Unit of competency details

Descriptor 

This unit of competency describes the skills and knowledge required to attach a holter monitor to produce a diagnostic trace and analyse the trace following the monitoring process

Application 

Work will be performed within a prescribed range of functions involving routine and non-routine methods and procedures which require the exercise of some discretion and judgement

All procedures are carried out in accordance with organisation policies and procedures, occupational health and safety policies and procedures, current infection control guidelines and Australian and New Zealand Standards for maintaining infection control

All tasks are carried out in accordance with State or Territory legislative requirements

Pre-requisite unit 

This unit must be assessed after successful achievement of pre-requisite:

• HLTCA401C Perform electrocardiography (ECG)

Employability Skills 

This unit contains Employability Skills

Elements define the essential outcomes of a unit of competency.

The Performance Criteria specify the level of performance required to demonstrate achievement of the Element.

ELEMENT 

PERFORMANCE CRITERIA 

1. Prepare equipment for use

1.1 Check equipment  for good working order

1.2 Check materials  for availability and supply

1.3 Insert new battery and cassette tape correctly into holter monitor

2. Prepare client for holter monitor

2.1 Receive and process the request  for holter monitor in accordance with organisation procedures

2.2 Identify the client correctly following the organisation's guidelines for preventing client misidentification

2.3 Reassure and provide information to the client regarding the ECG procedure appropriately and completely

2.4 Involve the client fully in discussions about their treatment using language they can understand

2.5 Provide the client with the opportunity to ask questions and discuss areas of concern

2.6 Record client information 

2.7 Review client medical history and address pre-existing conditions

2.8 Obtain and document consent following ethical and legal requirements

3. Attach holter monitor electrodes

3.1 Maintain the client's privacy and dignity throughout procedure

3.2 Complete preparation of client's skin  for electrode placement as required

3.3 Position the client correctly and comfortably and place electrodes in accordance with client's needs and current standards

3.4 Attach leads correctly and double check lead placement

3.5 Take a trial trace and check for interference, wandering baseline and amplitude

3.6 Advise supervisor or an appropriate person if you think a client may be at risk

4. Analyse holter monitor trace

4.1 Remove the holter monitor from client

4.2 Review and correct the computer analysis of holter tape

4.3 Identify and action abnormal ECG patterns which require immediate medical attention

4.4 Print the full report and submit to cardiologist for review

4.5 Print final report printed and send to requesting medical officer

5. Complete holter monitor process

5.1 Remove holter monitor leads and electrodes from client

5.2 Provide client with assistance as required on completion of procedure

5.3 Clean holter monitor and leads on completion of procedure

5.4 Dispose of disposable holter monitor electrodes and other materials in accordance with waste management procedures

5.5 Remove holter monitor battery from device

5.6 Store holter monitor leads in accordance with manufacturer's specifications

5.7 Store holter monitor machine in accordance with manufacturer's specifications and OHS policy and procedures

REQUIRED SKILLS AND KNOWLEDGE 

This describes the essential skills and knowledge and their level required for this unit.

Essential knowledge :

The candidate must be able to demonstrate essential knowledge required to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

This includes knowledge of:

• Anatomy and physiology relevant to holter monitoring and interpretation
• Causes of the common trace interference and the appropriate remedies
• Confidentiality and privacy requirements of client information
• Electrical safety requirements
• Principles of function, usage, indications, limitations and care of equipment relevant for performance of holter monitoring
• Routine maintenance policy and procedures for equipment

Essential skills :

It is critical that the candidate demonstrate the ability to:

• Communicate effectively with clients in relation to the procedure and manage clients' anxiety level
• Comply with organisation policies and procedures including those of OHS and infection control
• Demonstrate all steps that must be taken to ensure equipment is safe for use
• Identify and manage all forms of interference with trace
• Identify the equipment requirements for performance of holter monitoring
• Prepare different types of equipment for the performance of holter monitoring
• Produce a good client holter monitor trace
• Recognise boundaries of responsibilities and refer problems to supervisor or other appropriate health professional

continued  ...

