Module - Monitoring and Supporting Critically Ill Patients (SPS124)

STP

Aim of this module

This module provides trainees with the knowledge and understanding that underpins the specialist module in Critical Care Science and provides the trainees with the specialist underpinning knowledge and understanding to undertake learning in the workplace. This module will enable critical care trainees to monitor critically ill patients according to the indications for and the selection of suitable methods of monitoring. They will be able to recognise and respond to trends in physiological variables. Additionally, they will be expected to use their knowledge to write a technical specification and a standard operating procedure and undertake a risk analysis. Trainees will be expected to build and extend their professional practice.

Work-based learning outcomes


1. Check and prepare equipment used in high-level transfer of patients.
2. Perform non-invasive ventilation.
3. Perform ECG monitoring, recognising and responding to trends in physiological variables.
4. Perform non-invasive BP monitoring, recognising and responding to trends in physiological variables.
5. Perform oxygen saturation monitoring, recognising and responding to trends in physiological variables.
6. Perform Capnography (CO2) monitoring recognising and responding to trends in physiological variables.
7. Perform invasive pressure monitoring, recognising and responding to trends in physiological variables.
8. Obtains and interprets the results from blood gas samples.
9. Perform a range of near patient tests at the point of care specific to critical care patient requirements, quality assuring the results.
10. Write a technical specification for a specialist critical care item of equipment and evaluate (both clinical and financial), procure and set up maintenance contract arrangements.
11. Write a standard operating procedure and undertake a risk analysis ensuring all relevant patient safety aspects are included.

Work-based Competencies


Learning outcome Title Knowledge
1 1, 2, 3, 4, 5, 6, 7, 9

Perform all tasks in accordance with relevant procedures/protocols/legislation including infection control, health and safety, 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 critical care procedure.
  • The potential hazards and risks and the actions to be taken to minimise these.
  • Relevant guidelines.
  • The importance of checking and confirming the patient identity and the implications of not doing so.
  • Critical incident notification and when to judge when it is necessary to document in incident reporting.
  • Role of senior staff and procedures involved.
2 1, 2, 3, 4, 5, 6, 7, 9

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

  • 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.
  • Recognition of the contraindications to testing prior to the test, as defined by department protocol/national guidelines.
  • 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 1, 2, 3, 4, 5, 6, 7, 9

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.

  • Pathophysiology and the appropriate choice of procedures, considering the findings from the history and clinical examination.
  • The importance of introducing yourself and your role as a clinical scientist trainee as part of the process of introduction and consent.
  • Common questions and concerns of patients and carers about procedures.
  • Risks and benefits of undertaking the procedure.
  • The information needs of patients following the procedure.
  • The authority level for provision of information to patients.
  • The process of notifying patients of the results.
  • The importance of explaining the procedure for each procedure to the patient and gaining informed consent, including the unconscious patient.
  • The relevant procedures and requirements for patient conformance.
  • Clinical indications for and contraindications to challenge testing.
  • Principles, guidance and law with respect to informed consent.
4 1, 2, 3, 4, 5, 6, 7, 9

Use a range of data management systems and methods to support and improve safe and effective patient care in the critical care environment.

Critical Care informatics

  • Patient/Unit management
  • Monitoring systems, networks and interfaces
  • CIS data acquisition, data logging and reports
  • Care bundles
  • Audit
  • ICNARC and CCMDS
5 1

Prepare the equipment in readiness for a patient transfer, communicating with the team, patient/relatives to maximise the safety and comfort of the patient during the transfer.

  • Current legislation that governs the transfer of patients to intensive care units, including NICE guidelines.
  • Planning and communication.
  • Modes of transport, advantages and disadvantages.
  • Principles of safe patient transfer.
  • Monitoring and supporting the critically ill patient during transport safely and effectively, including:
  • ventilation
  • Current legislation that governs the transfer of patients to intensive care monitoring
  • resuscitation
  • infusion pumps
  • suction.
  • Strategies to manage space limitations and personnel.
  • Ethical and governance issues surrounding transfer.
  • The effect of patient transfer on wellbeing of the patient and their relatives.
6 2

Prepare the equipment required to perform non-invasive ventilation (NIV) and perform pre-use checks.

  • Standard operating procedure (SOP) for NIV.
  • Modes/settings available and appropriate selection for specific patient needs.
  • Range of equipment used, relative merits and principles of measurement, including:
  • recognition of the errors or potential risks of using defective equipment in clinical practice and the implications of use
  • the application of relevant troubleshooting skills
  • identification of common faults and remedial action
  • current safety standards, including safety testing and routine maintenance
  • requirements for set-up and calibration specific to that procedure.
  • Preparation of life support equipment, where appropriate.
7 2

Discuss the options available for the patient–ventilator interface when using NIV.

