Description:

This course is the clinical application of sleep related diagnosis and treatment. Students will have the opportunity to further refine their skills in obtaining and evaluating high quality sleep recordings and gaining clinical competence associated with advanced-level polysomnographic technology skills. Enrollment in certain courses may require a professional liability fee of $16.00. Students will be notified via their JCCC student e-mail account if the fee is due and instructions on how to pay the fee. 24 hrs. clinical/wk.

Supplies: Refer to the instructor's course syllabus for details about any supplies that may be required.

Textbook(s): For information see - http://bookstore.jccc.net

Course Fees: NONE

Course Objectives:

Upon successful completion of this course the student should be able to:

1. Assess the physician’s polysomnographic request in order to determine its completeness and appropriateness in ensuring valid data collection.
2. Assess the patient’s medical history and interview the patient to anticipate the nature and likelihood for special testing requirements or medical intervention.
3. Orient the patient in preparation for polysomnographic procedures and possible interventions.
4. Select, calibrate, apply, maintain and troubleshoot polysomnographic related equipment to ensure valid data collection and in accordance with established guidelines.
5. Acquire, verify, and document and respond to calibrations, events and conditions associated with the polysomnographic procedure or protocol.
6. Determine and implement appropriate therapeutic interventions according to established guidelines.
7. Follow policies and procedures in establishing patient safety measures and in responding to emergency situations.
8. Score sleep stages and arousals and related respiratory, movement and miscellaneous events to facilitate interpretation of sleep study results.
9. Generate and validate a report of the scoring of objective and subjective data in order to summarize the polysomnographic procedure.
10. Demonstrate personal behaviors consistent with professional and employer expectations, to include dependable attendance and punctuality, appropriate professional appearance and preparedness, positive interaction skills, adaptability to interruptions and participation in continuing education activities.
11. Identify and integrate logistical approaches to improve timing, efficiency and decision making without compromise to patient care in completing assigned activities.

Content Outline & Competencies:

I. Pre-Tesing Phase
   A. Verify the medical order and protocol
   B. Assess the history, physical information, medications, procedure
request, and study protocol to determine completeness and
appropriateness.
   C. Determine special precautions related to infection control and other
patient-specific factors
   D. Recognize and clarify unclear, inappropriate, or contradictory
orders.
   E. Obtain and review the sleep history and pre-sleep questionnaires
   F. Confirm patient’s medications and identify caffeine or alcohol
intake
   G. Assess and respond to the patient's special needs (age, cognitive
level, physical or emotional discomfort, ability to cooperate, etc.)
   H. Recognize and respond to any special testing considerations or
medical interventions that may be needed based on patient assessment.
   I. Explain pre-testing, testing and post-testing procedures to a
patient in terms appropriate for the patient’s age and mental or
cognitive status
   J. Orient the patient to their preparation/testing schedule and the
sleep center, including their sleep room and bathroom/changing area and
where to access food, water, and medication storage

II. Prepare, Organize and Apply Necessary Equipment and Monitors	
   A. Determine, gather, and prepare the necessary equipment and supplies
needed to conduct the specified study or protocol.
   B. Correctly measure, apply and connect electrodes, sensors and
monitors based on patient specific order/procedure and
internationally-accepted standards
   C. Check for proper function and appropriate signal according to
accepted standards
   D. Interface electrodes and ancillary equipment to data acquisition and
recording system.
   E. Label recording with patient demographic information, study
information, sleep location and technologist identification
   F. Set up a correct montage based on patient orders/procedure and
verify that proper filter and sensitivity settings are selected
   G. Calibrate all necessary equipment for the procedure as ordered
   H. Implement equipment and physiologic (bio)calibrations
   I. Verify proper electrode impedance values and signal quality of all
channels
   J. Adjust equipment to achieve proper function and report deviations
from the ordered procedure

III. Monitoring, Documentation, and Therapeutic Interventions
   A. Adhere to procedural protocols, to include MSLT, MWT, parasomnia
studies, PAP therapy and supplemental oxygen titration.
   B. Demonstrate the procedure for documenting and reporting routine
observations, therapeutic levels, clinical events, changes in procedure,
and other significant events to facilitate scoring and interpretation of
polysomnographic results
   C. Determine and take appropriate corrective action to assure proper
signal display during the monitoring and therapeutic phases of the study.
   D. Report any adverse clinical conditions through the use of
appropriate monitoring and assessment skills.
   E. Perform routine PAP mask sizing, mask fitting, and headgear
adjustment.
   F. Titrate therapeutic interventions to achieve optimal and safe
clinical outcomes.
   G. Follow lights-on procedures to verify integrity of collected data
and complete the data collection process.
   H. Demonstrate appropriate removal, maintenance, and cleaning of sleep
monitoring and therapeutic equipment.
   I.Administer a post-study questionnaire and finalize documentation of
required paperwork.

