Training activity information
Details
Check and assess device site and escalate any abnormal findings
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 when checking and assessing a device site and escalating abnormal findings.
- Consider how the relevant learning outcomes apply, specifically concerning identifying changes in patient conditions requiring escalation.
- Discuss with your training officer to gain clarity on expectations for site assessment and the protocol for escalating potential complications, for example, signs of infection or erosion.
What is your prior experience of this activity?
- Consider possible challenges that might arise e.g., ambiguous findings, patient anxiety, or managing a patient with underlying comorbidities like diabetes and how you might 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 escalating abnormal findings.
- Acknowledge how you feel about checking and assessing the device site and escalating abnormal findings.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop related to physical examination, identification of potential issues, and appropriate escalation.
- Identify specific insights you hope to gain regarding common device site complications and wound care.
What additional considerations do you need to make?
- Consult actions identified from previous experiences with patient assessment or identifying complications.
- Identify any important information about the patient’s clinical history (e.g., anticoagulation status) or specific concerns they have raised that you need to consider beforehand.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst inspecting or palpating the device implant site?
- Are you encountering situations such as:
- Identifying signs of infection, erosion, or a significant haematoma that requires immediate action and escalation?
- Difficulty differentiating between minor irritation and signs of serious complication (e.g., skin breakdown) during assessment?
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 deciding if a finding is within normal limits or abnormal?
- Consider the steps you are taking in the moment, such as:
- Actively concentrating on differentiating between minor irritation and signs of serious infection or erosion?
- Immediately seeking guidance from a senior colleague or physician if you identify any signs of infection, erosion, or a significant haematoma?
- How are you feeling in that moment? For instance, are you finding it difficult to differentiate between minor irritation and a more serious issue? Is it affecting your confidence in identifying abnormalities?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are the physical assessment and initial identification of abnormal findings appropriate for your role?
- What are you learning as a result of the unexpected development? For example, are you gaining a better understanding of the appearance of healthy versus problematic device sites?
On action
What happened?
- Begin by summarising the key points of the experience of assessing the device site.
- Consider specific events, actions, or interactions which felt important, such as your physical assessment of the implant site, noting any findings such as redness, swelling, tenderness, or skin breakdown, and how you documented or escalated these.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately seeking clarification from a senior colleague about a concerning sign of potential erosion or infection. 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 clinical assessment skills. What strengths did you demonstrate (e.g., vigilance)? What skills and/or knowledge gaps were evident, such as improving your ability to recognise signs of infection, erosion, or haematoma?
- Identify any challenges you experienced, such as determining the appropriate level of escalation, and how you reacted to these. How does this activity contribute to your role in identifying complications?
- 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, including incorporating any feedback received about your assessment of the device site and your ability to escalate abnormal findings.
- Identify specific signs or symptoms of device site complications that you need to be more vigilant for. How will you ensure thorough assessment and appropriate escalation in future patient encounters? 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 wound care protocols?
Beyond action
Have you revisited the experiences?
- Have you reviewed your actions from your previous reflections for this activity? What specific signs of infection, erosion, or other complications (e.g., haematoma) did you previously find challenging to recognise or assess fully? Have you completed these previously identified actions? For example, if you planned to review the specific warning signs of impending skin erosion, how did this improve your inspection and palpation skills during routine checks?
- Engage in professional storytelling with peers, near peers, or colleagues about challenging device site presentations or cases where immediate escalation was required due to suspected infection. Did these discussions provide valuable learning on recognising subtle warning signs or navigating the escalation process, shaping your approach to future patient assessments?
How have these experiences impacted upon current practice?
- Consider how the accumulated learning from performing or reflecting on device site assessment will support you in preparing for observed ‘in-person’ assessments for the module, such as an OCE where you explain wound site care to a patient.
- How has your confidence in performing thorough device site checks and recognising when findings are abnormal or require escalation evolved? For example, how does this critical skill contribute to patient safety and your ability to identify changes requiring immediate investigation in a patient presenting with discomfort?
- What transferable skills e.g., clinical inspection and palpation skills or risk identification did you develop through this activity, and how will this understanding help you assess patient surgical sites following other cardiac procedures?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Perform and interpret complex CIED follow up and effectively communicate results to patients and clinical staff as appropriate. |
| # 4 |
Outcome
Identify changes in patient conditions requiring escalation of findings to the relevant responsible person(s) and with reference to the patient pathways. |