Control infection risks in accordance with departmental protocols.

• Protocols and requirements for hygiene and infection control related to the relevant range of investigations, including preparation, conduct and completion of investigation.
• Protocol for hand washing and how effective hand washing contributes to control of infection.

Minimise risks and hazards in compliance with health and safety policies.

• The relevant health and safety regulations specific to cardiac science investigations, the potential hazards and risks, and the actions to be taken to minimise these.

Obtain a suitably completed request form, greet the patient, check patient identity and take a recent clinical history.

• Referral routes for cardiac diagnostic investigations.
• Requirements for correct completion of request forms and how to validate.
• The importance of checking and confirming the patient identity and the implications of not doing so.
• Structure of a patient history and key information required.

Prepare the environment and set up equipment ready for use for each type of investigation, including resuscitation equipment.

• 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.

Explain the procedure for each type of investigation to the patient, address any procedure-related questions they may have and provide information on how the patient will be informed of the results.

• The importance of explaining the procedure to the patient.
• The pathophysiology of the cardiovascular system and the appropriate choice of investigation, considering the findings from the history and clinical examination.
• The use of diagnostic investigations, relevant to competency, in the management of a patient presenting with myocardial infarction, angina or an arrhythmia requiring pacemaker insertion.
• Common questions and concerns of patients about procedures.
• Risks and benefits of undertaking the investigation.
• The information needs of patients following investigation.
• The authority level for provision of information to patients.
• The process of notifying patients of the results.
• The range of treatment pathways and their relevance/applicability to cardiac disease.
• The options available to patients with cardiac disease and the implications and benefits of each.
• Factors affecting selection of treatment option.

Treat patients in a way that respects their dignity, rights, privacy and confidentiality.

• The rights of the patient with regard to consent for treatment and confidentiality of consultation and medical records.
• Key factors influencing dignity, rights, privacy and confidentiality, including age, gender, culture and beliefs.
• Correct positioning of the patient to ensure comfort, co-operation and optimal investigation results.
• The impact of incorrect positioning or non-co-operation on investigation results.

Take appropriate action to respond to the specific needs of the patient, as defined by department protocol.

• Recognition of the contraindications to testing prior to the test, as defined by department protocol.
• The range of needs of people with disabilities within a typical care pathway for patients with diseases affecting the lower cardiovascular system.

Gain informed consent for each investigation.

• The importance of explaining the procedure for each investigation to the patient and gaining informed 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.

Perform a resting ECG on an adult patient to meet the needs of the referral request.

• How to identify electrode sites in line with current Society for Cardiological Science and Technology /American Heart Association guidelines to achieve optimum ECG waveform.
• How to prepare the patient’s skin for electrode placement.
• Correct placement and positioning of electrodes to minimise artefact.
• Selection of machine settings to meet the needs of the referral/request.
• Correct operation of ECG equipment.
• How to monitor the recording and make adjustments to maximise results.
• Routine maintenance and calibration procedures.

Measure all amplitudes and intervals from the ECG.

• The derivation of the ECG.
• The relationship between the ECG and the cardiac cycle.
• Identification of amplitudes and intervals in ECG and normal ranges.
• Effect of exercise on the normal ECG.

Check and annotate ECG recording and identify both normal and variations from normal, including:

• life-threatening arrhythmias
• myocardial ischaemia and infarction.

• How to check and annotate recordings to ensure accuracy, completeness, legibility and suitability for analysis and reporting.
• Normal variations related to age, gender, activity and ethnic origin.
• When to refer results to a senior colleague for further action.
• ECG changes associated with myocardial infarction and myocardial ischaemia.
• ECG changes of life-threatening arrhythmias.
• Diagnosis and pharmacological treatment of myocardial infarction and myocardial ischaemia.
• Non-pharmacological treatment of cardiac disease.
• Invasive treatment of myocardial infarction and myocardial ischaemia.
• Treatment of life-threatening arrhythmias.

Set up a cardiac monitor on a range of adult patients.

• Standard Operating Procedure for setting up a cardiac monitor.
• Electrode sites for cardiac monitoring to achieve optimum ECG waveform.
• Choice of monitor and monitor settings and rate alarm.
• Routine maintenance and cleaning of cardiac monitors.

Measure blood pressure in a range of adult patients, using both an:

• manual method
• automated method.

• British Hypertension Society Guidelines for Blood Pressure Measurement.
• Importance of cuff size.
• Location of pulse in the cubital fossa.
• The correct use of palpation to estimate systolic BP.
• Correct inflation of the cuff to at least 30 mmHg above the estimated BP.
• Correct rate of pressure reduction to maximise results.
• Difficulties that may be encountered in obtaining an accurate BP measurement and relevant remedial actions.
• How to check and confirm results.
• Normal range for systolic and diastolic blood pressure.
• White coat hypertension.
• When to refer results to a senior colleague for further action.
• Routine maintenance and calibration procedures.

Fit ambulatory ECG monitoring equipment in a range of adult patients, explaining the procedure to the patient and checking the patient’s understanding.

• Standard Operating Procedure for ambulatory ECG monitoring.
• Factors influencing selection of correct ambulatory monitoring devices.
• Correct preparation of ambulatory ECG recording equipment, including recorder and choice of the most appropriate electrodes for the ambulatory ECG monitoring.
• Requirements for preparation of the patient’s skin for electrode placement and how to instruct a patient for self-positioning.
• Correct positioning of electrodes on the patient’s skin.
• The importance and use of the patient diary.
• How to activate ambulatory devices.
• Information needs of patients fitted with ambulatory devices, including pre-test, fitting, use, activation, deactivation, diary, cleaning and removal.
• Factors influencing the quality of results from ambulatory recordings, including minimisation of artefacts.
• Routine maintenance and calibration procedures.

Fit ambulatory BP monitoring equipment in a range of adult patients.

• SOP for ambulatory BP monitoring.
• Pharmacological treatment of hypertension.
• Non-pharmacological treatment of hypertension.
• Choice of programmes/settings for ambulatory blood pressure recording.
• Normal ranges for ambulatory BP and home BP.
• Identification of white coat hypertension.
• The information needs of patients following ambulatory BP monitoring.
• Routine maintenance and calibration procedures.

Remove ambulatory monitoring equipment.

• Correct removal of ambulatory devices.
• Requirements for cleaning devices in compliance with infection control.
• The information needs of patients following ambulatory monitoring.

Prepare the results for analysis and review the report with senior staff, where appropriate.

• How to check accuracy of recording, identify artefacts and determine suitability for analysis.
• How to download data and produce results in an appropriate format for next stage of processing.
• The possible clinical outcomes for the patients.

Critically evaluate a range of cardiac diagnostic services and treatment pathways for patients with common cardiac diseases.

• Requirements for patient-centred diagnostic services.
• Treatment pathways for patients with common cardiac diseases.
• The evidence base underpinning diagnostic services and treatment pathways.