Sleep Study in Children - bcpft.nhs.uk

Sleep Study of 28 Version 1.0 October 2017

Standard Operating Procedure 21 (SOP 21)

Sleep Study in Children

Why we have a procedure?

A sleep study is an overnight assessment of a child’s heart rate, oxygen saturation levels and perfusion index (adequacy of blood flow under the probe) during sleep. The study provides information regarding the adequacy of oxygenation. For paediatrics a Consultant-led sleep study service is coordinated with Community Children’s Nurses. A sleep study is arranged for one night, for parents to carry out at home. They are also performed at a consultants request on an individual basis - condition dependant. Sleep studies are performed in BCPFT using the Masimo Radical 97 machine, hereafter referred to as the sleep study monitor. For the purpose of this document, babies and children will be referred to as children throughout this document. The aim of this SOP is to provide guidance for the process of performing Paediatric sleep studies at home.

What overarching policy the procedure links to?

Children’s Community Nursing Team Operational Policy Also read in conjunction with:

Oxygen Therapy for Children in the Black Country Partnership Foundation Trust

Medical Device Policy

Infection Prevention and Control Policy

CCN Operational Policy

Which services of the trust does this apply to? Where is it in operation?

Division Inpatients Community Locations

Mental Health Services x x

Learning Disabilities Services x x

Children and Young People Services x All

Who does the procedure apply to?

For all BCPFT staff involved in the paediatric sleep study process for babies/ Children who meet the CCN/Palliative care team referral criteria


When should the procedure be applied?

At initial transfer of care - from the Neonatal Community Nursing Team or the Children’s Ward Outreach Team to the CCN - a date will be identified as to when the next sleep study should be carried out. The CCN will arrange with the parents/carers to carry out the study within the patient’s home. Following review of this study by the Paediatric Consultant with an interest in Sleep Study, a decision will be made as to when a repeat study will be required. This and any subsequent sleep study’s will be carried out by the CCN and will be used to assess the adequacy of oxygenation during sleep. Similar study can also be done in the wakeful state to assess the effect of activities, such as feeding, on the oxygenation.

How to carry out this procedure

Sleep Study Process 1.0 Paediatric Sleep study Referrals If a sleep study is requested as part of a discharge follow up, a date for carrying out the study will be identified by the patients named Paediatric Consultant or the Identified Sleep Study Consultant. The CCN are responsible for ensuring that the study is carried out on the selected date. The distribution of the monitor will be recorded in the equipment folder stored in the CCN office to allow monitoring and compliance. This will be the responsibility of the Trust CCN Team. 1.1 Paediatric Home Sleep Studies Following the receipt of a sleep study request, the CCN will review the availability of the monitor during the weekly patient handover. The option is for the monitor to be delivered/ collected on a Tuesday and be returned Thursday, or, alternatively, delivered/ collected on a Friday and returned Monday. This will enable parents/ carers to repeat the sleep study on a second night if required. Returning the monitor after 24 hours will be optional. 1.2 The following process will then take place:

Discuss with the parents/carers of the child the home sleep study (Appendix 1 and 2)

The CCN key Worker will contact the parents/carers and arrange to deliver the sleep study monitor at a convenient time.

Upon delivery of the sleep study monitor the following must be performed: - Complete BCPFT Medical Devices loan contract form, (Appendix 3). - Distribute Patient Information Leaflet’ to parent/carer (Appendix 5). - Carryout teaching session to parent/carer using the ‘Sleep Study At Home

assessment document’ (Appendix 4) and the checklist in the sleep study assessment document (Appendix 4).

- Remove the sleep study assessment form from the sleep study assessment document and give to the parent/carer (Appendix 4).

The CCN Team must ensure that all equipment is distributed as stated in section 2.1


Out of hours the parents/ carers will be advised to contact the Children’s Ward if they have any concerns during the sleep study. Out of hours is considered 16:00 – 08:00 Monday to Friday, Weekends and Bank holidays.

The CCN will advise parents of the appropriate out of hours contact number. This will be documented on the Patient Information leaflet (Appendix 5).

The CCN will collect the sleep study monitor on the day allocated as above.

The CCN team must download the data as soon as possible to ensure no interruptions, delays or errors in the service. In the event that the named nurse is unable to download the data, another nurse should be identified by the team leader to accommodate time to download the data. Staff to follow download chart for the Radical 97 (Appendix 6).

