Guide – Criteria for Stage 1, 2 & 3 Stage 1 Stage 2 Stage 3 Demonstrate the ability to prepare the patient for an ECG Introduce yourself to the patient, check the patient’s identity and other demographic details and refer to request card to verify referral Provide patient with rationale for planned test and gain verbal consent Prepare the patient for the investigation and provide an explanation of the procedure, provide a dignity sheet to female patients Demonstrate the ability to accurately apply electrodes Identify accurate electrode positions according to AHA/SCST guidelines Remove and dispose electrodes after use Demonstrate appropriate skin preparation and electrode application as required Demonstrate the ability to modify the procedure if necessary e.g. post cardiac surgery due to dressing, amputation etc Demonstrate the ability to record, optimise and dispatch an ECG Record a 12 lead ECG and 3 lead rhythm strip as appropriate Accurately label and dispatch the trace Demonstrate the ability to optimise the ECG trace, identify and minimise any artefact which is present Be aware of the procedure for dealing with ECG abnormalities Demonstrate the ability to store, modify and download a recorded ECG as appropriate Demonstrate the ability to store an ECG once recorded Demonstrate the ability to modify and recall data on the ECG machine Demonstrate the ability to download the stored ECG via the modem or wireless connection if applicable Shows awareness of and follows infection control procedures Wash hands as per trust policy Maintain awareness of infection control i.e. barrier rooms/bays Demonstrate appropriate decontamination of the ECG machine and couch
Clinical Competency Area – Recording a 12-lead ECG Minimum stage 3 proficiency should be achieved, where this is not the case please complete action plan to achieve stage 3. Document competency ( 1-3 ) & sign Stage 1 – Foundation Stage 2 – Intermediate 3 - Competent Stage 1 Date & Initial Stage 2 Date & Initial Stage 3 Date & Initial Assessor Date & Initial Graduate Date & Initial Demonstrate the ability to prepare the patient for an ECG Demonstrate the ability to accurately apply electrodes Demonstrate the ability to record, optimise and dispatch an ECG Demonstrate the ability to modify and download a recorded ECG as appropriate Shows awareness of and follows infection control procedures Outcome: Assessor Feedback: Assessor: Date & Initials Graduate: Date & Initials
Guide – Criteria for Stage 1, 2 & 3 Stage 1 Stage 2 Stage 3 Able to operate the playback/analysis system. Download ECG strips for interpretation. Manipulate analyser settings. Able to down load data from storage device for analysis. Ability to change machine settings. Example: prematurity settings for atrial ectopics, sweep speed, amplitude etc Troubleshoot problems with analysis system/hardware Recognise and classify ECG complexes. Recognise areas of artefact and label correctly. Is able to classify normal rhythm, atrial and ventricular ectopics, Atrial fibrillation/flutter and dangerous rhythms. Able to recognise and classify ECG complexes to intermediate level as defined in ECG interpretation competency Recognises complex rhythms: SVT vs VT Aberrancy Check automatic evaluations for accuracy including histograms and trends. *NB – may not be available on all systems. Produces accurate trends and histograms Is able to correlate trends/histograms with patient activities Able to comment on findings with reference to diagnosis. Example; chronotropic incompetence, AF rate control etc. Ability to correlate patient symptom times/diary events with recordings. File/print ECG strips at symptom times Able to comment on findings at symptom times. Example: Normal or abnormal Able to correlate abnormal ECG findings with patient symptoms Select ECG tracings sufficient to illustrate and support the final evaluation. Uses automatically selected information for inclusion in the report. Includes onset and offset of arrhythmia with appropriate sweep speed/amplitude settings Able to correlate ECG tracings with patient activities/symptoms Production of a signed/dated factual report according to local guidelines. Produces a report containing histograms, trends and patient symptoms Includes additional information to support diagnosis Understands implications of report/diagnosis on patient care Recognition of circumstances where views of colleagues should be sought. Able to ask colleagues for help with ECG recognition Able to prioritise findings for medic review Able to recognise urgent findings and seek advice from medics. Example: on-call registrar to review dangerous rhythms Ability to store a copy of the report in line with local guidelines. Able to the report electronically on individual workstation Able to demonstrate methods for long-term storage/archiving Able to retrieve stored reports from archiving system 5 Clinical Competency Area – Ambulatory ECG Interpretations