Transport of Critically Ill Patients —
Training activity: 6

Details

Apply monitoring and therapeutic equipment for transfer

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Considerations

• Levels of monitoring required and their compatibility with location of transfer
• Communication of discrepancies with the clinical team
• Devices connected to the patient are fit for use and required for the duration of the procedure
• Compatibility with the receiving department

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like?

• Identify what is expected of you in relation to securely and correctly attaching all necessary monitoring and therapeutic equipment to the patient, ensuring it is functioning correctly and displaying accurate data before commencing the transfer.
• Consider how the learning outcomes apply, specifically in relation to applying equipment during transfer and ensuring it enables continuous monitoring and therapy throughout the movement phase.
• Discuss with your training officer to gain clarity of what is expected of you in relation to connecting transport equipment, managing lines and cables, and verifying signal quality or therapy delivery.

What is your prior experience of this activity?

• Think about what you already know about connecting specific transport devices (e.g., ECG leads, SpO2 probes, ventilator circuits, infusion lines).
• Consider possible challenges you might face during the activity, such as patient movement, limited access, tangled lines, or poor signal quality.
• Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if you need assistance from nursing staff or the medical team for complex line management or patient positioning.
• Acknowledge how you feel about applying this equipment – comfortable with the practical steps?

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as efficiently and safely connecting multiple pieces of equipment or troubleshooting common issues during connection (e.g., lead placement, sensor function).
• Identify the specific insights you hope to gain into how equipment placement impacts data quality or strategies for managing cables during movement.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of struggling with cable management or securing devices.
• Identify important information you need to consider before embarking on the activity, such as any specific patient considerations (e.g., skin integrity, presence of dressings/bandages) that might affect equipment application and ensuring you have all necessary consumables.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst applying monitoring (e.g., physiological variables) or therapeutic equipment?
• Are you encountering situations such as:
  • Equipment not connecting correctly or functioning unexpectedly (e.g., a monitor shows poor signal quality despite appropriate application)?
  • Difficulty ensuring secure placement for movement due to patient anatomy or access limitations?
  • The patient reports unexpected discomfort or anxiety related to the equipment application, challenging the communication strategy?

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to placement or securement to resolve poor signal quality?
• Consider the steps you are taking in the moment, such as:
  • Immediately adjusting the placement or securement method while communicating reassurance to the patient about the equipment
  • Pausing the application to seek advice from a colleague regarding equipment setup or patient comfort
• How are you feeling in that moment? For instance, are you finding it difficult to connect complex devices or ensure compatibility? Is it affecting your confidence in ensuring the equipment is securely applied for movement?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully troubleshooting a common equipment connection issue by adjusting the placement? Or are you needing support because the patient discomfort or equipment setup requires senior guidance to resolve?
• What are you learning as a result of the unexpected development? For example, are you mastering a more effective technique for securing and managing multiple lines/cables? Or gaining insight into the importance of communicating with the patient about the equipment being applied?

On action

What happened?

• Begin by summarising the key steps you took when applying monitoring and therapeutic equipment to the patient for transfer.
• Consider specific events, actions, or interactions which felt important, such as ensuring secure placement of infusion lines or resolving unexpected readings/artefacts on the transport monitor.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately adjusting the SpO2 probe placement when poor signal quality was noted.
• How did you feel during this experience, e.g., focused on securing equipment or challenged by limited access to the patient interface?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding the practical application of monitoring or therapeutic equipment in the context of transfer readiness. What strengths did you demonstrate, e.g., skill in managing multiple cables and lines to prevent tangling?
• What skills and/or knowledge gaps were evident, e.g., difficulty ensuring reliable monitoring in a patient with poor perfusion?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in securing reliable monitoring or communicating effectively about patient status?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding securing an invasive monitoring line that presented a risk of dislodgement.

What will you take from the experience moving forward?

• Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to improving your effectiveness in applying transfer equipment.
• What will you do differently next time you approach applying monitoring equipment, for instance, by proactively managing patient interface issues to ensure secure and reliable monitoring?
• Do you need to practise any aspect of the activity further, such as troubleshooting poor signal quality or techniques for ensuring secure and reliable monitoring?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of applying equipment for transfers in different patient populations or complex clinical scenarios since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how an instance where a subsequent transfer required managing complex line security and equipment placement in a highly mobile patient forced you to re-evaluate the technique used for securing connections and managing cables during your first attempt at this training activity.
• Considering what you understand about technical manipulation, patient interface issues, and ensuring monitoring accuracy now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your efficiency and accuracy in applying equipment and securing connections based on further learning and experiences? For example, how you proactively sought expertise with specific devices or improved technique for challenging patient anatomies to ensure reliable data.
• Has discussing techniques for applying or troubleshooting monitoring/therapeutic equipment or the impact of equipment application issues affecting monitoring accuracy with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a transfer where equipment application issues affected therapeutic delivery reinforced the need for meticulous setup.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent equipment application and securing experiences, contributed to your overall confidence and competence in technical manipulation, patient preparation, and ensuring reliable monitoring/therapy application, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated ability in efficiently and accurately applying monitoring and therapeutic equipment now enables you to demonstrate complex equipment set up and troubleshooting during transport in a DOPS assessment.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to securing patient interface with critical equipment? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice from the Training Officer immediately when equipment application issues affect monitoring accuracy or if the patient reports unexpected discomfort or anxiety related to the equipment application, requiring senior clinical resolution.
• Looking holistically at your training journey, how has this initial equipment application experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to applying equipment, communication and assessing changes? For example, how this foundational experience has supported your development in proactive troubleshooting and ensuring patient safety through equipment interface.

Relevant learning outcomes

#	Outcome
# 4	Outcome Apply, or remove, equipment during any stage of the transfer of critically ill patients.
# 5	Outcome Discuss and agree a transfer plan with the multi-disciplinary team ensuring the best interests of the patient, and all elements of their care, are considered throughout.
# 6	Outcome Communicate effectively with the patient, relatives and the multi-disciplinary team at all stages of the process.
# 7	Outcome Assess changes in the patients’ physiological variables, or in the equipment performance, during transfer; and remedy or apply contingency measures as required.