Module - Introduction to Critical Care Science (SPS101)

STP

Aim of this module

This rotation will enable trainees to gain underpinning knowledge, skills and experience of Critical Care Science through introduction to the range of critical care diagnostic, monitoring and therapeutic services provided in the specialism, and the interaction with patients and patient-centred practice. Trainees will be expected to perform some routine procedures and develop and build their professional practice.

Work-based learning outcomes


  1. Use correct aseptic technique and aseptic handling of medical devices in the critical care environment.
  2. Perform a range of bedside monitoring techniques and be able to interpret acute events and actions required, differentiating between physiological and technical abnormalities in patient monitoring techniques. (This should include ECG monitoring, oxygen saturation monitoring and non-invasive BP monitoring.)
  3. Administer oxygen therapy across a range of delivery systems to critically ill patients.
  4. Perform a blood gas measurement and describe its clinical relevance.
  5. Store medical gases correctly, ensuring adherence to the safety issues in the context of the critical situation.
  6. Use the National Early Warning Scoring system in relation to critical care.
  7. Document local diagnostic and treatment pathways for critically ill patients within a critical care environment.

Work-based Competencies


Learning outcome Title Knowledge
1 1, 2, 3, 4, 5

Perform all tasks in accordance with relevant procedures/protocols/legislation, including infection control, health and safety, and critical incident reporting, ensuring appropriate patient identity checks are performed and the patient is fully identified on each type of recording.

  • Protocols and requirements for hygiene and infection control related to the relevant range of procedures, including preparation, conduct and completion of the procedure.
  • Protocol for hand washing and how effective hand washing contributes to control of infection.
  • The relevant health and safety regulations specific to the cardiac procedure.
  • The potential hazards and risks and the actions to be taken to minimise these.
  • Relevant guidelines.
  • Decontamination methods:
    • chemical sterilisation
    • steam autoclaving
    • irradiation.
  • The importance of checking and confirming the patient identity and the implications of not doing so.
  • Process of critical incidence reporting.
2 2,3,4

Respect the dignity, rights, privacy and confidentiality of patients at all times, taking appropriate action to respond to the specific needs of the critically ill patient.

  • The rights of the patient with regard to privacy and dignity.
  • The rights of the patient with regard to confidentiality of consultation and medical records.
  • Requirements of patients with disabilities and special needs.
  • Key factors influencing dignity, rights, privacy and confidentiality, including age, gender, culture and beliefs.
  • The importance of checking and confirming the patient identity and the implications of not doing so.
  • Presenting signs and symptoms of a patient who is acutely ill, deteriorating or collapsed.
  • Gaining consent in critical care situations.
  • Correct positioning of the patient to ensure comfort, co-operation and optimal investigation results.
  • The range of needs of people with disabilities within a typical care pathway for a patient requiring critical care.
  • Pathology, clinical features and the management of common problems that present to Critical Care.
  • Early identification of a sick patient.
3 2,3,4

Prepare the environment and set up equipment ready for use for monitoring, therapy or measurement.

  • Range of equipment used, relative merits and principles of measurement.
  • Requirements for the investigation environment to ensure the privacy, dignity and comfort of the patient.
  • Recognition of the errors or potential risks of using defective equipment in clinical practice and the implications of use.
  • Identification of common faults and remedial action.
  • Current safety standards, including safety testing and routine maintenance.
  • Preparation and calibration of equipment.
4 2,3,4

Explain the procedure to the patient, if they are fully cognitive, or the relative if present, address any procedure-related questions and gain appropriate consent.

  • The importance of explaining the procedure for each investigation to a patient or their relatives and gaining informed consent as appropriate to critically ill patients.
  • The importance of introducing yourself and your role as a clinical scientist trainee as part of the process of introduction and consent.
  • The relevant procedures and requirements for patient conformance.
  • Clinical indications for and contraindications to each investigation.
  • Principles, guidance and law with respect to informed consent, including the unconscious patient.
5 1

Use correct non-touch aseptic technique in the critical care environment.

  • Purpose of the aseptic technique to minimise the risk of introducing pathogens into a wound or other susceptible site.
  • Difference between non-touch aseptic technique and the modified aseptic technique or ‘clean’ technique.
  • Purpose of the aseptic technique to minimise the risk/prevent transfer of pathogens to other susceptible sites, service users, or staff.
  • Indications for use of an aseptic technique.
  • Standard operating procedure (SOP) for aseptic technique, including equipment and procedure.
6 1

Use correct modified aseptic technique (clean technique) in the critical care environment.

  • Purpose of modified aseptic technique (clean technique).
  • Indications for clean technique.
  • SOP for aseptic (clean) technique, including equipment and procedure.
7 2

Set up a cardiac monitor on adult patients, interpreting and responding to trends in physiological variables.

  • SOP for setting up a cardiac monitor.
  • Electrode sites for cardiac monitoring to achieve optimum electrocardiogram (ECG) waveform.
  • Choice of monitor and monitor settings and rate alarm.
  • How to minimise patient discomfort in relation to monitoring devices.
  • How to recognise technical artefacts.
  • Routine maintenance and cleaning of cardiac monitors.
8 2

Set up non-invasive blood pressure (BP) monitoring equipment in adult patients, interpreting and responding to trends in physiological variables.

