|Title||Sleep Therapeutics in Paediatrics|
By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and apply their knowledge to be competent in the management, delivery, interpretation and reporting of a Paediatric Positive Airway Pressure Therapy service within scope of practice of Consultant Clinical Scientist.
Knowledge and understanding
By the end of this module the Clinical Scientist in HSST will analyse, synthesise, evaluate and critically apply their expert knowledge in a paediatric setting with respect to:
- the various components of a device and a PAP circuit.
- the principles of PAP therapy and the various modes of PAP therapy including:
- Fixed pressure CPAP
- Auto-titrating PAP
- Bi-level PAP
- other nocturnal ventilation
- the various algorithms in different PAP devices and explain how this may effect treatment in a variety of clinical situations. For example, how they differ in respiratory event detection, responses to different respiratory events and responses to leak, and describe how this may affect the pressure profiles
- how changes to pressure settings will affect control of respiratory events and comfort.
- the difference between IPAP and EPAP settings and their effects on ventilation and control of airway collapse.
- the factors which effect the pressure required for effective PAP therapy including:
- the indications and benefits of PAP therapy
- the relative and absolute contra-indications to PAP therapy in children
- the barriers to using PAP therapy (both physical and psychological)
- the principles of humidification and the different types of humidification available
- the various types of interface available and discuss the advantages and limitations of each.the possible side effects of using PAP therapy and the possible ways to alleviate them
- critically reflect on the challenges of applying research to practice in relation to these areas of practice and suggest improvements, building on a critique of available evidence.
Technical and clinical skills
By the end of this module the Clinical Scientist in HSST, with respect to interventions in sleep diagnostics in paediatrics, will be able to demonstrate a critical understanding of current research and its application to the performance and mastery to:
- select the appropriate device and interface for any individual paediatric patient, taking into account diagnosis (OSA, mixed apnoeas, UARS etc), breathing method (nasal or mouth), facial features, personal preference.
- make the appropriate settings on the PAP device
- provide a good mask fit.
- describe the initial ventilator settings for e.g. biPAP based upon the baseline study (e.g. using the baseline respiratory rate to set the backup rate and IPAPmin /IPAP max where applicable
By the end of this module the Clinical Scientist in HSST will be expected to critically reflect and apply in practice a range of clinical and communication skills to advise and communicate effectively with patients, relevant clinicians, patients and the public and other healthcare professionals and will:
- advise on the patient pathway with regular review, management and follow-up
- provide patient education and support to improve compliance with therapy
- interpret PAP machine downloads and take action accordingly
- identify problems with compliance and provide solutions to other healthcare workers/MDT
- identify patients who are most likely to need further help and support provide full documentation and reports on patient treatment to general practitioners and MDT
- provide titrating biPAP in response to e.g. obstruction, hypoventilation, patient/machine asynchrony
Attitudes and behaviours
By the end of this module the Clinical Scientist in HSST will be expected to evaluate their own response to both normal and complex situations demonstrating the professional attributes and insights required of a Consultant Clinical Scientist working within the limits of professional competence referring as appropriate to senior staff and will:
- recognise the importance of child safeguarding.
- comply with CQC requirements for documentation of devices and arranging appropriate service / safety testing.
- be concerned with patient confidentiality at all times.
- be enthusiastic in continuous improvement of therapeutic services, with particular reference to auditing practice, evidence based practice, new and improved technologies.
- keep up-to-date with respect to new machines/technology as it becomes available and take an analytical approach to reviewing them.
- appreciate the complex history patients with sleep disordered breathing may have and make a holistic approach to treatment.