Module - Respiratory and Sleep Science 2 (SPS127)

STP

Aim of this module

This module provides trainees with the knowledge that underpins the third year specialist module in Respiratory and Sleep Science and gives trainees the tools to undertake learning in the workplace. This rotation will enable trainees to perform a range of clinical diagnostic investigations undertaken to investigate disorders of or affecting the respiratory system, interact with patients and demonstrate safe, patient-centred practice. Trainees will be expected to build on the competence gained in the earlier module, explaining procedures to patients and gaining informed consent, enhancing and extending practical skills in undertaking diagnostic investigations, setting up and maintaining the equipment used, producing and interpreting results, and building their professional practice.

Work-based learning outcomes


1. Perform and interpret assessments of blood gas status and identify the requirements for supplemental oxygen therapy.
2. Perform full cardiopulmonary exercise testing in the investigation of respiratory, vascular and cardiac disease.
3. Identify the requirement for and initiate non-invasive ventilation (NIV) in patients with both acute and chronic respiratory failure.
4. Discuss and agree management strategies for disorders of respiratory or sleep and demonstrate the communication skills required to discuss subjects that may be difficult and work with patients.
5. Perform, analyse and technically report polysomnographic sleep investigations in patients referred to a sleep service.

Work-based Competencies


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

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.
2 1,2,3,5

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

  • The relevant health and safety regulations specific to respiratory and sleep science investigations, the potential hazards and risks, and the actions to be taken to minimise these.
3 1,2,3,5

Select suitable technology for each type of investigation, choosing and adapting the appropriate diagnostic technique, patient position, machine settings and transducer for each patient.

  • Factors influencing the choice of technology for investigating respiratory and sleep symptoms.
  • Clinical indications, contraindications and patient benefit for respiratory and sleep investigations.
  • Medication used to treat respiratory symptoms and conditions.
4 1,2,3,5

Set up equipment ready for use for each type of investigation.

  • 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
    • identification of common faults and remedial action
    • current safety standards, including safety testing and routine maintenance.
5 1,2,3,5

Obtain a suitably completed request form, greet the patient, check patient ID and ensure that the patient’s identity is confirmed as correct and fully identified on each type of recording system.

  • The requirements for correct completion of request forms and how to validate the request.
  • The importance of checking and confirming the patient identity and the implications of not doing so.
6 1,2,3,5

Explain the procedure for each type of investigation to the patient and address any questions they may have relating to the procedure, including the process after the procedure and how the patient will be informed of the results.

  • The pathophysiology of the respiratory and sleep system and the appropriate choice of investigation, considering the findings from the history and clinical examination.
  • 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.
7 1,2,3,5

Gain informed consent for each investigation/consultation.

  • 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 and contraindications for challenge testing.
  • Principles, guidance and law with respect to informed consent.
8 1,2,3,4,5

Initiate a consultation, elicit information, clarify as necessary, summarise, and empathise and use active listening techniques while taking a patient history.

  • The features that should be present in an effective patient consultation.
  • Structure of a consultation model, e.g. the Calgary-Cambridge model, using a logical sequence that includes:
    • brief biographical
    • history of presenting complaint
    • past history
    • smoking/alcohol
    • medication (prescribed and other)
    • allergies
    • family/social
    • concerns and expectations
    • summary
    • commonly used questioning techniques used during history taking and know when to use them.
  • Difference between a health professional-centred and patient- centred consultation.
  • How to modify techniques for patients with special needs, relevant to the circumstances of the patient.
  • The importance of checking for patient allergies in case they are not already documented.
  • Key symptoms relating to respiratory and sleep disorders.
  • Changes in the normal anatomy and physiology result in abnormalities of respiratory and sleep systems.
9 1,2,3,5

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.
  • Requirements of patients with disabilities and special needs.
  • Key factors influencing dignity, rights, privacy and confidentiality, including age, gender, culture and beliefs.
10 1,2,3,4,5

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 a patient with diseases affecting the lower gastrointestinal tract.
11 1,2,3,5

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.

  • Common presenting conditions and pathological processes underlying the presentation of patients referred for these investigations.
  • SOPs for each investigation.
  • Procedure and protocols for performing either arterial blood gases or an ear lobe capillary sample.
  • Advantages and disadvantages of each technique.
12 1

Analyse and interpret a range of blood gas results and take appropriate action with the required degree of urgency in a range of conditions, including normal, Type 1 and Type 2 respiratory failure.

  • Common presenting conditions and pathological processes underlying the presentation of patients referred for this investigation.
  • Normal blood gas values.
  • Abnormal blood gas values, including Type 1 and Type 2 respiratory failure.
  • Routine maintenance, calibration and quality assurance.
13 1

Identify requirements for long-term oxygen therapy, including ambulatory, and undertake assessments in accordance with national guidelines, titrating oxygen according to patient requirements and clinical indications.

  • Common presenting conditions and pathological processes underlying the presentation of patients referred for this investigation.
  • Requirements for ambulatory oxygen therapy.
  • Indications for and contraindications to oxygen therapy.
  • Health and safety regulations for oxygen therapy.
  • Mechanism of action of a range of respiratory drugs delivered to patients.
14 1

Complete appropriate documentation based on the results of the assessment undertaken and the patient’s clinical needs, and identify further investigations and/or future management plans.

