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Evidence Guide: HLTNE607D - Perform long term electroencephalography (EEG) 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

 

HLTNE607D - Perform long term electroencephalography (EEG) 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 for client details
  2. Identify special needs of clients to capture clinical events
  3. Select equipment, materials and location for test according to clinical events to capture previous routine EEG results and/or at the direction of neurologist/neurosurgeon
  4. Ensure equipment and materials selected are clean and dry, in working order, and, where applicable, calibrated and sterilised
  5. Review relevant, current literature and protocols
  6. Arrange client bookings according to organisation procedures, clients' needs, reason for study and surgical operating
Review client booking list for client details

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify special needs of clients to capture clinical events

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Select equipment, materials and location for test according to clinical events to capture previous routine EEG results and/or at the direction of neurologist/neurosurgeon

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Review relevant, current literature and protocols

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Prepare client for procedure

  1. Ensure information on access to test location and test to be attended is received by client, including hospital stay requirements where necessary
  2. Receive and process request for LTM EEG
  3. Correctly identify the client, reassure and inform client regarding the procedure and length of stay
  4. Give client/carer the opportunity to ask questions and discuss areas of concern
  5. Review client's medical history, seek clarification on specific details and take action, as required
  6. Check client consent has been obtained
  7. Prepare diary for recording of clinical events and give instruction on recording clinical events to client/carer
Ensure information on access to test location and test to be attended is received by client, including hospital stay requirements where necessary

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Receive and process request for LTM EEG

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Correctly identify the client, reassure and inform client regarding the procedure and length of stay

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Check client consent has been obtained

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Prepare diary for recording of clinical events and give instruction on recording clinical events to client/carer

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
  3. Select intra-operative or depth electrodes according to client needs or surgical requirements under the guidance of the neurologist and/or neurosurgeon
  4. Adjust camera and microphone position according to client needs, clinical event and concurrent test results where applicable
  5. Conduct head measurement to verify sites for electrode placement according to current standards and organisation policies and procedures
  6. Complete skin preparation according to infection control guidelines and client's needs
  7. Attach other monitoring equipment as required
  8. Connect correctly required leads correctly between interface/head box and machine
  9. Connect correctly intra-operative or depth electrodes between interface/head box and machine under the guidance of the neurologist and/or neurosurgeon where applicable
  10. Accurately label and notate intra-operative or depth electrode placement and map position on brain where applicable
  11. Perform pre-monitoring electrode impedance and establish integrity of electrodes and application
  12. Adjust equipment and electrodes as required
  13. Attach devices to client safely and securely, where appropriate
  14. Set time correlation/synchronisation between clinical and cerebral recorders
  15. Enter client details on monitoring equipment or on long term monitoring storage devices
  16. Perform pre monitoring 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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Select intra-operative or depth electrodes according to client needs or surgical requirements under the guidance of the neurologist and/or neurosurgeon

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Adjust camera and microphone position according to client needs, clinical event and concurrent test results where applicable

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

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:

 

 

 

 

 

 

 

Connect correctly required leads correctly between interface/head box and machine

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Connect correctly intra-operative or depth electrodes between interface/head box and machine under the guidance of the neurologist and/or neurosurgeon where applicable

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Accurately label and notate intra-operative or depth electrode placement and map position on brain where applicable

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Perform pre-monitoring electrode impedance and establish integrity of electrodes and application

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Adjust equipment and electrodes as required

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Attach devices to client safely and securely, where appropriate

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Set time correlation/synchronisation between clinical and cerebral recorders

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Enter client details on monitoring equipment or on long term monitoring storage devices

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Perform pre monitoring on machine and biological calibration

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Conduct long term EEG recording

