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
Intra-operative monitoring including neurophysiology tests are only conducted in hospitals in an operating theatre
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 an intraoperative neurophysiology test and to provide an interim report to assist the surgeon or neurologist
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 intra-operative neurophysiology monitoring
Observation of simulation and/or role play when performing intra-operative neurophysiology monitoring
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 intra-operative neurophysiology monitoring (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 neurosurgical intraoperative tests interpretation, including neurological disorders
Basic pharmacology related to neurological function
Causes of the varied artefacts and interferences seen in the operating theatres and their appropriate remedies or limitations
Complications and contraindications for clients undergoing test procedure, in particular related to surgical intervention
Concepts of electronics and physics relevant to the performance of an intraoperative neurophysiology tests and the range of equipment used
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 intraoperative testing
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 additional electrode types and their appropriate placement by surgeons or neurologists
Medical terminology relevant to perform intraoperative neurophysiology tests
Normal and abnormal EEG waveforms
Protocols for intraoperative neurophysiology test procedures
Purpose of intraoperative neurophysiology tests eg: diagnostic, prognostic, classification of events
Routine maintenance policy and procedures for equipment
Units of measurement
Waveform rhythm disturbance and appropriate test alterations
Essential skills:
It is critical that the candidate demonstrate the ability to:
Apply knowledge of boundaries of responsibilities and refer problems to supervisor, neurologist or surgeon or other appropriate health professional
Communicate effectively with clients and carers in relation to the procedure and manage their anxiety level
Comply with policies and procedures including those of WHS and infection control
Identify and respond to contraindications before and during test
Identify steps that must be taken to ensure equipment is safe for use
Produce a diagnostic intraoperative test result
Produce a diagnostic pre-operative test 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:
Alter machine settings for a range of polygraphic variables and to enhance waveforms
Attach additional electrode types to headbox while surgeon is inserting onto client i.e. grid, strip, depth electrodes
Correctly attach electrodes and leads
Correctly identify and validate abnormal findings
Correctly operate neurophysiology equipment
Correctly perform preparation
Deal with conflict
Demonstrate basic cardiopulmonary resuscitation
Demonstrate computer skills relevant to workers' role
Identify an intraoperative neurophysiology test recording result that is unsatisfactory for diagnostic purposes
Identify an intraoperative neurophysiology test recording result which may require immediate medical attention
Manage the known common interferences in the production of a intraoperative neurophysiology test recording
Measure for the placement of electrodes to achieve an intraoperative neurophysiology test recording of diagnostic quality including routine and non-routine
Produce an intraoperative neurophysiology test recording satisfactory for diagnostic purposes including ability to design montages and select machine parameters appropriately
Select appropriate montages for a range of clinical conditions or activation procedures and redesign montages when necessary
Solve problems including an ability to use available resources
continued ...