Once the data has been downloaded the data must be emailed to the Named Sleep Study Consultant and their secretary along with the child’s name, address, date of birth, gestation at birth, any major clinical problems, amount of oxygen study was performed in, and the name of the patients consultant.

2.0 Paediatric Equipment and Equipment Distribution 2.1 The following will be required to perform a sleep study at home

Masimo Radical 97 machine with mains cable and monitoring cable.

Sensor +/- Securing Wrap.

Instructions for use- Patient Information Leaflet (Appendix 5).

Sleep study at home assessment document which includes the pre distribution checklist for the Masimo radical 97 monitor, and the home sleep study assessment form (Appendix 4).

Medical Devices loan contract form (Appendix 3). 2.2 The parent/carer will be given a teaching session from the CCN team on the

use of the machine using tools identified in section 2.1

The CCN nursing team will assess the child’s age and distribute the appropriate sized sensor +/-securing wrap

2.3 Returning of Paediatric Equipment

The CCN Team are responsible for logging the Masimo Radical 97 Monitor back into the service. The Medical Devices Loan contract form return section is to be completed and given back to the parent/carer for receipt of return (Appendix 3).

The CCN team are responsible for decontaminating equipment immediately after use following the BCPFT Disinfection policy

3.0 Paediatric Follow up Upon completion of the sleep study the follow up is decided by the referring consultant dependent on results and the individual needs of the child.

The CCN Staff should follow the download chart for the Radical 97 (Appendix 6).

Once the data is downloaded the following must be completed: - Copy of the report is printed out and put in the child/baby’s notes. - Email the report to the Named Sleep Study Consultant and their Secretary

(using a secure email address) with clinical details that includes: Basic child details (full name, date of birth, address and contact

number) Gestation at birth (if appropriate) Major clinical problems Amount of supplemental oxygen,


CCN to deliver the sleep study machine

to the family

Machine returned by Nurse, Parent or Carer to CCN office. The Masimo Radical 97 Loan

contract form completed to state monitor returned, the Sleep Study Assessment

Document collected and the monitor to be decontaminated on return. Monitor form

(Appendix 8) to be kept with the machine until download complete

CCN Team to contact parents/carers to

arrange delivery and provide information

regarding sleep study

CCN to inform parents/carers of the results of the sleep study, any changes

required and will review the child as per normal

policy

Name of the child’s identified Paediatric Consultant This will insure that the Consultant can review the study in a timely manner, as the medical notes may not be available straight away.

Paediatric Sleep Study Pathway

All consultant referrals Named sleep study via letter/email consultants secretary

Home sleep Review by named sleep study study consultant for home sleep study

Referral letter/email forwarded to CCN Team (secure email) CCN Team to:

Complete Masimo Radical 97 loan contract form within (Appendix 3)

Distribute the patient information leaflet to parent/ carer (Appendix 5)

Carryout out teaching session to parent/carer as per pre distribution Masimo checklist for the Radical 97 Monitor (Appendix 4) Complete and sign checklist – keep filed in child’s notes

Distribute sleep study machine

Distribute the sleep study assessment document within (Appendix 4) to stay with the patient

Sleep study downloaded by the CCN on designated

computer

Named consultant to analyse the CCN to email the named consultant the sleep study download and and secretary the downloaded advise the CCN team of any information (secure email) changes to treatment CCN to print off download and all emails relating to the child and file in child’s notes


5.0 Definitions and Abbreviations

Masimo Radical 97 - The brand and type of monitor used to perform the sleep study.

Neonates- up to 28 days

Children – 28 days to 16 years of age

Perfusion index - The ratio of the pulsatile blood flow to the nonpulsatile static blood flow in a patient's peripheral tissue, such as finger tip, toe, or ear lobe.

6.0 Roles and Responsibilities 6.1 Team Leader The CCN team leader is responsible for ensuring that the guideline is accessible for all members of staff. The CCN team leader is responsible for reviewing the process and service delivery. The team leader is responsible for ensuring all members of BCPFT CCN are kept up to date with this guideline and compliance to its contents.

