EEG in the Intensive Care Setting —
Training activity: 6

Details

Adapt EEG procedures as appropriate to patient state and surroundings

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 appropriately adapting EEG procedures based on the patient’s state and their intensive care surroundings.
• Consider how the learning outcomes apply, specifically in relation to performing EEG recordings with necessary modifications while maintaining patient safety and preparing environments and maintaining safety in the complex ICU setting.
• Discuss with your training officer to gain clarity of what is expected of you in relation to recognising the need for procedural adaptation e.g., working around a respirator and implementing appropriate modifications while ensuring recording quality.

What is your prior experience of this activity?

• Think about what you already know about performing procedures in complex or challenging environments or adapting techniques based on patient condition.
• Consider possible challenges you might face during the activity, such as managing severe patient instability, dealing with monitoring equipment interference, limited access to the patient, or maintaining sterile fields, 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 a proposed adaptation (e.g., using a reduced electrode set) might significantly compromise diagnostic yield and requires pathological justification
  • If encountering unfamiliar life support equipment or advanced monitoring where interaction requires senior verification to maintain electrical safety
• Acknowledge how you feel about undertaking a technical procedure like an EEG in the high-pressure and complex intensive care environment.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as assessing the patient state and environment to determine necessary adaptations e.g., adjusting electrode application for difficult access or working around monitoring equipment.
• Identify the specific insights you hope to gain into the most common challenges in ICU EEG or effective strategies for maintaining recording quality despite environmental factors and patient instability.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of performing procedures in challenging clinical settings or on patients with complex needs.
• Identify important information you need to consider before embarking on the activity, such as reviewing the patient’s current physiological state, understanding the function of surrounding equipment (e.g., dialysis or ECMO), and familiarising yourself with ICU-specific protocols like infection control and electrical safety.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst adapting the EEG procedure to the patient’s state and surroundings?
• Are you encountering situations such as:
  • The patient’s physiological state or level of consciousness changes unexpectedly during preparation or recording e.g., increased agitation, haemodynamic instability?
  • Surrounding ICU equipment e.g., ventilators, infusion pumps, monitors, electrical beds, causes unforeseen technical challenges, interference, or difficulty in accessing the patient?
  • There is a sudden need for medical or nursing intervention for the patient, requiring you to quickly stop, pause, or move equipment?

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 electrode placement, equipment management, or recording technique in response to the unexpected situation?
• Consider the steps you are taking in the moment, such as immediately modifying the procedure or seeking assistance from ICU staff or your supervisor or changing your plan on the spot.
• How are you feeling in that moment? For instance, are you finding it difficult to troubleshoot technical issues while focusing on patient safety? Is it affecting your confidence in continuing the recording effectively or maintaining quality?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, were you able to complete the adapted EEG procedure safely and successfully? Or are you needing support because unresolvable technical interference required senior technical input?
• What are you learning as a result of the unexpected development? For example, are you mastering a more effective technique for adapting procedures on the fly in the ICU environment? Or gaining insight into real-time troubleshooting technical issues caused by life support equipment?

On action

What happened?

• Begin by summarising the key steps you took when performing an EEG recording and having to adapt the procedure based on the patient’s state or the surroundings.
• Consider specific events, actions, or interactions which felt important, such as how you successfully worked around infusion pumps or ventilator tubing to apply electrodes or the steps taken to manage infection control requirements during electrode placement.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately modifying electrode placement or technique in response to unexpected haemodynamic instability or a sudden need for medical intervention.
• How did you feel during this experience, e.g., did you feel focused on maintaining patient safety despite environmental constraints, or stressed due to unforeseen technical interference from surrounding electrical equipment?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding performing modified EEG recordings in complex settings. What strengths did you demonstrate, e.g., ability to prioritise patient safety when technical issues arose?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with specific troubleshooting techniques required for interference caused by particular ICU equipment (e.g., dialysis or ECMO)?
• Compare this experience against previous engagement with similar activities – Has your practice improved in troubleshooting technical issues in real-time or rapidly modifying the recording plan due to changes in patient state?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding whether a proposed procedural adaptation (e.g., using a reduced electrode set) would compromise the diagnostic yield or ensuring electrical safety when managing unfamiliar life support equipment, 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 managing patient state and equipment interference in the ICU environment.
• What will you do differently next time you approach adapting an EEG procedure, for instance, by proactively reviewing the technical specifications of common ICU devices to anticipate interference and plan mitigation strategies?
• Do you need to practise any aspect of the activity further, such as refining real-time electrode management for agitated patients or troubleshooting technical interference?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences performing EEG recordings in the intensive care setting (ICU), especially those requiring complex technical troubleshooting or managing significant patient instability, 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 recording suffered from persistent, severe interference from ECMO or dialysis equipment forced you to re-evaluate the depth of your environmental and technical assessment before beginning electrode placement during your first attempt at this training activity.
• Considering what you understand about procedural adaptation, patient safety, and troubleshooting in a complex environment 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 procedural adaptation and technical troubleshooting protocols based on further learning and experiences? For example, how you proactively refined your approach to managing electrical safety and infection control protocols while applying electrodes in difficult positions (e.g., around ventilators), demonstrating you have adapted improvements based on further learning.
• Has discussing challenging procedural adaptations (e.g., working around advanced life support) or the impact of recording artefacts 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 recording where severe artefact obscured critical brain activity refined your understanding of the critical nature of meticulous environmental preparation in maintaining safety and diagnostic yield.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent procedural adaptation experiences, contributed to your overall confidence and competence in performing modified EEG procedures in the ICU, particularly in preparing for assessments like Direct Observations of Practical Skills (DOPS)? For example, how your accumulated ability in applying electrodes and managing technical environments now enables you to confidently execute procedural steps for DOPS such as recording EEG in the unconscious patient or applying/removing electrodes under difficult circumstances.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to adapting EEG procedures? 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 ICU nursing staff or Technical Manager immediately when patient state or specific life-support requirements necessitate procedural modifications that fall outside standard training protocols.
• Looking holistically at your training journey, how has this initial procedural adaptation experience, revisited with your current perspective, contributed to your development in performing EEG recordings with modifications and maintaining safety? For example, how this foundational experience in managing technical interference and artefacts supports your development in accurately identifying artefacts during the subsequent interpretation activities.

Relevant learning outcomes

#	Outcome
# 2	Outcome Prepare patients and environments for testing, maintaining safety and patient dignity.
# 3	Outcome Perform EEG recordings in an intensive care setting, with modifications depending on the nature of the patient, including sequential activation procedures, maintaining patient safety.