Cardiac Core —
Training activity: 11

Details

Prepare ILR for implant

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.

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 preparing and setting up an Implantable Loop Recorder (ILR) for insertion.
• Consider how the learning outcomes apply, specifically concerning the requirements for preparing and setting up for ILR insertion.
• What does successful preparation, verification, and setup of the ILR device look like for this activity, ensuring patient safety and adherence to protocols?
• Discuss with your training officer to gain clarity on expectations for the specific preparation steps, technical checks, and documentation required before implant.

What is your prior experience of this activity?

• Think about what you already know about ILR device function, indications, and the procedural steps that require pre-procedure preparation.
• Consider possible challenges you might face during the activity, such as technical setup issues, ensuring sterility of the device, or verifying patient details against the device model, and think about how you might plan to handle them.
• 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 when encountering technical issues or novel device models during preparation.
• Acknowledge how you feel about embarking on this training activity involving sterile devices and procedural setup.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop related to device preparation, verification, or ensuring seamless procedural workflow in the implant setting.
• Identify specific insights you hope to gain regarding the nuances of preparing different ILR models or the importance of implant measurements and observations.

What additional considerations do you need to make?

• Consult actions identified following previous experience of assisting in procedures or handling implantable devices.
• Identify important information you need to consider before embarking on the activity, such as the specific device model being used, patient details, and standard operating procedures for ILR preparation.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst preparing the device or verifying its status?
• Are you encountering situations such as:
  • An issue with the sterility or packaging of the ILR device or its accessories?
  • Discrepancy between the expected initial programming parameters and the device capabilities, or issues with programming head connectivity?
  • The procedural plan changing mid-prep, requiring a modification of the prepared components or settings?

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 adherence to the protocol or procedure flow?
• Consider the steps you are taking in the moment, such as:
  • Immediately halting the preparation to verify the sterility or expiry date of the components with a senior colleague?
  • Rapidly consulting the implant documentation to confirm necessary parameters or components for the altered procedure plan?
  • Seeking immediate guidance regarding uncertainty about device integrity or initial programming required for the ILR?
• How are you feeling in that moment? For instance, are you finding it difficult to concentrate on the sterile technique? Is it affecting your confidence in ensuring all necessary components are present?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully troubleshooting minor connectivity issues? Or are you needing support because the uncertainty regarding device integrity requires senior sign-off?
• What are you learning as a result of the unexpected development? For example, are you learning a more effective verification checklist for preparing devices? Or gaining insight into the criticality of sterile field management during ILR setup?

On action

What happened?

• Begin by summarising the key points of the experience of preparing the Implantable Loop Recorder (ILR) for implant.
• Consider specific events, actions, or interactions which felt important, such as the checks performed, any programming steps, and how you ensured the device was ready for the sterile field.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, resolving an unexpected issue in the preparation process or ensuring all necessary components were available. How did you feel during this experience?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding preparing an ILR for implantation. What strengths did you demonstrate e.g., adherence to protocol? What skills and/or knowledge gaps were evident e.g., knowledge about the specific device model or pre-implant steps?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved?
• Identify any challenges you experienced, such as technical issues in the preparation process, and how you reacted to these. How does this activity contribute to your procedural support skills in device implantation?
• Identify anything significant about the activity, such as needing to seek advice or clarification on device programming or sterile field procedures.
• Acknowledge any changes in your own feelings now you are looking back on the experience.

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 incorporating any feedback received on your technique for preparing a patient for ILR.
• What will you do differently next time to ensure accuracy and efficiency in preparing ILRs for future implants? Has anything changed in terms of what you would do if you were faced with a similar situation again?
• Do you need to practise any aspect of the activity further, such as reviewing protocols or checklists for ILR preparation?

Beyond action

Have you revisited the experiences?

• Have you reviewed your actions from your previous reflections for this activity? What specific actions did you previously identify you would need to take to improve your practice related to device preparation and adherence to sterile protocols?
• Have you completed these previously identified actions? For example, if you planned to review the specific setup requirements for different ILR models, how did completing this action impact your subsequent performance when preparing devices for insertion?
• Engage in professional storytelling with peers, near peers, or colleagues about procedural setup challenges or instances where device integrity checks identified issues. How has discussing these events influenced your appreciation for patient safety and meticulous preparation?

How have these experiences impacted upon current practice?

• Consider how the accumulated learning from performing or reflecting on ILR preparation will support you in preparing for observed ‘in-person’ assessments for the module.
• How has your practice in supporting device implantation developed and evolved over time? For example, how does the attention to detail required for ILR preparation inform your practice when providing scientific support for pacemaker implant?
• What transferable skills e.g., adherence to sterile protocols or technical verification did you develop through this activity, and how will this understanding help you contribute to the safety and efficiency of other cardiac procedures?

Relevant learning outcomes

#	Outcome
# 5	Outcome Prepare and setup for implantable loop recorder (ILR) insertion and manage follow-up post implant, including use of remote monitoring.