and variations related to patient age, gender, activity and ethnic origin. Identify life-threatening/serious changes to the ECG as detailed below: Atrial arrhythmias Ventricular arrhythmias Myocardial ischaemia and Infarction Identify other common changes to the ECG as detailed below: Sinus arrhythmia Atrial enlargement Ventricular hypertrophy Electrolytic imbalances Endocrine disorders Bundle Branch Block Hemi-blocks Atrio-ventricular block Junctional rhythms 27

Refer any concerns about the recording to the appropriate person. 28

Learning Outcome 6 Demonstrate the ability to measure resting blood pressure (BP) on a range of patients, using analogue and digital equipment. Competency Reviewer Date Comments/Evidence Obtain a suitably completed request form, greet patient, check patient ID and recent clinical history. Treat patient in a way which respects their dignity, rights, privacy and confidentiality. Explain the procedure to the patient and gain consent. Choose the correct cuff size for the patient. Locate the pulse in the cubital fossa. Ensure the posture and position of the arm is correct. Estimate systolic BP by palpation. Inflate the cuff at least 30mmHg above the estimated systolic blood pressure and reduce the pressure smoothly. Make an accurate measurement of blood pressure. Identify any difficulties in obtaining an accurate BP measurement for the patient and take remedial action and re-measure if necessary. Check the results and consult senior staff if necessary. 29

Learning Outcome 7 Demonstrate the ability to fit and remove ambulatory BP devices and produce clinical data in an appropriate format. Competency Reviewer Date Comments/Evidence Obtain a suitably completed request form, greet patient, check patient ID and recent clinical history. Treat patient in a way which respects their dignity, rights, privacy and confidentiality. Explain the procedure to the patient and gain consent. Prepare the BP device for connection to the patient. Give the patient a clear and concise explanation of the BP device. Measure the resting BP manually and identify any abnormalities or concerns. Programme the BP recorder appropriately. Choose and apply the correct size BP cuff for the patient. Identify the site for the placement of the microphone where applicable. Measure BP to ascertain baseline accuracy. Review device instructions with the patient, including safety advice and completion of the diary. Arrange a follow-up appointment for the patient. On the patients return, remove the 30

equipment and explain the next steps. Download the patients BP data and produce the results in the appropriate format. Present the results in a format in line with local policy. Clean BP equipment and cuff in accordance with departmental policy. 31

Learning Outcome 8 Demonstrate the ability to fit and remove ambulatory ECG devices Competency Reviewer Date Comments/Evidence Obtain a suitably completed request form, greet patient, check patient ID and recent clinical history. Treat patient in a way which respects their dignity, rights, privacy and confidentiality. Explain the procedure to the patient and gain consent. Choose an ambulatory ECG device most suited to the patient and their symptoms. Explain the procedure to the patient, giving detailed instructions and checking the patient s understanding. Choose the most appropriate electrodes for the ambulatory ECG device. Choose the optimal electrode position and either prepare the patients skin and apply electrodes, or instruct the patient how to prepare their skin and apply the electrodes Prepare the ambulatory ECG recorder for connection to the patient. Connect the leads and recorder (or explain to the patient how to connect) in such a way that artefact is minimised and to ensure patient comfort. Explain the use of the patient diary and how to activate the device as necessary. Explain to the patient what to do with the recorder at night and when to return the device. Remove the equipment from the 32

patient (or explain how to remove), clarify symptoms and explain the procedure for receiving results. Review report with senior staff where appropriate. Clean the ambulatory ECG equipment in accordance with departmental protocol. 33

Learning Outcome 9 Demonstrate the ability to analyse ROUTINE ambulatory ECG recording (excluding pacing, inherited disease and paediatrics) Competency Reviewer Date Comments/Evidence Operate a playback/analyser system. Recognise, analyse and interpret the ECG features seen during playback. Correlate patient symptoms with ECG findings. Check automated evaluations for accuracy and use to inform the final interpretation. Review the entire recording. Select ECG tracings sufficient to illustrate and support the final evaluation. Produce a factual report. Review report with senior staff when appropriate. 34