  • Apply patient specific requirements when deciding which interface is appropriate.
8 3

Set up a cardiac monitor and monitor heart function in a range of critically ill patients, interpreting and responding to trends in physiological variables and calibrating as necessary.

  • Standard operating procedure.
  • Range of equipment used, relative merits and principles of measurement, including:
    • recognition of the errors or potential risks of using defective equipment in clinical practice and the implications of use
    • the application of relevant troubleshooting skills
    • identification of common faults and remedial action
    • current safety standards, including safety testing and routine maintenance
    • requirements for set-up and calibration specific to that procedure.
  • Preparation of life support equipment, where appropriate.
  • Electrode sites for cardiac monitoring to achieve optimum ECG waveform.
  • Choice of monitor and monitor settings and rate alarm.
  • How to recognise technical artefacts.
  • Principles of acquiring appropriate data and converting it into information to support the diagnosis and treatment of critically ill patients.
  • How to minimise patient discomfort in relation to monitoring devices.
  • Normal ranges and interpretation in the context of the clinical circumstances.
  • Identification of abnormalities requiring urgent intervention.
  • How to differentiate real change from artefact and respond appropriately.
  • Cleaning and disinfection post monitoring.
  • Routine maintenance.
9 4

Set up non-invasive BP monitoring equipment in a range of patients, interpreting and responding to trends in physiological variables and calibrating as necessary.

  • Range of equipment used, relative merits and principles of measurement, including:
    • recognition of the errors or potential risks of using defective equipment in clinical practice and the implications of use
    • the application of relevant troubleshooting skills
    • identification of common faults and remedial action
    • current safety standards, including safety testing and routine maintenance
    • requirements for set-up and calibration specific to that procedure.
  • Preparation of life support equipment, where appropriate.
  • SOP for non-invasive BP monitoring.
  • 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 blood pressure monitoring.
  • Normal BP ranges.
  • Routine maintenance, calibration.
  • Cleaning and disinfection post monitoring.
10 5

Set up oxygen saturation monitoring equipment on a range of patients, interpreting and responding to trends in physiological variables and calibrating as necessary.

  • Range of equipment used, relative merits and principles of measurement, including:
    • recognition of the errors or potential risks of using defective equipment in clinical practice and the implications of use
    • the application of relevant troubleshooting skills
    • identification of common faults and remedial action
    • current safety standards, including safety testing and routine maintenance
    • requirements for set-up and calibration specific to that procedure.
  • Standard operating procedure.
  • 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.
  • Normal ranges and interpretation in the context of the clinical circumstances.
  • Identification of abnormalities requiring urgent intervention.
  • How to differentiate real change from artefact and respond appropriately.
  • Choice of monitor and monitor settings and rate alarm.
  • How to recognise technical artefacts.
  • Routine maintenance and calibration.
  • Cleaning and disinfection post monitoring.
11 6

Set up capnography (CO2) monitoring equipment on a range of patients, interpreting and responding to trends in physiological variables and calibrating as necessary.

  • Range of equipment used, relative merits and principles of measurement, including:
    • recognition of the errors or potential risks of using defective equipment in clinical practice and the implications of use
    • the application of relevant troubleshooting skills
    • identification of common faults and remedial action
    • current safety standards, including safety testing and routine maintenance
    • requirements for set-up and calibration specific to that procedure.
  • Preparation of life support equipment, where appropriate.
  • SOP for capnography.
  • How to minimise patient discomfort in relation to monitoring devices.
  • Normal ranges and interpretation in the context of the clinical circumstances.
  • How to differentiate real change from artefact and respond appropriately.
  • Routine maintenance and calibration.
  • Cleaning and disinfection post monitoring.
12 7

Set up for invasive blood pressure monitoring for a range of patients interpreting and responding to trends in physiological variables and calibrating as necessary.