Essential skills  (contd ):

In addition, the candidate must be able to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

This includes the ability to:

• Communicate with people from diverse cultural and linguistic backgrounds
• Correctly operate of holter monitor machine
• Correctly prepare skin, place electrodes and anchor electrodes and leads
• Deal with conflict
• Identify a holter monitor trace that is unsatisfactory for diagnostic purposes
• Manage the known common interferences in the production of a holter monitor trace
• Prepare and use equipment for performance of holter monitoring
• Produce a holter monitor trace satisfactory for diagnostic purposes
• Solve problems Problem including the ability to use available resources
• Take into account opportunities to address waste minimisation, environmental responsibility and sustainable practice issues
• Use effective verbal and non verbal communication skills with a range of internal and external persons
  Organisation may require competence in English or a community language, depending on client group
• Use numeracy skills ranging from the ability to complete basic arithmetic calculations, recording stock levels and statistical information
• Use oral communication skills required to fulfil job roles in a safe manner and as specified by the organisation, including skills in asking questions, providing clear information, listening to and understanding workplace instructions, and clarifying workplace instructions when necessary
• Use reading and writing skills required to fulfil job roles in a safe manner and as specified by the organisation
  The level of skill required involves reading and documenting clinical information and understanding policy and procedure manuals
• Work with others and display empathy with client and relatives

EVIDENCE GUIDE 

The evidence guide provides advice on assessment and must be read in conjunction with the Performance Criteria, Required Skills and Knowledge, the Range Statement and the Assessment Guidelines for this Training Package.

Critical aspects for assessment and evidence required to demonstrate this competency unit :

• The individual being assessed must provide evidence of specified essential knowledge as well as skills
• Where, for reasons of safety, access to equipment and resources and space, assessment takes place away from the workplace, simulations should be used to represent workplace conditions as closely as possible
• Consistency of performance should be demonstrated over the required range of workplace situations

Access and equity considerations :

• All workers in the health industry should be aware of access and equity issues in relation to their own area of work
• All workers should develop their ability to work in a culturally diverse environment
• In recognition of particular health issues facing Aboriginal and Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on health of Aboriginal and Torres Strait Islander people
• Assessors and trainers must take into account relevant access and equity issues, in particular relating to factors impacting on health of Aboriginal and/or Torres Strait Islander clients and communities

Context of and specific resources for assessment :

Relevant organisation policy, guidelines, procedures and protocols

Method of assessment 

• Clinical skills involving direct client care are to be assessed initially in a simulated clinical setting (laboratory). If successful, a second assessment is to be conducted during workplace application under direct supervision
• Observation of work activities when performing holter monitoring
• Observation of simulation and/or role play when performing holter monitoring
• Discussion of physical and/or behavioural contingency scenarios involving duty of care
• Authenticated transcripts of relevant education/ training courses
• Recognition of relevant life/work experience
• Written assessments/projects, questioning, e-learning can be used to assess knowledge
• Authenticated reports of experience in performing holter monitoring (documentation associated with performance reviews, supervisor/coordinator evaluations of work performance)
• Training records associated with first aid, occupational health and safety training, orientation/induction training, safe manual handing, universal infection control procedures
• Case study and scenario as a basis for discussion of issues and strategies to contribute to best practice

Related units :

• This unit can be assessed independently, however holistic assessment practice with other health services units of competency is encouraged

RANGE STATEMENT 

The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance.

Checking of equipment must include :

• Cleanliness
• New battery
• Calibration
• Settings appropriate for a 3 or 5 lead rhythm
• Maintenance in accordance to the relevant Australian Standards

Materials may include :

• Electrodes
• Battery
• Cassette tape
• Surgical tape
• Skin prep
• Tissues

Request may come from :

• Registered medical practitioner
• Registered nurse

Procedural information may include :

• How to complete diary
• When to press event button
• How to turn off device

Client information may include :

• Name
• Medical record number
• Date and time
• Client symptoms
• Time holter monitoring started

Skin preparation may include :

• Cleaning and abrading the skin
• Drying thoroughly prior to electrode application

Review and correction of computer analysis of holter tape may include :

• Review and correct all templates
• All events
• Arrhythmias
• Abnormal rates

Assistance for the client may include :

• Cleaning of gel from chest and limbs
• Re-arranging of clothing