  • SOPs for the investigation.
  • Requirements for further investigations and/or future management.
  • Procurement arrangements for the provision of long-term oxygen therapy.
15 2

Assess the patient and undertake cardiopulmonary exercise testing using an appropriate protocol in patients with respiratory, vascular and cardiac disease.

  • SOPs for the investigation.
  • Common presenting conditions and pathological processes underlying the presentation of patients referred for these investigations.
  • Indications for and contraindications to exercise testing.
  • Suitability of the patient for the proposed investigation.
  • Range and use of exercise protocol.
  • Baseline measurements appropriate to the clinical question.
  • How to choose and adapt diagnostic technique, patient position, machine settings and transducer for each patient.
  • Routine maintenance, calibration and quality assurance.
16 2

Record results of cardiopulmonary exercise testing accurately in an appropriate format and analyse and technically interpret full cardiopulmonary exercise tests.

  • Technical comments that may influence the test outcome.
  • Appropriate lifestyle change techniques for supporting the patient in their treatment and management plan.
  • Requirements for further investigations and/or future management.
  • Normal/abnormal ranges.
17 3

Assess the patient, determine the appropriate settings and obtain accurate baseline measurements of NIV therapy where appropriate.

Initiate appropriate NIV therapy and monitor clinical status.

  • SOPs for the investigation.
  • Common presenting conditions and pathological processes underlying the presentation of patients referred for these investigations.
  • Suitability of the patient for the proposed investigation.
  • Appropriate interface and equipment settings to optimise NIV therapy.
  • Potential impact of NIV therapy on the patient’s symptoms, using objective and subjective assessment.
18 4

Undertake consultations with patients to explain and agree therapeutic strategies for the management of their sleep conditions.

  • Relationships that exist between body weight and dysfunctions of the cardiac, respiratory and endocrine systems which result in sleep disorders.
  • Psychological tools available to encourage improved sleep, including cognitive behavioural therapy (CBT), sleep hygiene, sleep restriction and sleep scheduling.
  • Surgical tools available to correct sleep disorders.
  • Use of actigraphy and sleep diaries in the modification of sleep scheduling.
  • Patient-centred consultations.
  • Effective listening and speaking.
19 5

Perform polysomnographic procedures in patients with various sleep disorders, in accordance with recognised protocol, scoring and technically interpreting each procedure.

  • SOPs for the investigation.
  • Effects of changing filter settings, gain and collection frequency on calibration signals on a polysomnography recorder.
  • Choice and adaptation of electrode montage, recorder settings and transducers for each patient.
  • Position electrodes in accordance with the recommended placement system and securely attach the electrodes.
  • Routine maintenance, calibration and quality assurance.
  • Impedances and biological calibration signals.
  • Disorders of sleep, including, but not limited to, obstructive sleep apnoea, central sleep apnoea, narcolepsy, movement disorders, parasomnias and dyssomnias.
  • Requirements for further investigations and/or future management.
20 5

Apply the polysomnography practice to Multiple Sleep Latency Test (MSLT) or Maintenance of Wakefulness Test (MWT) testing in accordance with established American Academy Sleep Medicine (AASM) guidelines.

  • MSLT and MWT testing.
  • AASM guidelines.
21 1,2,3,5

Decontaminate equipment and leave in a suitable condition for reuse.

Methods of equipment decontamination.

Work-based assessment


Complete 5 Case-Based Discussion(s)
Complete 5 of the following DOPS and/or OCEs
Type Title
DOPS Perform a blood gas assessment using either arterial blood gas analysis or ear lobe capillary sampling
DOPS Perform a long term oxygen therapy assessment on a patient in Type 2 respiratory failure
DOPS Perform a long term oxygen therapy assessment on a patient in Type 1 respiratory failure
DOPS Perform an ambulatory oxygen assessment in a patient who significantly desaturates on air
DOPS Perform a full cardiopulmonary exercise test on a patient under investigation for respiratory symptoms
DOPS Perform a full cardiopulmonary exercise test on a patient being assessed for fitness for surgical intervention
DOPS Technically interpret results of a full cardiopulmonary exercise test
DOPS Initiate non invasive ventilation NIV on a patient admitted to hospital with acute Type 2 respiratory failure
DOPS Initiate NIV, in the outpatient setting, on a patient with chronic Type 2 respiratory failure
DOPS Perform a full polysomnography on a patient with a respiratory sleep disorder
DOPS Perform a full polysomnography on a patient with a nonrespiratory sleep disorder
DOPS Provide a technical report on a full polysomnography study in a patient with a respiratory sleep disorder
DOPS Provide a technical report on a full polysomnography study in a patient with a non respiratory sleep disorder
OCE Complete a home oxygen order form HOOF for a patient requiring long term oxygen therapy LTOT
OCE Discuss the results of investigations with a patient requiring non invasive ventilation NIV. Describe the role of NIV and its implications to the patient and family.
OCE Obtain consent from a patient requiring supplemental oxygen therapy
OCE Obtain a history from a patient attending for initiation of NIV for chronic Type 2 respiratory failure
OCE Prepare a patient for undertaking a full cardiopulmonary exercise test
OCE Undertake a check of a resuscitation trolley ensuring effectiveness and appropriate stock levels