Learning Outcome 10 Demonstrate the ability to assist (2 nd person) in Cardiac Exercise Stress Testing Competency Reviewer Date Comments/Evidence Check all resuscitation equipment in the room. Obtain a suitably completed request form, greet patient, check patient ID and recent clinical history. Treat the patient in a way which respects their dignity, rights, privacy. Review the clinical history of the patient for suitability to perform the test. Explain the procedure to the patient and gain their consent. Confirm that the patient has adhered to any pre-test instructions. Ensure that the patient is suitably dressed and wearing appropriate footwear. Prepare electrodes sites and apply electrodes to the patient to obtain accurate and artefact-free recordings. Record the patients resting ECG and blood pressure and compare these with the last set of patient recordings. Carefully explain the procedure to the patient, demonstrate walking technique, to ensure that the patient understands how to perform the procedure safely. Encourage the patient to reach a level of activity which would achieve their optimal result. 35

Monitor and record the ECG and blood pressure throughout the test. Record any adverse or unexplained changes and take appropriate action. Identify when to end the test. Support the patient through the recovery period. Provide a recovery period in line with local and national guidelines Produce ECG tracings of sufficient accuracy to support the supervisor s clinical report. Clean equipment in accordance with departmental procedures. 36

Learning Outcome 11 Demonstrate the ability to assist at diagnostic and therapeutic invasive procedures. Competency Reviewer Date Comments/Evidence Greet patient, check patient ID and recent clinical history. Treat patient in a way which respects their dignity, rights and privacy. Explain the procedure to the patient and gain their consent. Comply with hand hygiene and asepsis procedures in accordance with local polices. Check all recording and resuscitation equipment prior to procedures. Check the patient has adhered to any pre-investigation instructions where necessary. Assemble the pressure transducers and monitoring lines to ensure a sterile, fluid-filled and air-free system. Check the calibration of the transducer. Identify mid-chest position on the patient and correctly align transducer. Choose equipment appropriate to the investigation. Zero pressure to ensure a correct patient baseline reading / measurement. 37

Take recordings appropriate to the investigation, make measurements from these and change the range and paper speed to suit the pressures recorded. Recognise artefacts which might affect the quality of the tracings and rectify these. Evaluate pressures from all cardiac chambers and structures, and inform medical staff of the values and any abnormalities in line with local policy. Collect patient blood samples and analyse as appropriate to the investigation. Make haemodynamic measurements in line with the overall patient investigations. Check ECG, BP and patient status throughout the procedure and report any adverse changes as necessary. Produce accurate ECG and haemodynamic tracings and a record of the procedure in accordance with departmental policy. Select and prepare equipment for the implant of bradycardia devices. Under direct supervision, make appropriate measurements. Complete the required documentation. Inform the patient of the follow-up procedures. 38

Learning Outcome 12 Demonstrate the ability to assist at the implant of bradycardia management devices. Competency Reviewer Date Comments/Evidence Greet patient, check patient ID and recent clinical history. Treat patient in a way which respects their dignity, rights and privacy. Explain the procedure to the patient and gain their consent. Comply with hand hygiene and asepsis procedures in accordance with local polices. Check all recording and resuscitation equipment prior to procedures. Check the patient has adhered to any pre-investigation instructions where necessary. Check ECG and patient status throughout the procedure and report any adverse changes as necessary. Select and prepare equipment for the implant of bradycardia devices. Under direct supervision, make appropriate measurements. Complete the required documentation. Inform the patient of the follow-up procedures. 39

Section 4.6 Division: Theme: Specialism: Years 2 and 3: Physiological Sciences Cardiovascular, Respiratory and Sleep Sciences Respiratory and Sleep Physiology Work-base Training [20 Credits] Year 2 and Year 3 The following outcomes are appropriate to all investigations and must be achieved for ALL investigations. Learning Outcome 3 Plan and prepare a range of patients for the performance of a range of respiratory investigations. Competency Reviewer Date Comments/Evidence Obtain the correct referral for the patient and the investigation to be performed. Ensure the referral contains sufficient information. If insufficient information then request further data or refer the matter to more senior staff. Identify and act upon any special requirements of the patient and, if necessary, discuss with senior staff and carers. Review contraindications to testing prior to the test these must also be checked with the patient on arrival into the laboratory. Perform hand washing before and after any patient contact. Greet patients and carers promptly and courteously and take all practicable steps to reassure patients and optimise effective communication and comprehension. Obtain and review relevant patient information e.g. medication, smoking history together with any previous test results. Make height and weight measurements in accordance with 40

standardised procedures, adapting them where necessary. 41

Learning Outcome 4 Plan and prepare a range of equipment for the performance of respiratory investigations. Competency Reviewer Date Comments/Evidence Ensure that the equipment is in working order in order for the test to be performed. Identify equipment faults and report or rectify. Ensure that the recording system is correctly configured in accordance with the requirements of the test. Ensure accurate completion of equipment maintenance records. Ensure the environment is suitable for the investigation being undertaken e.g. chair is positioned or there is access for a wheelchair 42

