Portions of the Design Document for a course on Neonatal Electroencephalography 1 Introduction... 2 1.1. Organizational Setting... 2 1.1.1. Type of Business... 2 1.1.2. Who They Serve... 2 1.2. Current Situation... 2 1.3. Desired Situation... 2 1.4. Gap... 3 1.5. Rationale for Training... 3 1.6. Intervention... 3 1.7. Target Population... 3 1.8. Instructional Goal... 3 2. A Portion of the Instructional Goal Analysis... 4 3 A Portion of the Performance Objectives and Assessment Items Specifications... 6 1
1 Introduction 1.1. Organizational Setting 1.1.1. Type of Business Children s Hospital of Philadelphia (CHOP) is a leading pediatric hospital and research facility. Originally established over 150 years ago, CHOP is recognized as a premier children s hospital in the United States. The Division of Neonatology provides comprehensive care for critically ill patients at the CHOP facility and through intensive care nurseries at Hospital of University of Pennsylvania, Pennsylvania Hospital, Chester County Hospital, Doylestown Hospital, Holy Redeemer Hospital and Medical Center, and Phoenixville Hospital. Care teams include fellows, residents, physician assistants, staff nurses, neonatal nurse practitioners, clinical nurse specialists, ECMO specialists, clinical staff, charge nurses, respiratory care practitioners, social workers, dietitians, case managers, physical therapists, occupational therapists, speech therapists and lactation specialists. According to CHOP s website, Children's Hospital's Division of Neonatology and Newborn/Infant Intensive Care Unit is ranked No. 1 in the nation for neonatal care in U.S. News & World Report's 2008 Best Children's Hospitals survey. We also have been ranked the No. 1 neonatal care program in the nation by Parents magazine. 1.1.2. Who They Serve The Division of Neonatology serves critically ill newborns and infants up to forty-eight weeks old. Each year, the Newborn/Infant Intensive Care Unit (NICU) cares for more than 900 babies each year. The Division of Neonatology also maintains a Neonatal Outreach Program to serve referring emergency physicians, neonatologists, and pediatricians. The Outreach Program facilitates weekly clinical conferences and consensus meetings. Finally, the Division of Neonatology offers an annual continuing medical education course for neonatal healthcare providers to keep them up to date with advances in treating sick neonates. 1.2. Current Situation CHOP s Neonatal care team includes a number of bedside caregivers such as nurses, residents and physicians. While these caregivers represent a large spectrum of skills, most of them are not skilled at using or interpreting electroencephalography (EEG) information in treating patients. Disorders that are treatable but not clinically visible are given inadequate attention and diagnostic errors are made due to a lack of information and skills in EEG. 1.3. Desired Situation 2
Better knowledge of EEG monitoring in the neonate will enable caregivers to detect electrographic seizures and interpret characterization of the ongoing EEG in order to provide improved care to patients. 1.4. Gap Bedside caregivers of neonates are unable to recognize common, normal EEG features, recognize abnormal features of EEG, or identify seizures that would aid in the treatment of neonates. 1.5. Rationale for Training Neonatal caregivers are not routinely trained in EEG analysis, but these skills enable bedside caregivers to diagnose disorders that are not clinically visible. Bedside caregivers have differing skill levels and require training that is self-initiated, self-paced, and can be completed in the time available to the caregiver, which is minimal and includes frequent interruptions. 1.6. Intervention Neonatal caregivers will receive self-paced training in Neonatal EEG in order to recognize and treat disorders diagnosed by EEG. Upon completing training, learners will be able to: Describe EEG monitoring procedures EEG features EEG patterns and artifacts Differentiate EEG patterns and artifacts And develop a blueprint for using EEG analysis for bedside care 1.7. Target Population The target audience of the EEG curriculum includes: Neonatal Nurses Neonatologists Neurology Residents and Fellows All of these learners have a variety of bedside skills, and possess advanced knowledge in working with neonates, but most are lacking skills in reading and interpreting EEGs, particularly the EEGs of neonates. 1.8. Instructional Goal Neonatal bedside caregivers will be able to describe EEG monitoring procedures, recognize EEG features, identify EEG patterns and artifacts, differentiate EEG patterns and artifacts, and interpret EEG data in order to treat neonatal patients at the bedside. 3
2. A Portion of the Instructional Goal Analysis Domain: Intellectual Describe EEG procedures EEG features patterns Differentiate patterns Interpret data 1 2 3 4 5 rationale 1.1 Describe 10-20 system 1.2 selection methods 1.3 application methods 1.4 Discuss generation of EEG activity 1.5 cortical locations 1.2.1 electrode locations 1.2.2 mistakes 1.2.2.1 Label measurements Label frontal Label central Label parietal Label temporal 1.2.2.1 1.2.2.2 1.2.2.3 1.2.2.4 1.2.2.5 landmarks 1.2.2.8 4 Label occipital 1.2.2.6 Label occipital 1.2.2.7
Describe EEG procedures EEG features patterns Differentiate patterns Interpret data 1 2 3 4 5 evolution of 3.1 abnormal EEG features 3.2 normal transients 3.1.5 abnormal positive sharps 3.2.5 synchrony 3.1.4 abnormal transients 3.2.4 symmetry 3.1.3 abnormal voltage 3.2.3 transitions asymmetry 3.1.2 3.2.2 continuity 3.1.1 5 discontinuity 3.2.1
3 A Portion of the Performance Objectives and Assessment Items Specifications Skill Performance Objective Example Assessment Item Notes cortical locations Given a diagram, learners will Using the diagram on the left, drag and drop identify cortical locations to include the cortical labels to their correct locations. frontal, temporal, parietal, and occipital lobes; the central region; and vertex. electrode locations in the modified neonatal 10-20 system sources of artifact electrographic seizures Given a diagram, learners will identify electrode locations to include Fp1, Fp2, Fz, C3, C4, Cz, T3, T4, Pz, O1, O2. On prompting, learners will recognize sources of artifact including physiologic and nonphysiologic causes. Given EEG traces, learners will identify electrographic EEG seizures with 85% accuracy. Using the diagram on the left, drag and drop the electrode labels to their correct locations. Select all of the options that indicate physiologic sources of artifact: Pulse Chest physiotherapy ECMO Eye blinks Electrical interference Tremors EKG Emesis Respirations Mechanical Ventilators Locate the seizure in the EEG trace below. Position your mouse over the uppermost left corner of the seizure s beginning, and drag the mouse until you have outlined the entire seizure. 6
Skill Performance Objective Example Assessment Item Notes seizure mimics Given examples of seizures and artifacts, learners will identify seizure mimics as distinct from seizure with 85% accuracy. The EEG traces below include two examples of EEG seizures and several seizure mimics. Drag the labels correctly to the outlined areas. EMG artifact EKG artifact Given several of EEG traces including artifacts, learners will identify EMG artifacts. Given several of EEG traces including artifacts, learners will always identify EKG artifacts. From the following five traces, choose the example that exhibits an EMG artifact. From the following five traces, choose the example that exhibits an EKG artifact. Depending on specificity and difficulty of this question, labels may include seizure and mimic or the mimics can be delineated: sucking, patting, eye movements, etc. 7