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Evidence Guide: HLTNE606D - Perform intra-operative neurophysiology monitoring

Student: __________________________________________________

Signature: _________________________________________________

Tips for gathering evidence to demonstrate your skills

The important thing to remember when gathering evidence is that the more evidence the better - that is, the more evidence you gather to demonstrate your skills, the more confident an assessor can be that you have learned the skills not just at one point in time, but are continuing to apply and develop those skills (as opposed to just learning for the test!). Furthermore, one piece of evidence that you collect will not usualy demonstrate all the required criteria for a unit of competency, whereas multiple overlapping pieces of evidence will usually do the trick!

From the Wiki University

 

HLTNE606D - Perform intra-operative neurophysiology monitoring

What evidence can you provide to prove your understanding of each of the following citeria?

Prepare equipment, material and environment

  1. Review client booking list is reviewed for client details
  2. Identify special needs of clients
  3. Select equipment, materials and location for test
  4. Ensure equipment and materials selected are clean and dry, in working order, and, where applicable, calibrated
  5. Clean and prepare equipment surfaces accordingly for entering the theatre environment
  6. Review relevant, current literature and protocols
  7. Arrange client bookings according to surgeons operative list
  8. Firmly label electrodes at both ends
  9. Identify in consultation with operating room staff the optimal positioning of equipment, cables and leads to achieve minimal electrical interference
Review client booking list is reviewed for client details

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify special needs of clients

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Select equipment, materials and location for test

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Clean and prepare equipment surfaces accordingly for entering the theatre environment

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Review relevant, current literature and protocols

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Arrange client bookings according to surgeons operative list

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Firmly label electrodes at both ends

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify in consultation with operating room staff the optimal positioning of equipment, cables and leads to achieve minimal electrical interference

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Prepare client for pre-operative test procedure

  1. Ensure information on access to test location and test to be attended is received by client
  2. Receive and process request for baseline pre-operative test
  3. 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
  4. Give client/carer the opportunity to ask questions and discuss areas of concern
  5. Check client consent has been obtained
  6. Review the client's medical history, seek clarification on specific details and take appropriate action, as required
Ensure information on access to test location and test to be attended is received by client

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Receive and process request for baseline pre-operative test

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Give client/carer the opportunity to ask questions and discuss areas of concern

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Check client consent has been obtained

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Review the client's medical history, seek clarification on specific details and take appropriate action, as required

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Attach monitoring equipment

  1. Utilise personal protective equipment in accordance with standard and additional precautions
  2. Select type and number of electrodes according to client needs and test procedure
  3. 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
  4. Apply non-routine electrodes according to neurologists advice or inserted by neurologist or surgeon
  5. Complete skin preparation according to infection control guidelines and client's needs
  6. Attach other monitoring equipment as required
  7. Correctly connect required leads between interface/head box and machine
  8. Perform pre test for electrode impedance and establish integrity of electrodes and application
  9. Adjust equipment and electrodes as required
  10. Enter client details on testing equipment or on paper traces, as required
  11. Perform pre test on machine and biological calibration
Utilise personal protective equipment in accordance with standard and additional precautions

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Select type and number of electrodes according to client needs and test procedure

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Apply non-routine electrodes according to neurologists advice or inserted by neurologist or surgeon

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Attach other monitoring equipment as required

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Correctly connect required leads between interface/head box and machine

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Perform pre test for electrode impedance and establish integrity of electrodes and application

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Adjust equipment and electrodes as required

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Perform pre test on machine and biological calibration

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Conduct intraoperative recording

  1. Perform additional validation techniques
  2. Apply techniques according to client details and annotate concurrent results on record
  3. Validate electrode impedance throughout test as required
  4. Recognise artefacts, annotate on the record, and eliminate or reduce
  5. Document other variables originating or being recorded in the theatre environment on the test if appropriate
  6. Document artefacts created by the theatre environment and cease recording as required
  7. Identify expected waveforms related to clinical conditions and age groups
  8. Identify abnormal patterns and waveforms which require immediate attention and inform neurologist and surgeon
  9. Use derivations and machine settings according to test requirements, concurrent results and client needs
  10. Add/attach further monitoring equipment and/or electrodes in response to concurrent findings under the guidance of the surgeon
  11. Annotate on recording response to activation procedure and changes throughout the procedure
  12. Determine appropriate length of recording under the guidance of the neurologist or surgeon and concurrent test results.
  13. Identify and meet surgeon's needs during the test procedure relevant to obtaining maximal accuracy
  14. Identify and respond to severe reactions and complications in accordance with organisation emergency procedures
Perform additional validation techniques

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Validate electrode impedance throughout test as required

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Recognise artefacts, annotate on the record, and eliminate or reduce

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Document other variables originating or being recorded in the theatre environment on the test if appropriate

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Document artefacts created by the theatre environment and cease recording as required

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify expected waveforms related to clinical conditions and age groups

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify abnormal patterns and waveforms which require immediate attention and inform neurologist and surgeon

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Add/attach further monitoring equipment and/or electrodes in response to concurrent findings under the guidance of the surgeon

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Annotate on recording response to activation procedure and changes throughout the procedure

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Determine appropriate length of recording under the guidance of the neurologist or surgeon and concurrent test results.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify and meet surgeon's needs during the test procedure relevant to obtaining maximal accuracy

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Completion of procedure

  1. Perform post test electrode impedance and verify integrity of electrode and contact
  2. Perform post test machine and biological calibration performed
  3. Validate existence of the computerised file validated on hard drive, if required
  4. Remove electrodes from client and wash paste/gel/glue off client at completion of procedure
  5. Record test details for retrieval and statistical purposes according to department procedures
  6. Provide information to client and carer according to duty of care
  7. Clean, dry and store equipment in accordance with manufacturer's guidelines and infection control guidelines
  8. Dispose of disposable electrodes and other materials in accordance with waste management procedures and infection control guidelines
Perform post test electrode impedance and verify integrity of electrode and contact

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Perform post test machine and biological calibration performed

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Remove electrodes from client and wash paste/gel/glue off client at completion of procedure

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Provide information to client and carer according to duty of care

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Generate report

  1. Review and correct client details as required
  2. Review and correct annotations to provide accurate and concise information
  3. Forward technical report/results with accompanying documentation to neurologist for review or assessment and reporting
Review and correct client details as required

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Review and correct annotations to provide accurate and concise information

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Assessed

Teacher: ___________________________________ Date: _________

Signature: ________________________________________________

Comments:

 

 

 

 

 

 

 

 

Instructions to Assessors

Evidence Guide

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

Required Skills and Knowledge

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

Range Statement

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