6.2 Named Sleep Study Consultant The Named Sleep Study Consultant’s responsibility is to children referred to them for assessment of sleep disordered breathing from GP’s, ENT and Paediatric Colleagues. The Named Sleep Study Consultant will advise on sleep study results for all patients that are currently inpatients or under the care of the Paediatric or Neonatal community teams. Following discharge of these children into the care of the CCN, the Named Sleep Study Consultant will provide his knowledge and expertise to the CCN, with regards to sleep studies, and provide a review service for the CCN following completed sleep studies. The Named Sleep Study Consultant will send a report back to the CCN, with recommendations of further care. It is NOT the responsibility of the Named Sleep Study Consultant to book appointments. 6.3 Paediatric Consultants The Paediatric Consultants must receive an update from the CCN that advises them that a sleep study has been carried out and what the recommendations are. The Paediatric Consultants must ensure that any recommendations are discussed with the CCN to ensure compliance. 6.4 Community Children’s Nursing Team (CCN) The CCN team is responsible for coordinating the community sleep study process for children on the team’s caseload and ensuring that all involved parties receive training in order to prepare, carryout and download the sleep studies. The CCN are responsible for keeping a log of all sleep studies requested, booked and completed. The CCN Team are responsible for ensuring that sleep study data is downloaded correctly and that all reports downloaded have been sent to the Sleep Study Named Consultant and their Secretary, with the relevant required data. Following the review of the sleep study the CCN are responsible for informing the patients Named Paediatric Consultant, and informing them of any recommendations. The recommendations must be carried out by the CCN Team. If an appointment is recommended in review of the study, then this must be arranged by the CCN, or the CCN to advise the parent to book, via the appropriate Paediatric Consultant Secretary. They are responsible for ensuring that the sleep study software is updated accordingly and the Team Leader will be the link between The Machine representative and


Community Children’s Nursing team. They will be responsible for arranging training on the sleep study equipment. They are responsible for ensuring the monitor is distributed to the parent/carer, deliver a teaching session on use and collected after use. They are also responsible for ensuring that all tamper settings are disabled to ensure accurate and safe data collection. They are responsible for ensuring that the monitors are within service date as per the BCPFT Medical Device policy and ensuring follow up is in place for all sleep studies performed at home. 6.5 Sleep Study Named Consultants Secretary The Sleep Study Named Consultants Secretary must receive a copy of the sleep study at the same time as the Named Sleep Study Consultant. Where necessary the Secretary will arrange appointments with the relevant Consultant when contacted by the CCN or the child’s parent, following a review of the sleep study 7.0 Training and Support The Community Children’s Nursing Team will be trained by the Sleep Study Equipment Representative. The CCN Team must complete the sleep study competency package (Appendix 7). The CCN Team can request for support from the Trust’s IT department with regards to the sleep study computer software. 8.0 References British Thoracic Society guidelines for home oxygen in children With Complements to Dudley Group of Hospitals for use of their Trust Guidelines:

Discharge of babies from the Neonatal Unit Guideline

Sleep study in neonates, babies and children guideline


Appendix 1

Dear Parent/Carer(s) of ................................, We have received a request for your child to have a sleep study at home. We offer the sleep study at home service on a Tuesday and a Friday. We will contact you to arrange delivery or collection of the machine at a time arranged. You will have the monitor for a maximum of two nights to allow for a repeat study on the second night if the first is unsuccessful. We request the following;

Collection/delivery Tuesdays (time to be arranged as above), and returned Thursday (time to be arranged).

Collection Fridays (time to be arranged as above) and returned Monday (time

to be arranged).

On receiving the monitor you will be asked to sign a Masimo Radical 97 loan contract form, which will be completed on the machines return. You will be given a short teaching session on how to set up the machine and an information leaflet to support you at home. We ask you to kindly inform us of any disturbances or changes in your child overnight, such as your snoring, being unsettled, and bathroom visits etc, on the sleep study assessment form. We ask that you please log the time of these events to enable comparison with the data collected. When your child’s sleep study is completed the data will be analysed by the Named Sleep Study Consultant and the results sent to the CCN. Any recommendations or further appointments that are required will be discussed with you by us. If you have any problems with the sleep study overnight, you are welcome to contact the Community Children’s Nurses on 01384 321 522 for advice. We look forward to hearing from you Regards The Community Children’s Nursing Team


Appendix 2 Date:

Dear You have been provided with a …………………………………………………………………and have been shown how to use the equipment by………………………………………………….. This equipment remains the property of Black Country Partnership NHS Foundation Trust and the Community Children’s nursing Team and has been loaned to you in good condition. It is the responsibility of the parent/carer/professional to keep the equipment in good condition. Failure to do so may render the equipment unsafe for use. Whilst we appreciate that some wear and tear during normal usage may occur, i.e. straps deteriorating, screws missing or parts worn or broken, you must inform ………………… immediately to ensure the safety of …………………. I would therefore be grateful if you could complete the attached slip, accepting full responsibility for the use of the equipment in question, and return to the Community Children’s Nursing Team (full address above) as soon as possible. Thank you for your co-operation in this matter.

