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

Pre-requisite unit

This unit must be assessed after successful achievement of pre-requisite:

HLTNE401D Perform electroencephalography (EEG)

ELEMENT

PERFORMANCE CRITERIA

1. Prepare equipment, material and environment

1.1 Review client booking list for client details

1.2 Identify special needs of clients

1.3 Select equipment, materials and location for test

1.4 Ensure equipment and materials selected are clean and dry, in working order, and, where applicable, calibrated

1.5 Review relevant, current literature and protocols

1.6 Arrange client bookings according to organisation procedures, clients' needs, and reason for study

2. Prepare client for procedure

2.1 Confirm receipt of information by client

2.2 Receive and process request for polysomnographic recording

2.3 Correctly identify client, reassure and inform client regarding the procedure

2.4 Give opportunities for client/carer to ask questions and discuss areas of concern

2.5 Check client consent has been obtained

2.6 Review client's medical history, seek clarification on specific details and take actioned, as required

3. Attach monitoring equipment

3.1 Utilise personal protective equipment in accordance with standard and additional precautions

3.2 Select type and number of electrodes according to client needs, including multiple polygraphic recording electrodes

3.3 Conduct head measurement to verify sites for cerebral electrode placement according to current standards and organisation policies and procedures

3.4 Identify positioning of monitoring equipment for other physiological measurements

3.5 Complete skin preparation according to infection control guidelines and client's needs

3.6 Attach other monitoring equipment as required

3.7 Correctly connect required leads between interface/head box and machine

3.8 Perform pre-test electrode impedance and establish integrity of electrodes and other recording devices, and application

3.9 Adjust equipment, electrodes, and other recording devices as required

3.10 Enter client details on testing equipment or on paper traces, as required

3.11 Perform pre test on machine and biological calibration, including calibration of all polygraphic variables and AC/DC amplifiers

4. Conduct polysomnographic recording

4.1 Perform additional validation techniques performed

4.2 Apply techniques according to client details and annotate concurrent results on record

4.3 Validate electrode impedance throughout test as required

4.4 Use troubleshooting methods to isolate problems with any recording device used in the study.

4.5 Recognise artefacts are recognised, annotate on the record, and eliminate or reduce on all polygraphic channels

4.6 Identify expected waveforms related to clinical conditions and age groups

4.7 Identify sleep states and staging

4.8 Identify changes in physiological parameters are identified, correlate to client's record and action as required

4.9 Identify and action abnormal EEG patterns and waveforms which require immediate attention

4.10 Use derivations and machine settings according to test requirements, polygraphic variables, concurrent results and client needs

4.11 Add/attach further monitoring equipment and/or electrodes in response to concurrent findings

4.12 Annotate on recording any changes throughout the procedure

4.13 Determine appropriate length of recording according to standards, medical referral and concurrent polysomnographic results.

4.14 Identify and meet client needs during the polysomnographic recording

4.15 Identify and respond to severe reactions and complications to in accordance with organisation emergency procedures

5. Complete procedure

5.1 Perform post test electrode impedance and verify integrity of electrode and contact

5.2 Perform post test machine and biological calibration

5.3 Validate existence of the computerised file on hard drive, if required

5.4 Identify and action abnormal test patterns which require immediate medical attention

5.5 Remove EEG leads and electrodes and other recording devices from client and wash paste/gel off client

5.6 Provide client with assistance as required, on completion of the procedure

5.7 Confirm timely follow up with referring doctor for results

5.8 Record test details for retrieval and statistical purposes according to department procedures

5.9 Provide information to client and carer according to duty of care

5.10 Clean, dry and store equipment in accordance with manufacturer's guidelines and infection control guidelines

5.11 Dispose of disposable EEG electrodes and other materials in accordance with waste management procedures and infection control guidelines

6. Generate report

6.1 Review and correct client details reviewed and corrected

6.2 Review annotations reviewed and correct to provide accurate and concise information including sleep staging

6.3 Forward technical report/results with accompanying documentation to neurologist or respiratory specialist for review or assessment and reporting

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 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

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.

This unit contains Employability Skills