  1. Perform additional validation techniques
  2. Apply techniques according to client details and annotate concurrent results on record or recording diary
  3. Validate electrode impedance throughout recording at regular intervals
  4. Recognise artefacts, annotate on the record or in recording diary, and eliminate or reduce
  5. Identify and action clinical events which require immediate attention
  6. Note clinical events in recording diary
  7. Identify and action abnormal EEG which correlates to clinical events and requires immediate attention
  8. Use derivations and machine settings according to test requirements, concurrent results and client needs
  9. Select activation procedures according to request form and client's concurrent results/response
  10. Monitor client's response to activation procedure and adapt procedure accordingly
  11. Add/attach further monitoring equipment and/or electrodes in response to concurrent findings
  12. Annotate on recording or record diary response to activation procedure and changes throughout the procedure
  13. Determine appropriate length of recording according to standards, medical referral, concurrent EEG results and clinical events captured
  14. Identify and meet client needs during the LTM EEG
  15. 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 or recording diary

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Validate electrode impedance throughout recording at regular intervals

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Recognise artefacts, annotate on the record or in recording diary, and eliminate or reduce

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify and action clinical events which require immediate attention

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Note clinical events in recording diary

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify and action abnormal EEG which correlates to clinical events and requires immediate attention

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Select activation procedures according to request form and client's concurrent results/response

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Monitor client's response to activation procedure and adapt procedure accordingly

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Annotate on recording or record diary response to activation procedure and changes throughout the procedure

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Determine appropriate length of recording according to standards, medical referral, concurrent EEG results and clinical events captured

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify and meet client needs during the LTM EEG

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. Identify and capture sufficient number of clinical events, as directed by neurologist and/or neurosurgeon
  2. Perform post monitoring of electrode impedance and verify integrity of electrode and contact
  3. Perform post monitoring machine and biological calibration
  4. Validate existence of the computerised file on hard drive and other long term data recording mediums if required
  5. Remove EEG leads and electrodes from client and wash paste/gel off client where applicable.
  6. Provide client with assistance as required, on completion of the procedure
  7. Confirm timely follow up with referring doctor for results
  8. Record monitoring details for retrieval and statistical purposes according to department procedures
  9. Provide information to client and carer according to duty of care
  10. Clean, dry and store equipment in accordance with manufacturer's guidelines and infection control guidelines
  11. Dispose of disposable EEG electrodes and other materials in accordance with waste management procedures and infection control guidelines
Identify and capture sufficient number of clinical events, as directed by neurologist and/or neurosurgeon

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Perform post monitoring of electrode impedance and verify integrity of electrode and contact

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Perform post monitoring machine and biological calibration

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Validate existence of the computerised file on hard drive and other long term data recording mediums if required

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Remove EEG leads and electrodes from client and wash paste/gel off client where applicable.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Confirm timely follow up with referring doctor for results

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Record monitoring 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 EEG electrodes and other materials in accordance with waste management procedures and infection control guidelines

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Generate report

  1. Review client details and correct as required
  2. Review clinical events diary
  3. Identify and review EEG which correlates to clinical events
  4. Choose additional EEG samples as required
  5. Review and correct annotations to provide accurate and concise information
  6. Forward technical report/results with accompanying documentation and time correlations to neurologist for review or assessment and reporting
Review client details and correct as required

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Review clinical events diary

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify and review EEG which correlates to clinical events

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Choose additional EEG samples 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 and time correlations 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 long term electroencephalography (EEG) monitoring

Observation of simulation and/or role play when performing long term electroencephalography (EEG) 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 long term electroencephalography (EEG) 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 EEG interpretation, including neurological disorders

Basic pharmacology related to neurological function

Complications and contraindications for clients undergoing LTM EEG procedure, in particular related to activation procedures and clinical events

Concepts of electronics and physics relevant to the performance of an LTM EEG and the EEG recording apparatus

Confidentiality requirements of client information

Data storage and recycling appropriate to LTM EEG recording apparatus and clinical events captured

Derivations, montage design and type, and machine settings, including understanding of when and how to change them

EEG rhythm disturbance and appropriate test alterations

Electrical safety requirements

Emergency procedures in the event of complications relevant in the provision of assistance in the performance of LTM EEG

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

Medical terminology relevant to perform an EEG

Normal EEG rhythms and abnormal EEG activity

Protocols for LTM EEG procedure

Purpose of LTM EEG eg: diagnostic, prognostic, classification of events

Routine maintenance policy and procedures for equipment

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 other appropriate health professional