Yours sincerely

Community Children’s Nursing Team


Appendix 3

PLEASE COMPLETE THE FORM BELOW AND RETURN TO - Community Children’s Nursing Team.

I confirm that I …………………………………………………………………………………….

Parent/carer/professional of ……………………………………………………………………..

have been shown how to use ………………………………………………………… and I

accept full responsibility for this equipment whilst it is in my possession and I undertake to

maintain the equipment in a good, clean condition and will inform …………………………

immediately should it become faulty in any way.

Signed: ……………………………………………

Date: ………………………………………………..

Agreed return date: ............................................ Returned to: Community Children’s Nursing Team Date received: ...................................... Received by: ............................................................


Appendix 4: Sleep Study at Home Assessment Document

Sleep Study at Home Assessment Document

Name: ...................................... NHS Number: ...................................... DOB: .................................................... Address: .............................................. .............................................................. .............................................................. ..............................................................

ID Sticker::

To be used for all sleep studies performed at home. Please retain this document in Community Children’s Nursing office until the sleep study is downloaded. Please remove the Home Sleep Study Assessment form and give to the parent/carer for assessment at home.


Pre Distribution Masimo Checklist for the Radical 97 Monitor

Section 1: To be carried out by a member of the CCN Team prior to distributing the sleep study machine to the parent/carer

Please initial when completed

Clear previous data

Check correct parameters set

Document contact details

Check within service date as per Trust Medical Devices Policy

Copy of parents information for home sleep study issued with machine

I confirm that the above has been carried out prior to distributing the Sleep study machine to the parents/carers Signature: .......................................Print: .........................................Date: ................ Section 2: Parents/carers teaching session to be carried out by a member of the Community children’s Nursing Team using the Sleep Study at Home Paediatric Parent’s Information Leaflet, ensuring the following items are discussed:

Please initial when completed

Plug into mains during study

Where on/off button is located

Where alarm silence button is located

Where signal indicators are and what they mean

Where to place probe and how to secure

How to manage interruptions to study i.e. going to bathroom

Checking child overnight

Amount of data needed

Establish date/time to return machine and where to take it

Parent/carers declaration I confirm that I have received training and feel competent in carrying out a sleep study at home using the radical 8 sleep study monitor Parent/carer signature:....................................Print:...............................Date:.......... Signature of staff distributing machine:.................................................... Print:....................................................................... Date:............................. Designation:……………………………………………………


Sleep Study Assessment Form

DATE: CONSULTANT:

NAME: UNIT NUMBER: NHS NUMBER:

ADDRESS:

SLEEP STUDY MACHINE USED

SMES NUMBER

Please insert

Comments

ACTION DATE SIGNATURE PRINT

STUDY DOWNLOADED

STUDY EMAILED

MACHINE CLEARED

DOB:


Sleep Study Assessment Form continuation sheet

Please indicate any event during the sleep study that may result in an abnormal reading e.g. nappy change, toilet break, crying, snoring, probe removed etc.

DATE/TIME EVENT


Appendix 5

CCN Team Patient Information Leaflet

Introduction

Your baby/child requires a sleep study at home due to changes to their oxygen therapy. This leaflet gives you more information about this.

What is a sleep study? A sleep study is an overnight assessment of a baby’s heart rate, breathing pattern and oxygen levels during sleep. It provides information to support changes to their oxygen therapy.

Why does my baby/child need a sleep study? There are various reasons for doing a sleep study but the most common in children is sleep apnoea. This condition can cause dips in oxygen levels at times when your child is asleep. A common symptom of this can be snoring or a disturbed sleep pattern but not every child who snores has sleep apnoea. Your baby/child may also need a sleep study to determine how well they cope with having the amount of oxygen they are given reduced or their oxygen therapy discontinued.

How is a sleep study done? We use a monitor to record your baby’s /child’s oxygen levels and pulse for one night using a soft sensor, attached to their finger, hand or foot. The information from the sleep study is downloaded and interpreted by the consultant paediatrician who will then decide on the appropriate treatment for your baby/child.

