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.
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.
|Number||Work-based learning outcome||Title||Knowledge|
Control infection risks in accordance with departmental protocols.
Minimise risks and hazards in compliance with health and safety policies.
Select suitable technology for each type of investigation, choosing and adapting the appropriate diagnostic technique, patient position, machine settings and transducer for each patient.
Set up equipment ready for use for each type of investigation.
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.
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.
Gain informed consent for each investigation/consultation.
Initiate a consultation, elicit information, clarify as necessary, summarise, and empathise and use active listening techniques while taking a patient history.
Treat patients in a way that respects their dignity, rights, privacy and confidentiality.
Take appropriate action to respond to the specific needs of the patient, as defined by department protocol.
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.
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.
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.
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.
Assess the patient and undertake cardiopulmonary exercise testing using an appropriate protocol in patients with respiratory, vascular and cardiac disease.
Record results of cardiopulmonary exercise testing accurately in an appropriate format and analyse and technically interpret full cardiopulmonary exercise tests.
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.
Undertake consultations with patients to explain and agree therapeutic strategies for the management of their sleep conditions.
Perform polysomnographic procedures in patients with various sleep disorders, in accordance with recognised protocol, scoring and technically interpreting each procedure.
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.
Decontaminate equipment and leave in a suitable condition for reuse.
|You must complete|
|5 Case-based discussion(s)|
|5 of the following DOPS / OCEs|
|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||DOPS|
|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||OCE|
The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.
1. Describe the structure, function, mechanics and control of the cardiorespiratory system and discuss the pathophysiology of common causes of respiratory failure.
2. Describe and critically evaluate the role of field exercise testing in the assessment for ambulatory oxygen and the role of short- and long-term oxygen therapy in the treatment of disease.
3. Describe the role of non-invasive ventilation in the treatment of acute and chronic respiratory failure in a range of disorders.
4. Discuss the range of ventilators available for non-invasive ventilation and compare and contrast their modes of action and functions.
5. Discuss the principles underpinning the assessment and monitoring of patients receiving non-invasive ventilation in the acute and chronic setting.
6. Explain the methods of measuring physiological changes during exercise and the physiological adaptations that occur with exercise training.
7. Compare and contrast the range of exercise tests available and their clinical application, including the application of cardiopulmonary exercise testing in the assessment of limitations to exercise.
8. Discuss the application of interpretation strategies to respiratory investigations.
9. Discuss the physiology and structure of sleep throughout life and the pathophysiology of non-respiratory sleep disorders, relating changes in physiology due to neurodegenerative sleep disorders
10. Discuss the use and principles of sleep polysomnography in the assessment of sleep and disorders of sleep and the role of video-polysomnographic recording in differential diagnosis.
11. Discuss the use and principles of neurophysiological recording equipment and identification of the characteristics of the normal waveforms/variation, in the awake and sleep EEG.
12. Describe the normal structure and function and chemistry of the neural pathways relating to sleep and wakefulness, circadian rhythm generation and its interaction with body function.
13. Discuss the use of psychological tools to treat hyper and hypo-somnolence.
14. Define the uses and limitations of tests of vigilance and sleep maintenance.