Essential skills (contd):
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
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
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
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/EP/MEP machine; digital, analogue, portable, standard, ambulatory, video and audio
Polygraphic equipment; ECG, EMG, EOG machines, respiration, movement and tremor monitors
Electrodes eg , disc, disc, screw, depth, grid or strip
Head box
Electrical Stimulator
Motor Evoked Stimulator
Photic stimulator
Operating Theatre Bed
Additional spare equipment, as required
Gels
Electrode pastes
Tape measure
Video cassette recorder and camera
Resuscitation equipment
Environment for pre-operative baseline may include:
Neurophysiology department
Wards
Private Neurologist's rooms
Intensive care units
Environment for operative test procedure may include:
Operating rooms
Radiology department
Clients must include:
Neonates
Infants
Children
Adolescents
Adults
Elderly
Client medical history may include:
Event/s leading to referral
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
Orthopaedic disorder
Action in response to client's medical history may include:
Omission of activation procedure/s
Additional activation procedure
Alteration to routine Neurophysiology test procedure
Personal protective equipment may include:
Gloves
Mask
Goggles
Gown
Other monitoring equipment may include:
Actogram
EMG
Movement sensors
Integrity of electrodes must include:
Ground
Reference
Active
Additional validation techniques must include:
Touch test (of electrodes)
Exchange electrodes
Replace electrodes
Low, and of similar value, impedances
Adequate twitch for EP stimulation
Techniques applied must include:
Montages
Derivations
Sensitivity
Filter
Display speed
Activations
Other variables may include:
Anaesthetic levels
Client blood pressure changes
Artefacts created by the theatre environment may include:
Use of electrical equipment eg diathermy, monitors
Client originated
Staff originated
Causes of changes throughout procedure must include:
Test findings
Clinical events
Variation in level of anaesthetic drug administered
Blood pressure alterations
Respiration changes
Position of machinery
Equipment
Environmental
Client's physiological and psychological state
Abnormal test patterns which require immediate medical attention must include:
Unilateral changes
Burst suppression and/or isoelectric
Frequent sub clinical seizure pattern
Status epilepticus
Reduction in waveforms from baseline traces not associated with anaesthetic changes
Delays in waveforms from baseline traces not associated with anaesthetic changes
Other conditions or variations to waveforms which may endanger the health and well being of the client
Complications and severe reactions may include:
Seizure
Cardio-respiratory arrest
Information provided to client/carer may include:
Appropriate follow up period with referring doctor to obtain results
How to remove residual glues, pastes from recording sites if client
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 is reviewed 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
Clean and prepare equipment surfaces accordingly for entering the theatre environment
Review relevant, current literature and protocols
Arrange client bookings according to surgeons operative list
Firmly label electrodes at both ends
Identify in consultation with operating room staff the optimal positioning of equipment, cables and leads to achieve minimal electrical interference
Ensure information on access to test location and test to be attended is received by client
Receive and process request for baseline pre-operative test
Correctly identify client is correctly identified, reassure and inform client regarding the pre-operative test procedure and of the involvement of the neurophysiology testing during their operative procedure
Give client/carer the opportunity to ask questions and discuss areas of concern
Check client consent has been obtained
Review the client's medical history, seek clarification on specific details and take appropriate action, as required
Utilise personal protective equipment in accordance with standard and additional precautions
Select type and number of electrodes according to client needs and test procedure
Conduct head measurement to verify sites for electrode placement according to current standards and organisation policies and procedures and confirm with neurologist requests for any additional routine electrodes
Apply non-routine electrodes according to neurologists advice or inserted by neurologist or surgeon
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 for electrode impedance and establish integrity of electrodes and application
Adjust equipment and electrodes as required
Enter client details on testing equipment or on paper traces, as required
Perform pre test on machine and biological calibration
Perform additional validation techniques
Apply techniques according to client details and annotate concurrent results on record
Validate electrode impedance throughout test as required
Recognise artefacts, annotate on the record, and eliminate or reduce
Document other variables originating or being recorded in the theatre environment on the test if appropriate
Document artefacts created by the theatre environment and cease recording as required
Identify expected waveforms related to clinical conditions and age groups
Identify abnormal patterns and waveforms which require immediate attention and inform neurologist and surgeon
Use derivations and machine settings according to test requirements, concurrent results and client needs
Add/attach further monitoring equipment and/or electrodes in response to concurrent findings under the guidance of the surgeon
Annotate on recording response to activation procedure and changes throughout the procedure
Determine appropriate length of recording under the guidance of the neurologist or surgeon and concurrent test results.
Identify and meet surgeon's needs during the test procedure relevant to obtaining maximal accuracy
Identify and respond to severe reactions and complications 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 performed
Validate existence of the computerised file validated on hard drive, if required
Remove electrodes from client and wash paste/gel/glue off client at completion of procedure
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 electrodes and other materials in accordance with waste management procedures and infection control guidelines
Review and correct client details as required
Review and correct annotations to provide accurate and concise information
Forward technical report/results with accompanying documentation to neurologist for review or assessment and reporting