Who provides the sleep study service? The sleep study service is provided by the CCN Team. A document is completed with parents to ensure that they are confident with the equipment and understand the process required before the study begins. All staff involved in the process have completed a training package supported by the outside agency supplying the equipment.

What happens next? The CCN Team will discuss with you a suitable date for your baby’s sleep study. They will provide the sleep study monitor and explain how to use it. They will also show you how to correctly place the sensor and start the study. You will need to sign a Massimo Radical 97 Loan Contract Form in your baby’s/child’s Sleep Study


Assessment Document. The study will need to be completed between 8pm and 8am.

Information on using the sleep study monitor Figure 1 shows the Massimo Radical 97 sleep study monitor used for the study.

Figure 1 – the Massimo Radical 97 sleep study monitor How to start your sleep study 1. Plug the monitor into a mains socket and switch it on to check it is

working. You can then switch if off again until you are ready to start the study.

2. Place the sensor on your baby’s/child’s foot or hand (see Figure 2

for correct positioning of the sensor on the foot or hand).

Figure 2 – correct positioning of the sensor on the foot or hand

http://www.google.co.uk/imgres?imgurl=http://www.masimo.com/images/sensors/SofTouch/LNOP_YI_Foam_app.jpg&imgrefurl=http://www.masimo.com/sensors/LNOP-Yi-Foam.htm&usg=__DHhDaNp0SUmf-QF9WcevP2HBsN4=&h=159&w=151&sz=5&hl=en&start=82&zoom=1&tbnid=s8dFQ0wnOteBdM:&tbnh=97&tbnw=92&ei=r0wRUvbSJ8WU0AXF3oDIAQ&prev=/search?q=masimo+sensor+on+foot&start=80&um=1&safe=active&sa=N&hl=en&gbv=2&tbm=isch&um=1&itbs=1&sa=X&ved=0CC4QrQMwAThQ


Please note that the sensor has two circular discs. When the monitor is switched on one disc glows red (LED) and the other doesn’t (detector). They should be placed approximately opposite each other. 3. Use the Velcro wrap to hold the sensor in place (see Figure 3) but

do not wrap it tightly as this can cause circulation problems and could give a poor reading.

Figure 3 – the Massimo Radical 97 sleep study sensor and securing wrap 4. Fix the securing wrap around the sensor and Velcro once these

are in place (see Figure 3). The sensor used for the foot has a self-adhesive securing wrap as part of the sensor.

5. Switch on the machine and wait while it runs through self checks. This can take up to two minutes.

The bars either side of the bottom reading both need to be green (please see Figure 1). If they are this shows you have a good signal. If they are red you need to check that the sensor is:

In place correctly

Not fixed too tightly

Your baby’s hand/foot is not cold If your baby/child is moving the signal may be lost but the monitor will find the signal again once the movement stops.

If the alarm sounds and the bell symbol is illuminated, don’t panic:

Check that the sensor is still in place

If the monitor still has a poor/red signal, reposition the sensor General Advice

http://www.google.co.uk/imgres?imgurl=http://www.pacificmedicalsupply.com/v/vspfiles/photos/Masimo 1602-2.jpg&imgrefurl=http://www.pacificmedicalsupply.com/Masimo_1602_Foam_Wraps_for_LNOP_YI_Sensors_p/masimo 1602.htm&usg=__HmGuKNThIF-vJEYpD8HMxH3Ltbg=&h=500&w=500&sz=29&hl=en&start=1&zoom=1&tbnid=cOTReQelqSIOGM:&tbnh=130&tbnw=130&ei=IUwRUpDIJ8ak0QX26IE4&prev=/search?q=masimo+foam+wrap&um=1&safe=active&sa=N&hl=en&gbv=2&tbm=isch&um=1&itbs=1&sa=X&ved=0CCwQrQMwAA

http://www.google.co.uk/imgres?imgurl=http://cdn2.bigcommerce.com/server1900/40748/products/140989/images/182222/Masimo-1544__29359.1339466904.1280.1280.png&imgrefurl=http://www.medequipdepot.com/1544-masimo-lnop-yi-multisite-reusable-sensor-1-box/&usg=__y2rdKkM5SA5hgPxG3fzy-QmPHFA=&h=551&w=600&sz=102&hl=en&start=160&zoom=1&tbnid=sLHItT3cJD9g5M:&tbnh=124&tbnw=135&ei=cEgRUs37C6PA0QWG6IDIBA&prev=/search?q=masimo+rad+8+sensors&start=140&um=1&safe=active&sa=N&hl=en&gbv=2&tbm=isch&um=1&itbs=1&sa=X&ved=0CFIQrQMwEziMAQ


You do not need to watch the monitor overnight but we do advise you to check on your baby/child a few times during the night to make sure that the sensor is in place.