  • Range of equipment used, relative merits and principles of measurement, including:
    • recognition of the errors or potential risks of using defective equipment in clinical practice and the implications of use
    • the application of relevant troubleshooting skills
    • identification of common faults and remedial action
    • current safety standards, including safety testing and routine maintenance
    • requirements for set-up and calibration specific to that procedure.
  • Preparation of life support equipment, where appropriate.
  • SOP for invasive blood pressure monitoring.
  • Indications for invasive blood pressure monitoring.
  • Advantages and disadvantages.
  • Principles of invasive pressure monitoring devices and optimisation to maximise accuracy:
    • catheter
    • tubing
    • transducer
    • amplifier and display unit
    • zero and calibration techniques
    • system dynamics, including damping, natural frequency, effect of air bubbles.
  • How to avoid extensive invasive procedures or monitoring.
  • How to minimise patient discomfort in relation to monitoring devices circumstances.
  • Identification of abnormalities requiring urgent intervention.
  • How to differentiate real change from artefact and respond appropriately.
13 7

Assist in monitoring intracranial pressure/electroencephalogram (EEG) monitoring, interpreting and responding to trends in physiological variables and calibrating as necessary.

  • Range of equipment used, relative merits and principles of measurement, including:
    • recognition of the errors or potential risks of using defective equipment in clinical practice and the implications of use
    • the application of relevant troubleshooting skills
    • identification of common faults and remedial action
    • current safety standards, including safety testing and routine maintenance
    • requirements for set-up and calibration specific to that procedure.
  • Preparation of life support equipment, where appropriate.
  • SOP for intracranial pressure and EEG monitoring.
  • Indications for intracranial/EEG monitoring.
  • Advantages and disadvantages.
  • Risk of infection.
  • Types of intracranial/EEG monitors.
  • Site of placement of the monitoring device.
  • How to minimise patient discomfort in relation to monitoring devices.
  • Normal ranges and interpretation in the context of the clinical circumstances.
  • Identification of abnormalities requiring urgent intervention.
14 8

Obtain a blood gas sample from an invasive arterial/venous pressure line in a critically ill patient and interpret the results.

  • Normal ranges and interpretation in the context of the clinical circumstances.
  • Identification of abnormalities requiring urgent intervention.
  • How to differentiate real change from artefact and respond appropriately.
15 9

Use the following point-of-care testing (POCT) methods/device to specified quality standards to generate accurate, valid results and document the results:

  • blood gas
  • oximetry
  • electrolyte/metabolyte analyser.
  • The current legislation governing Good Laboratory Practice relevant to near patient testing.
  • Clinical governance.
  • Relevant clinical pathology accreditation (CPA) standards.
  • Standard operating procedures.
  • User training.
  • The biological and statistical basis of biological variation, reference values and action limits.
  • Use of calibration and control materials.
  • The quality management process that ensures the correct location and storage of documentation and specimens at each stage of the process.
  • Principles and practice of internal quality control and external quality assessment.
  • Common analytical interferences caused by contamination, interferences, age of sample, etc.
  • Performance of analyses in accordance with appropriate standard operating procedure.
  • Routine maintenance and recording.
16 9

Interpret the results from near patient testing for a range of critically ill patients.

  • The information to be included in an interpretative report.
  • How to construct an interpretative report and the format required for presentation.
  • Limits of responsibility in the authorisation and issue of interpretative reports.
  • Clinical conditions that may require urgent action and how to instigate such action.
  • Normal and abnormal results and their significance to the clinical question or condition.
17 10

Write a technical specification for the purchase of a mechanical ventilator.

  • The complete procurement process and all available options with regard to the equipment/service specification.
18 10

Write a clinical/business case for the introduction of a POCT device into a new clinical area.

The needs analysis process, including both a clinical and financial appraisal.

19 11

Write an SOP for the set-up of equipment for a technical procedure.

The components required to develop a comprehensive SOP on a technical procedure.

20 11

Write an SOP for performing a procedure on a POCT device.

The components required to develop a comprehensive SOP on a POCT analytical procedure.

Work-based assessment


Complete 4 Case-Based Discussion(s)
Complete 4 of the following DOPS and/or OCEs
Type Title
DOPS Prepare the equipment required for a level 3 patient transfer including pre use checks.
DOPS Prepare equipment ready for ETCO2 monitoring. Connect to circuit on a ventilated patient. Obtain.
DOPS Accurately obtain a blood gas measurement ensuring sample quality, measurement accuracy and quality assurance results.
DOPS Set up the equipment required to obtain an accurate invasive arterial CVP measurement
DOPS Using local POCT operating procedures, perform a near patient test on for example a Glucose, INR, Hb.
OCE Participate in multidisciplinary transfer of ICU patient.
OCE Demonstrate to HCP the procedure of non invasive measurement of blood pressure on a HDU patient, giving explanation to HCP of safety aspects.
OCE Explain procedure and connect NIV ventilation to patient.