  • Importance of using only validated BP monitors.
  • SOP for setting up a non-invasive BP monitor, including choice of cuff size and positioning.
  • Acute pharmacological treatment of hyper and hypotension.
  • Choice of programmes/settings for BP monitoring.
  • How to minimise patient discomfort in relation to monitoring devices.
  • Normal BP ranges.
  • Routine maintenance, calibration and cleaning procedures.
9 2

Set up oxygen saturation monitoring equipment in adult patients, interpreting and responding to trends in physiological variables.

  • National guidance and trust policy (BTS Guideline; Thorax 2008).
  • SOP for setting up an oxygen saturation monitor.
  • Electrode sites for oxygen monitoring to achieve optimum performance.
  • How to minimise patient discomfort in relation to monitoring devices.
  • Choice of monitor and monitor settings and rate alarm.
  • How to recognise technical artefacts.
  • Routine maintenance, calibration and cleaning of oxygen saturation monitors.
10 3

Select, set up and deliver appropriate oxygen therapy, monitoring, interpreting and responding to changes appropriately using nasal cannulae, simple face masks, non- rebreathe masks and venturi masks.

  • SOP for oxygen therapy in critical care.
  • Trust oxygen prescribing and administration policy.
  • Procedures for emergency oxygen prescribing.
  • Principles of oxygen therapy.
  • Range of oxygen administration devices, advantages and disadvantages, colour coding.
  • Monitoring the patient to keep within the target saturation range.
  • Role of pulse oximetry measurements, including frequency of measurements.
  • Complications of oxygen therapy and actions to be taken.
  • When to seek assistance.
  • Actions in the event of a fire.
  • Routine maintenance, calibration and cleaning of oxygen therapy equipment and humidification.
11 3

Select, set up and deliver appropriate oxygen therapy and nebulising devices, monitoring, interpreting and responding to changes appropriately.

  • SOP for use of oxygen therapy and nebulising devices.

  • Indications for, contraindications to and pharmacology of treatments administered via nebulising devices.

  • Routine maintenance, calibration and cleaning of oxygen therapy equipment and nebulising devices.

12 4

Assess the patient’s suitability for the proposed investigation and obtain a blood gas sample suitable for the assessment of blood gas status using a recognised technique.

  • SOP for blood gas analysis.
  • Common presenting conditions and pathological processes underlying the presentation of patients referred for blood gas analysis.
  • Procedure and protocols for performing either arterial blood gases or an ear lobe capillary sample.
  • Advantages and disadvantages of each technique.
13 5

Correctly store medical gases for use in a critical care environment.

  • Categories of medical gases and the associated risks and hazards associated with their use and handling.
  • Legislation, regulation, policy and procedures applied to working with medical gases, including:
    • Management of Health and Safety at Work Regulations 1999
    • The Control of Substances Hazardous to Health (COSHH) Regulations
    • Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1985 (RIDDOR)
    • Medicines Act (1968) (and the role of The Medicines and Healthcare products Regulatory Agency [MHRA])
    • defect, failure and incident reporting (DATIX)
    • the trust medical gases operational policy.
  • Supply and storage of medical gases and sizing systems, including within a critical care environment and during patient transportation.
  • Types of pressure regulators, selection of correct type of regulator, maintenance and calibration.
  • Correct methods for handling medical gases.
  • Piped gases, protocols for maintenance and fault recognition and reporting.
  • Connecting to medical gas outlets: wall outlets or cylinder Schrader valves.
14 5

Assist in the connection of medical gases to wall outlets and cylinders.

  • Piped gases, protocols for maintenance and fault recognition and reporting.
  • Connecting to medical gas outlets: wall outlets or cylinder Schrader valves.
  • Process for reporting damaged medical gas pipes or outlets.
15 6

Use the National Early Warning Scoring system in relation to critical care.

  • Role of National Early Warning Score (NEWS) to promptly identify and manage clinically deteriorating patients.
16 7

Critically evaluate a range of critical care monitoring, therapeutic and diagnostic services and treatment pathways for critically ill patients.

  • Requirements for patient-centred diagnostic services.
  • Treatment pathways for patients with critical illness.
  • The evidence base underpinning diagnostic, monitoring and therapeutic services and treatment pathways in critical care.

Work-based assessment


Complete 1 Case-Based Discussion(s)
Complete 1 of the following DOPS and/or OCEs
Type Title
DOPS Set up equipment and consumables to measure NIBP on patient
DOPS Perform IQC on Blood Gas Analyser discuss clinical relevance
DOPS Set up and connect CPAP circuit to patient
DOPS Set up and perform pre use checks on Mechanical Ventilator
DOPS Perform a blood gas measurement and discuss the results
DOPS Prepare and connect consumables to facilitate ETCO2 monitoring on a ventilated patient
OCE Attend an equipment repair or calibration and introduce yourself to the relatives explaining the reason for the event
OCE Introduce yourself to a patient during the set up of a piece of equipment at the bedside