If your baby/child needs to be briefly disconnected from the monitor, unplug the sensor from the cable, and reconnect it when possible. The alarm will sound but it will stop when the sensor is reconnected and a signal has been found.

If your baby/child is awake or unsettled for a long period of time, you can switch off the monitor until they are asleep again, then switch it back on again as before.

What happens when the sleep study is over?

At 8am, switch off the monitor and disconnect the machine.

The CCN will arrange to collect the machine as soon as possible so that the information can be downloaded and sent to your consultant.

Please use this space for any notes you may which to make:

If you have any have any questions or if there is anything you do not understand about this leaflet please contact:

Community Children’s Nurses on 01384 321230(8am to 4pm, Monday to Friday) Out of hours (4pm – 8am weekdays, weekends and bank holidays), please contact the Children’s Ward on 01384 244271


Appendix 6:

Sleep Study Download Chart Radical 97

Downloading Radical 97 oximeter using visi-download 1. Logon to computer 2. Plug Radical 97 machine into mains 3. Connect to computer using cable (tightening screws to give good contact) 4. Switch on Radical 97 and wait for self check to complete 5. Click on VISIDOWNLOAD icon (Looks like a little graph) 6. When programme has loaded (white screen) click on download 7. Select RADICAL 97 from drop down menu 8. When grey screen appears click on download 9. Small box should appear after a short pause evidence of download will be

seen

Moving “pulse”

Number of packets

Percentage bar 10. When next grey screen appears highlight data to go on study

check against paperwork that date/time matches

(the programme automatically highlights the largest chunk of data)

more than one item can be highlighted if needed i.e if data not recorded in one go

11. When download is finished add patient data by clicking “patient details” tab 12. Click download again 13. The background will change to “graphs” and X will appear by the chosen

data(the study is now downloaded) 14. Click EXIT (bottom of grey screen) 15. Click Window at the top of the screen on grey bar ( Check child’s name

selected with tick symbol ) 16. Click Analyse at the top of the screen on grey bar 17. Slide cursor to PDF then across to secondary menu and click fuller report 18. Wait for computer to compile report (about 30secs) 19. Click OK when prompted 20. Exit programme using cross in top right corner of the screen 21. When Save Changes? Box appears select YES 22. Enter into log book 23. Sign home sleep study form 24. File paperwork


Appendix 7 - CCN Sleep Study Clinical Competencies- Registered Nurses

CCN Clinical Competencies – Registered Nurses

(To be used in conjunction with professional and Trust Guidelines)

Name………………………………………

Preceptor……..……………………………………… Designation……………………………… Date of commencement……………………………


Introduction As professionals we all strive to ensure the patients hospital experience is a positive one and for all to be treated as individuals, receive protection and be the recipients of high quality care. This right and expectation of the individuals is achievable but pivots upon, and is strengthened, by the support and development of confident and competent practitioners within the specialities. This being all the more imperative during the transition period from student to Registered Nurse The Black Country Partnership Foundation Trust believes that individualised support and development of its staff is paramount to achieve this goal. The development of knowledge-based practitioners with competency based knowledge and skills are essential to be able to deliver a high quality service. The perceived benefits of this programme are;

Improved quality care delivery

Reduced complaints

Reduced adverse incidents

Reduced length of stay

Reduced numbers of secondary infections or complications within treatment

Improved patients hospital experience to be the hospital of choice

Smooth transition from student to Registered Practitioner

The clinical competencies includes taught, self-directed and work based learning, consolidating individual’s knowledge and skills within the first six months after being appointed to the trust. The Programme is designed to equip nurses with a solid theoretical and practical knowledge. This being the first step towards competent knowledge based practitioners. Competence One of the main difficulties of measuring competence is the fact that the word means so many things to different people. The English National Board (ENB) regulation and guidelines (1990) define competency as the ‘ability to perform a particular actively to a prescribed standard’ and the Oxford Dictionary (1984) see it as ‘having the required ability knowledge or authority, effective, adequate’. These definitions bring together the fact that knowledge and skills are essential if a practitioner is to be competent. For the purpose of this document, competence is defined as the ability to provide the theoretical knowledge to support practice. In addition, the skills, standards and actions taken in practice are consistently at a recognised standard as outlined by professional, organisational and political guidelines, policy and recommendations and are supported by the theoretical knowledge. The clinical competence development pathways have been developed to bring together the taught theoretical knowledge and skills into practice within the clinical areas, aimed at bridging the theory practice gap. The competency based assessment tool has been adapted from the Bondy Framework.