Communicate effectively with clients/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

Ensure safety of the client during a clinical event

Identify a clinical event and its' correlation to the EEG recording

Identify steps that must be taken to ensure equipment is safe for use

Produce a diagnostic LTM EEG recording

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 correctly

Attach intra-operative and/or depth electrode leads under the guidance of the neurologist/neurosurgeon

Correctly identify abnormal findings

Correctly operate LTM EEG and associated monitoring equipment

Correctly prepare skin

Deal with conflict

Demonstrate basic cardiopulmonary resuscitation

Demonstrate computer skills relevant to workers' role

Ensure safety for the client during a clinical event

Identify an LTM EEG recording result that is unsatisfactory for diagnostic purposes

Identify an LTM EEG recording result which may require immediate medical attention

Identify and accurately document a clinical event

Identify methods for appropriate data storage according to EEG recording apparatus and clinical events captured

Identify samples of EEG specifically required for diagnostic purposes according to clinical events and purpose of monitoring.

Manage the known common interferences in the production of a EEG recording

Measure for the placement of electrodes to achieve an EEG recording of diagnostic quality

Produce an LTM EEG recording satisfactory for diagnostic purposes

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 ranging from the ability to complete basic arithmetic calculations, recording stock levels, statistical information or 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:

LTM EEG device, including cable or radio telemetry and ambulatory monitoring with or without audio and video recorders.

Time correlation between Video/audio and EEG recorder

EEG machine; digital, analogue, portable, standard

Polygraphic equipment; ECG, EMG, EOG machines, respiration, movement and tremor monitors

Electrodes eg caps, disc, mushroom, needle, intra-operative or depth electrodes

Head box

Photic stimulator and strobe light

Chair

Bed

Additional - accessories, toys, other stimuli

Gels and Electrode pastes

Tape measure

Video cassette recorder and camera

Audio recorder and microphone

Resuscitation equipment

Environment may include:

Neurophysiology department

Wards (short and long term stays)

Operating theatre

Private Neurologist's rooms

Intensive care units

Radiology department

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

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 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 time/date of last seizure

Psychiatric and behavioural disorders

Developmental disorder

Metabolic disorder

Medications

Action in response to client's medical history may include:

Omission of activation procedure/s

Additional activation procedure

Alteration of EEG procedure time

Reduction of medication only under the instruction of the Neurologist/Neurosurgeon

Personal protective equipment may include:

Gloves

Mask

Goggles

Gown

Other monitoring equipment may include:

ECG monitor

Respiration

Actogram

EMG

Oximetry

Movement sensors

Audio recorder

Integrity of electrodes must include:

Ground

Reference

Active

Devices may include:

Headbox

Microphone

Long term monitoring storage devices may include:

Cassette recorder tapes

Compact discs

Optical discs

Recording diary

Additional validation techniques must include:

Touch test (of electrodes)

Exchange electrodes

Replace electrodes

Low, and of similar value, impedances

Techniques applied must include:

Montages

Derivations

Sensitivity

Filter

Display speed

Activations

Time synchronisation between Video and EEG recorder

Accessory equipment used for activation procedures must include:

Photic stimulator and strobe light

Accessory equipment used for activation procedures may include:

Sleeping accessories, bed, covers, pillows, conducive environment

Blowing implements

Strobe light

Pattern stimulator

Reading material

Other - as appropriate to client history

Causes of changes throughout procedure must include:

Clinical events

EEG findings

Equipment

Environmental

Client's physiological and psychological state

Anaesthetic levels or sedation

Abnormal EEG patterns which require immediate medical attention must include but are not limited to:

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

Complications and severe reactions may include:

Seizure

Cardio-respiratory arrest

Information provided to client's and carer's may include:

Client event recording diary

Appropriate follow up period with referring doctor to obtain results

Risks of injury to client following procedure i.e. following sedation and/or sleep deprivation or reduced medication and prior to follow up with Neurologist i.e. driving, swimming, riding bicycles, bathing