Paediatric Neurophysiology —
Training activity: 6

Details

Plan and prepare to conduct pre-term neonatal EEGs

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 effectively planning and preparing for an EEG specifically on a pre-term neonate, including logistical adaptation for the sensitive NICU environment.
• Consider how the learning outcomes apply, specifically in relation to preparing patients and environments for testing, maintaining safety and patient dignity, and demonstrating effective communication with parents and neonatal staff during planning.
• Discuss with your training officer the specific environmental controls (e.g., temperature/humidity) and strict infection control protocols that must be planned and adhered to when preparing for a pre-term neonatal EEG.

What is your prior experience of this activity?

• Think about what you already know about procedural planning, coordinating specialised equipment, and working within high-acuity care settings.
• Consider possible challenges you might face during the activity, such as coordinating EEG equipment transportation into a sterile field, managing limited space around the neonate’s bed (e.g., incubator/respirator interface), or communicating with highly anxious parents, and think about 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. You will need to seek advice from your Training Officer when required, for example:
  • When required specialist miniaturized EEG equipment for pre-term recording is unavailable, affecting the ability to perform the study safely
  • If a pre-term neonate’s clinical status changes drastically (e.g., severe physiological instability) which necessitates immediate coordination with the neonatal team regarding procedure feasibility
  • When planning specific logistical requirements (e.g., temporary suspension of ventilator monitoring for electrode application) that requires formal sign-off from the senior neonatal medical team
• Acknowledge how you feel about planning and preparing for a medical procedure on a fragile, pre-term neonate, recognizing the low tolerance for environmental disruption.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as advanced organisational and contingency planning skills for coordinating procedures within a highly acute care environment.
• Identify the specific insights you hope to gain into the critical balance between acquiring diagnostic data and minimising physiological disruption when preparing a pre-term neonatal patient.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of planning procedures involving very young or vulnerable patients where environmental control was paramount.
• Identify important information you need to consider before embarking on the activity, such as reviewing specific institutional protocols for pre-term EEG setup, understanding the potential impact of recording on the neonate’s clinical status, and clarifying expectations with the neonatal team.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst planning and preparing for a pre-term neonatal EEG in the NICU?
• Are you encountering situations such as:
  • The required specialised equipment for the NICU environment e.g., isolation transformer or specialised leads is missing or malfunctioning during the checklist phase?
  • Unanticipated severe clinical instability is reported for the neonate (e.g., respiratory issues), complicating the preparation timing and handling precautions?
  • A conflict arises with nursing staff regarding space or environmental requirements for recording?

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 safety protocol checks by double-checking all equipment compatibility?
• Consider the steps you are taking in the moment, such as:
  • Immediately consulting the neonatal nursing staff to confirm the infant’s current stability and necessary handling precautions.
  • Making real-time adjustments to the planning schedule to minimise disruption to the infant’s care routine.
• How are you feeling in that moment? For instance, are you finding it difficult to coordinate the complex logistical interface between the EEG equipment and the neonatal environment? Is it affecting your confidence in meeting pre-test safety requirements?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully coordinating the timing and resource needs with the neonatal team? Or are you needing support because a deviation from standard infection control policy is required for entry into the specific neonatal unit, necessitating senior authorisation?
• What are you learning as a result of the unexpected development? For example, are you mastering the protocol for planning procedures in high-acuity care settings?

On action

What happened?

• Begin by summarising the key steps you took when planning and preparing the environment and equipment specifically for a pre-term neonatal EEG in the NICU setting.
• Consider specific events, actions, or interactions which felt important, such as how you confirmed the availability of specialised miniature electrodes or how you coordinated the necessary environmental adjustments (e.g., lighting, noise control) with the neonatal nursing team.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately consulting the Training Officer when the required safety protocols for a specific piece of monitoring equipment in the NICU conflicted with the standard EEG setup.
• How did you feel during this experience, e.g., did you feel anxious about working in the highly controlled environment or focused on ensuring technical readiness?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding planning for highly sensitive populations. What strengths did you demonstrate, e.g., meticulous review of safety and infection control protocols? What skills and/or knowledge gaps were evident, e.g., unfamiliarity with specific NICU operational logistics that affected timing and preparation sequence?
• Compare this experience against previous engagement with similar activities – has your practice improved in anticipating and mitigating environmental risks in acute care settings?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the safe coordination of EEG equipment with other life support machinery in the NICU, and how you reacted to this.

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 planning and preparation for pre-term neonatal studies.
• What will you do differently next time you approach planning a pre-term EEG, for instance, by proactively creating a detailed, documented communication plan outlining required environmental changes for the nursing team?
• Do you need to practise any aspect of the activity further, such as reviewing specialised protocols for minimising handling of pre-term infants or key learning outcomes related to preparing patients and environments?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences planning and preparing EEG recordings for pre-term neonates 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 pre-term neonate required highly specialised monitoring equipment and meticulous noise suppression forced you to re-evaluate the generality of your environmental preparation checklist you applied during your first attempt at this training activity.
• Considering what you understand about NICU protocols, complex equipment logistics, and the specific sensitivity of pre-term infants 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 pre-term EEG planning process based on further learning and experiences? For example, how you proactively reviewed and integrated the specific departmental policies concerning handling and infection control when preparing equipment for a pre-term patient, demonstrating you have adapted improvements based on further learning.
• Has discussing severe logistical or environmental challenges in the NICU or the impact of poor planning on the neonate’s clinical status 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 near miss where an incorrect power cord was used in a sterile field, refined your understanding of the critical nature of meticulous equipment safety verification during planning.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent pre-term EEG planning and preparation experiences, contributed to your overall confidence and competence in planning and preparing for vulnerable patients, particularly in preparing for assessments like DOPS? For example, how your accumulated ability in anticipating and mitigating logistical issues in acute care settings now enables you to confidently present a prepared and safe environment for a pre-term EEG during a DOPS assessment related to planning.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to planning pre-term neonatal EEGs? 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 Neonatal Consultant or Technical Manager immediately when unfamiliar equipment interaction or a non-standard fixation requirement for a pre-term baby is encountered, recognising this requires specialist technical or medical input.
• Looking holistically at your training journey, how has this initial pre-term EEG planning experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to preparing patients and environments and communication? For example, how this foundational experience has supported your development in practicing safely by providing the necessary knowledge base for the subsequent learning outcomes focused on performing the actual delicate procedure.

Relevant learning outcomes

#	Outcome
# 2	Outcome Prepare patients and environments for testing, maintaining safety and patient dignity.
# 3	Outcome Demonstrate effective and compassionate communication skills with all stakeholders, including patients and the multidisciplinary team.