Learning Outcome 5 Measure and evaluate dynamic lung volumes (FEV 1, FVC, PEF and MFVC s) in a range of patients. Competency Reviewer Date Comments/Evidence Prepare equipment and patient in accordance with learning outcomes 3 and 4. Give patient clear and concise instructions on the test requirements. Obtain accurate measurements of VC, FVC, FEV 1, PEF and MFVC s in accordance with recommended procedures and patient capability. Recognise reasons to stop the dynamic lung volume measurements to maintain the safety of the patient during the test. Identify and correct errors in patient technique. Distinguish between poor patient performance, technical faults or deterioration in clinical status. At the end of the test remove equipment, mouthpieces, nose clips etc., reassure patient and give appropriate time to recover from the test. Inform the patient of the procedure for notification of the results. Decontaminate equipment and leave in a suitable condition for reuse. Record the results accurately in an appropriate format together with any technical comments that may influence the test outcome Generate a suitable report. 43

Learning Outcome 6 Measure static lung volumes (TLC, FRC (or TGV) and RV) and all subdivisions using helium dilution, nitrogen washout or body plethysmography, in patients with a range of underlying disorders. Competency Reviewer Date Comments/Evidence Prepare equipment and patient in accordance with learning outcomes 3 and 4. Give patient clear and concise instructions on the test requirements. Obtain accurate measurements of TLC, FRC (or TGV) and RV and all subdivisions in accordance with recommended procedures and patient capability. Recognise reasons to stop the static lung volume measurements to maintain the safety of the patient during the test. Identify and correct errors in patient technique. Distinguish between poor patient performance, technical faults or deterioration in clinical status. At the end of the test remove equipment, mouthpieces, nose clips etc. reassure patient and give appropriate time to recover from the test. Inform the patient of the procedure for notification of the results. Decontaminate equipment and leave in a suitable condition for reuse. Record the results accurately in an appropriate format together with any technical comments that may influence the test outcome. Generate a suitable report. 44

Learning Outcome 7 Measure the uptake of carbon monoxide (CO) using the single breath technique as a guide to the gas exchange function in a range of patients with respiratory and non-respiratory disorders. Competency Reviewer Date Comments/Evidence Prepare equipment and patient in accordance with learning outcomes 3 and 4. Give patient clear and concise instructions on the test requirements. Obtain accurate measurements of VA, TLCO and KCO in accordance with recommended procedures and patient capability. Recognise reasons to stop the transfer factor measurement to maintain the safety of the patient during the test. Identify and correct errors in patient technique. Distinguish between poor patient performance, technical faults or deterioration in clinical status. At the end of the test remove equipment, mouthpieces, nose clips etc. reassure patient and give appropriate time to recover from the test. Inform the patient of the procedure for notification of the results. Decontaminate equipment and leave in a suitable condition for reuse. Record the results accurately in an appropriate format together with any technical comments that may influence the test outcome. Generate a suitable report. 45

Learning Outcome 8 Administration of a bronchodilator and the measurement of the response. Competency Reviewer Date Comments/Evidence Prepare equipment and patient in accordance with learning outcome 3 and 4. Select the appropriate bronchodilator and device and ensure that it is prepared in accordance with departmental procedure and manufacturer s instruction. Provide clear instruction to the patient and check their understanding. Administer the bronchodilator to the patient (or the patient selfadministers). Monitor and evaluate patient technique, recognise errors and correct where possible. Allow appropriate time following administration of bronchodilator. Ensure patient performs post bronchodilator tests in the same manner as baseline tests. At the end of the test remove equipment, mouthpieces, nose clips etc.reassure patient and give appropriate time to recover from the test. Inform the patient of the procedure for notification of the results. Decontaminate equipment and leave in a suitable condition for reuse. Record the results accurately in an appropriate format together with any technical comments that may influence the test outcome. Generate a suitable report. 46