The Universal Competency Framework Guidelines Adapted from K Bondy (1983) by K Castle (2006)

Guidelines

1. The acceptable level of achievement for competence is independent (Level 4). If the individual wishes to develop to Level 5 and/or 6, this will need to be discussed with the assessor as to whether this is appropriate for the activity/task and their role

2. A number of clinical posts will encompass the role of educator to others. This will

require the achievement of level 6 for a number of the competencies. This variance would be identified within the individual competency document.

3. Once the competency has been assessed the appropriate level box (0-6) is to be

signed and dated by the assessor / mentor. 4. If level 4 is not achieved by the target date e.g. from the professional development

plan, the reason is to be recorded in the assessor comments box. The learning outcome is to be discussed and an action plan and further training will be given to enable development within this area.

5. An individual may have three attempts at achieving a learning

outcome/competency. On each attempt the assessor and individual should evaluate the progress, learning and development needs and then devise an action plan to develop areas of weaknesses.

If a problem is identified in the achievement or there is a failure to achieve a Learning outcome, then the relevant line manager should be informed and Appropriate action taken in light of how dependent the activity is to the job role.

6. To achieve learning outcomes/competency a combination of verbal, written and

Observational evidence is to be used between the assessor and the individual. 7. If an error in documentation occurs the assessor should score a line through it,

date and sign. 8. Assessor comments should include verbal and written constructive comments to

support Competency Assessment, i.e. how was it assessed, reason for referral, actions to be taken/plan etc.


Universal Competency Framework

Adapted from K Bondy (1983) by K Castle (2006)

(Please refer to General Clinical Competence – Guidelines for completion)

1. Preceptorship 2. Clinical Competence document 3. Reflective accounts

1. Preceptorship

To have an identified individual to support development, practice and assessment within the clinical area

SCALE LEVEL

PROFESSIONAL STANDARDS

QUALITY OF PERFORMANCE

ASSISTANCE REQUIRED

Independent Level 4

Safe, accurate and fluently each time with initiative/ ability to identify, analyse and take appropriate action

1. Conducted in accordance with locally agreed, national and professional standards and practice. 2.Efficient, coordinated, confident within a reasonable time period

3. Demonstrates the ability to effectively identify, analyse and solve various issues related to the task/activity. 4. Research applied to practice

Without supporting cues

Supervised Level 3

Safe and accurate each time with occasional supporting cues.

1. Considers availability and relevance of research 2. Efficient, co-ordinated, confident, within a reasonable time period. 3. Conducted in accordance with locally agreed, national and professional standards and practice.

Occasional supportive cues.

Assisted Level 2

Safe and accurate most of the time.

1.Skillful in parts of behaviour 2. Awareness of standard, policy and practices. 3.Inefficient and uncoordinated within a delayed period of time

Frequent verbal and occasional physical cues. Directive cues in addition to supportive cues.

Marginal Level 1

Safe in some aspects of behaviour. Only performs at risk. Not always accurate.

1. Unskilled, inefficient 2. Over a delayed period of time.

Continuous verbal and physical cues.

Dependant Level 0

Unsafe. Unable to demonstrate behaviour

1. Unable to demonstrate procedure/ behaviour 2. Lack of confidence. 3. Lack of co-ordination and efficiency.

Continual verbal and physical cues.


Regular reviews, as identified in initial learning contract – documented in Preceptorship record

2. Clinical Competence document

Must be completed by a first level nurse

To achieve a learning outcome the individual must be able to - Provide an oral explanation - Identify the location of any relevant procedure files or guidelines - Be aware of any relevant research - Be aware of any specific standards related to this competency

- To be observed safely completing the competency where identified - To have covered all the areas outlined in the answer sheets

To ensure validity and reliability, the criteria outlined in the 1. Answer sheets 2. Trust procedure guidelines/policies 3. Professional Guide lines

Must act as the measure to determine competence or incompetence

3. Reflective accounts

Too often individuals provide care, make decisions or assessment in practice but never reflect if that was the right thing to do. To effectively reflect on practice it is essential to look at our own and practice and identify what we do well or where practice needs to change. The individual is required to complete reflective accounts. Johns (1993) reflective model has been included in the pack as a suggested model. A reflective account can only be useful if the individuals are honest with themselves. They will be required to look at an aspect of their practice or an experience and reflect on what they have been taught in the classroom, has it changed their practice, was what was learnt not used and should have been.

