Training activity information
Details
Manage device interactions for a patient undergoing a permanent CIED implant whose rhythm is supported by one of the following:
- Temporary wire/pacing box
- Transcutaneous pacing by external pads
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 managing device interactions for a patient supported by temporary pacing during a permanent CIED implant.
- Consider how the relevant learning outcomes apply, specifically regarding demonstrating effective physiological and scientific support, providing technical expertise, and ensuring patient safety.
- Discuss with your training officer to gain clarity on expectations for monitoring and intervention related to temporary pacing, for example, managing the pacing box settings or transcutaneous pad placement.
What is your prior experience of this activity?
- Think about what you already know about temporary pacing, transcutaneous pacing, and potential interactions during device implant.
- Consider possible challenges that might arise e.g., pacing capture/sensing issues, managing pacing dependency, temporary wire dislodgement, electromagnetic interference and think about how you might handle them.
- Recognise the scope of your own practice for this activity, i.e., know when/from whom you will need to seek advice or help regarding managing pacing dependency in the cath lab.
- Acknowledge how you feel about managing device interactions in this context.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop related to managing temporary pacing dynamics and ensuring seamless support for a pacing-dependent patient.
- Identify specific insights you hope to gain regarding the interplay between temporary support and permanent device placement.
What additional considerations do you need to make?
- Consult actions identified from previous experiences with temporary pacing or supporting device implants.
- Identify any important information about the patient’s underlying rhythm, degree of pacing dependency, or the temporary pacing setup you need to consider beforehand.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst monitoring the temporary pacing system?
- Are you encountering situations such as:
- Sudden loss of capture or sensing issues with the temporary wire/pacing box or transcutaneous pads?
- Troubleshooting connection issues or electromagnetic interference that complicates the monitoring of the temporary pacing system?
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 capture or sensing is adequate?
- Consider the steps you are taking in the moment, such as:
- Actively concentrating on interpreting complex temporary pacing waveforms or managing sudden loss of capture?
- Immediately seeking guidance from the physician or nursing staff if the temporary pacing system fails or capture is lost?
- How are you feeling in that moment? For instance, are you finding it difficult to troubleshoot connection issues effectively? Is it affecting your confidence in maintaining continuous monitoring?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are the monitoring and basic management tasks for temporary pacing appropriate for your role in supporting the implant procedure?
- What are you learning as a result of the unexpected development? For example, are you gaining a better understanding of the practical challenges of temporary pacing?
On action
What happened?
- Begin by summarising the key points of the experience of managing temporary pacing support.
- Consider specific events, actions, or interactions which felt important, such as how you monitored the patient’s rhythm, interacted with the temporary pacing equipment, and coordinated with the procedural team. Note how you managed the temporary pacing equipment.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, rapidly troubleshooting loss of capture on the temporary pacing box or managing electromagnetic interference. 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 temporary pacing methods and their management. What strengths did you demonstrate (e.g., technical management)? What skills and/or knowledge gaps were evident, such as challenges in maintaining pacing support or ensuring patient stability?
- Identify any challenges you experienced, such as technical aspects of managing temporary wires or external pads, and how you reacted to these. How does this activity contribute to your procedural support skills in complex cases?
- 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 ability to manage the device interactions.
- Identify specific technical or clinical aspects of managing temporary pacing during implant that require further attention or practice. How will you prepare for future cases involving temporary pacing support? 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 temporary pacing protocols or troubleshooting common issues?
Beyond action
Have you revisited the experiences?
- Have you reviewed your actions from your previous reflections for this activity? What specific challenges related to ensuring continuous pacing or managing the transition e.g., from external pacing to device implant did you previously encounter? Have you completed these previously identified actions? For example, if you planned to review the operational steps for a temporary pacing box, how did this action improve your understanding of temporary pacing systems and workflow during these complex procedures?
- Engage in professional storytelling with peers, near peers, or colleagues about procedures involving temporary pacing or challenging transitions during device implant. Did these conversations offer new insights into workflow, equipment management, or communication during these specific scenarios, influencing your approach in future cases?
How have these experiences impacted upon current practice?
- Consider how the accumulated learning from performing or reflecting on managing temporary pacing interactions will support you in preparing for observed ‘in-person’ assessments for the module, such as a DOPS titled ‘Support a CRT generator change in a patient with no underlying rhythm.’
- How has your confidence in anticipating potential issues and ensuring patient safety during implants involving temporary support evolved? For example, how does this development contribute to demonstrating effective physiological and scientific support during other complex implants?
- What transferable skills e.g., managing complex equipment setup or procedural coordination did you develop through this activity, and how will this understanding help you support patient monitoring in critical care settings?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Demonstrate effective physiological and scientific support for complex CIED implant, providing technical expertise, ensuring patient safety and appropriate procedural documentation. |
| # 4 |
Outcome
Identify changes in patient conditions requiring escalation of findings to the relevant responsible person(s) and with reference to the patient pathways. |