IV. Polysomnographic Record Scoring and Report Generation
   A. Review study-related documentation that may impact record scoring
procedures, including technologist worksheets and comments, patient
history and questionnaires, and calibration data.
   B. Evaluate sleep architecture and micro-architecture by comparing
sleep/wake data obtained from the study to typical findings.  
   C. Identify sleep onset, percent sleep stages (Wake, I, II, III, IV,
and REM), total recording time, total movement time, REM onset, and
arousals using sleep/wake data obtained from the study.  
   D. Score a PSG, PAP titration study, and MSLT/MWT according to
professionally accepted guidelines.
   E. Apply arousal scoring criteria to sleep/wake data according to
professionally accepted guidelines.
   F. Apply movement-related (PLM, non-PLM, and body) event scoring
criteria to sleep/wake data according to professionally accepted
guidelines.
   G. Apply cardiac-related (potentially life-threatening abnormalities)
event scoring criteria to sleep/wake data according to professionally
accepted guidelines.
   H. Apply respiratory-related (apnea, hypopnea, periodic breathing,
snoring, Cheyne-Stokes breathing, SpO2 desaturation events, event-related
CO2 changes, and upper airway resistance) event scoring criteria to
sleep/wake data according to professionally accepted guidelines.
   I. Identify other sleep-related activities, such as seizure activity,
alpha-delta sleep, drug spindles, and other significant EEG
abnormalities.
   J. Utilize data from PSGs, PAP titrations, MSLTs, MWTs and other
diagnostic and therapeutic procedures to determine the following
parameters:
      1. Lights-out/lights-on times.
      2. Total recording and total sleep time.
      3. Sleep efficiency.
      4. Amount and percentage of stages of sleep, REM sleep, NREM sleep,
movement, and wake time.
      6. Initial sleep latency and latency to each sleep stage.
      8. REM sleep episode assessment (# of episodes and REM density).
      9. Arousal (RERA, respiratory, spontaneous, limb movement) analysis
(in 	both REM and NREM).
     10. Range and averages for heart and respiratory rate.
     11. Percent of apneic sleep time
     12. Apnea index, hypopnea index, and combined apnea/hypopnea index
(AHI) in both REM and NREM).
     13. Respiratory disturbance index (RDI).
     14. Respiratory events per body position for total sleep (in both REM
and NREM).
     15. Range and averages for oxygen saturation level (in both REM and
NREM).
     16. Range and averages for respiratory event duration per total sleep
(in both REM and NREM).
     17. Number of periodic limb movements per total sleep (in both REM
and NREM).
     18. PLM index with and without arousal.
   K. Retrieve, save, and archive patient information, sleep/wake data and
test results into the computer.
   L. Recognize and correct invalid patient information, sleep/wake data
and test results.
   M. Generate and verify accurate computerized reports by tabulating
sleep/wake and clinical event data.

V. Technologist Professional Standards and Patient Safety and Emergency
Procedures
   A. Comply with the BRPT Standards of Conduct
   B. Follow laboratory and procedural protocols, guidelines, and
standards regarding safety and infection control issues
   C. Demonstrate effective written, non-verbal and verbal communication
skills
   D. Maintains a professional demeanor and interactions at all times with
staff, supervisor, patients and other health care professional
   E. Maintains professional responsibilities as it relates to attendance,
punctuality, appearance, conduct and continuing education activities.
   F. Recognize personal limitations and demonstrate ability to follow
directions
   G. Recognize and respond to patient safety and emergency situations
   H. Demonstrate proper techniques for infection control
   I. Integrate logistical approaches to improve timing, efficiency, and
decision making without compromise to patient care in completing assigned
activities.

Methods of Evaluation of Competencies:

Evaluation of student mastery of course competencies will be accomplished using the following methods:

Performance		                        60-75%
Case Presentations and project assignments	10-20%
Professional habits and attitudes		10-20%

Grade Criteria:

A  =   92-100%  	
B  =   83-91%  	
C  =   75-82%*	
D  =   67-74%	
F  =    0 - 66%

*minimum required to continue in program

Caveats:

1. Students will have provided proof of health conducive to being in a health care
2. environment. In addition, drug screening and other requirements may be imposed by clinical agencies. Students are responsible for any and all costs related to their health care or other imposed requirements.
3. Students will need to provide their own transportation to and from scheduled clinical activities.
4. Students are expected to comply with the JCCC Student Code of Conduct as detailed in the JCCC College Catalog. Failure to comply may result in a faculty decision regarding program promotion and constitute a reason to fail the course.
5. Students are expected to comply with the appearance, attendance and other program policies described in the Program Administrative Guideline Handbook.
6. A grade of “C” or better is required for the course for program promotion to subsequent polysomnography course work.
7. Students will need basic word processing and Internet skills for the completion of some papers, exercises and projects.

Disabilities:

If you are a student with a disability, and if you will be requesting accommodations, it is your responsibility to contact Access Services. Access Services will recommend any appropriate accommodations to your professor and his/her director. The professor and director will identify for you which accommodations will be arranged.

JCCC provides a range of services to allow persons with disabilities to participate in educational programs and activities. If you desire support services, contact the office of Access Services for Students With Disabilities (913) 469-8500, ext. 3521 or TDD (913) 469-3885. The Access Services office is located in the Success Center on the second floor of the Student Center.