Reflective accounts are to be completed for personal portfolios

Used as evidence to show competence

Clinical Competence Document

Trust and Professional Guidelines and Policies to be assessed against

Professional body guidelines

Trust policy and guidelines

Royal Mardsen Clinical Nursing Procedures manual

NMC Professional Guidelines

Essence of Care


Clinical Competence – Competency Work Book

STATEMENT OF COMPETENCE

1 The Practitioner demonstrates the knowledge and skills to be able to carry out Sleep Study monitoring.

0

1

2

3

4

1.1 Demonstrates effective assessment of and record vital signs in respect to:

Colour

Tone

Heart rate

Respiration rate

Oxygen requirement

Awareness of own limitations

1.2 Using the Masimo radical 97 Pulse oximeter, demonstrates, with rationale, the following functions with confidence:

Switch on /self check

Checking and Adjustment of alarms “sen off”,” no sen”

Correct positioning and choice of sensors

Appropriate sites for sensor

Correct application and placement of sensor and how to secure

Alarms and trouble shooting

Volume adjustment

Signal/ pulse bar-significance of green or red signal

Perfusion index bar- significance of green or red signal

How to enter set up menu

Brightness control

Effects of high ambient light

1.3 Demonstrates the correct procedure to parents, on how to use the

Masimo Radical 97 in the home including the following: Switch on /self check

Correct positioning and choice of sensors

Appropriate sites for sensor

Correct application and placement of sensor and how to secure

Volume adjustment

Signal/ pulse bar-significance of green or red signal

Perfusion index bar- significance of green or red signal

Effects of high ambient light

Alarms and trouble shooting

Contact numbers for advice


1.4 Ability to discuss the Trust Policy’s and Guidelines, when using medical devices:

Correct use of machine

Reporting faulty equipment process

Cleaning

Maintenance

1.5 Demonstrates, providing a rationale, the importance of ‘downloading’

the patients information, and the need for interpretation by a Consultant

Comments (what evidence was used within the section to support competency of the nurse, areas of concern,

reasons for possible referral)

Assessor

I confirm that ............................................ is competent in carrying out sleep study monitoring to level 4, in

competencies 1.1-1.5.

Signature:......................................................... Print:...................................................................Date:......................

Practitioner

I confirm that I have undertaken training and I am competent in carrying out sleep study monitoring to level 4 in

competencies 1.1-1.5.

Signature:......................................................... Print:...................................................................Date:......................


Appendix 8 - Monitor Identification Label

Sleep Study

This machine has a sleep study to be downloaded for; Name: .......................................... Recorded on;……………………… Date: .............................................

Please do not use until downloaded- data could be lost.


Where do I go for further advice or information?

Training Staff may receive training in relation to this procedure, where it is identified in their appraisal as part of the specific development needs for their role and responsibilities. Please refer to the Trust’s Mandatory & Risk Management Training Needs Analysis for further details on training requirements, target audiences and update frequencies

Monitoring / Review of this Procedure In the event of planned change in the process(es) described within this document or an incident involving the described process(es) within the review cycle, this SOP will be reviewed and revised as necessary to maintain its accuracy and effectiveness. Equality Impact Assessment Please refer to overarching policy

Data Protection Act and Freedom of Information Act Please refer to overarching policy

Standard Operating Procedure Details

Review and Amendment History

Version Date Description of Change

1.0 Oct 2017 New SOP for BCPFT

Unique Identifier for this SOP is BCPFT-CYPF-SOP-OP-21

State if SOP is New or Revised New

Policy Category Children’s Services

Executive Director whose portfolio this SOP comes under

Director of Nursing and AHPs

Policy Lead/Author Job titles only

Team Leader, Community Paediatric Specialist Team

Committee/Group Responsible for Approval of this SOP

CYPF Quality and Risk Safety Group

Month/year consultation process completed

September 2017

Month/year SOP was approved October 2017

Next review due September 2020

Disclosure Status ‘B’ can be disclosed to patients and the public

Sleep Study in Children - bcpft.nhs.uk

Documents

Transcript of Sleep Study in Children - bcpft.nhs.uk