Credential Maintenance Program...Credential Maintenance Program Assessment Content Outline As a credentialed practitioner, you already know maintaining and enhancing the knowledge

Credential Maintenance ProgramAssessment Detailed Content Outlines

Respiratory Therapist

Neonatal/Pediatric Specialty

Adult Critical Care Specialty

Pulmonary Function Technology

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Sleep Disorders Specialty

Credential Maintenance Program

Assessment Content Outline

As a credentialed practitioner, you already know maintaining and enhancing the knowledge established on initial credentialing is a crucial component to professional development and career advancement, as well as patient care. That’s why maintaining your credential(s) through the Credential Maintenance Program (CMP) is necessary to ensure your continued competence as respiratory care methodologies and technologies change over time.

The CMP has three options to maintain your credential(s) 1) take quarterly assessments and/or document up to 30 continuing education credits, 2) earn another NBRC credential, or 3) pass the same credentialing examination again. If you choose to maintain your credentials through option 1, your performance on the assessments will determine whether or not you have to document CE with the NBRC.

The assessment component is key in our goal of strengthening the relationship between competencies of credential holders and expectations linked to those credentials. Content will focus on tasks that put patients at risk and have a high pace of change. The assessment and CE option of the CMP include the following features:

• Complete quarterly assessments through year four of your certification cycle. Assessment items cover topics that put patients at risk or practice that changes most rapidly.

• Assessment progress will be kept track of automatically and displayed in your personal Credential Maintenance

Dashboard along with your current CE requirement.

• Revisit learning content linked to assessment items and monitor progress from the Credential Maintenance Dashboard.

• Quarterly review of your progress and peer performance.

• Seek the continuing education (CE) you need to optimize patient care to satisfy your CE requirement.

• Document the number of CE indicated on your dashboard during the fifth year of your certification cycle, if

needed. The number of CE required is based on assessment performance and categorized in three zones: Green, Yellow, and Red. Strong performance on the assessments will place you in the Green or Yellow Zones, eliminating or reducing the amount of CE required.

• Participation in the CMP is separate from licensing requirements in your state. You must continue to comply

with your state’s requirements. For more information about all CMP options, visit nbrc.org.






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Effective: January 2020

© 2019. NBRC. All rights reserved. ~ 1 ~


Respiratory Therapist Assessment Detailed Content Outline

Items are linked to open cells.

*Test takers will be asked to integrate (apply or analyze) information.

Items Cognitive

Level

Ethics

R

ecall

Integration*

Totals

First Quarter of the Calendar 10

I. PATIENT DATA 4 4 8

A. Evaluate Data in the Patient Record 2 2 4

1. Patient history, for example, • history of present illness (HPI) • orders • medication reconciliation • progress notes • DNR status / advance directives • social, family, and medical history

2. Physical examination relative to the cardiopulmonary system

3. Lines, drains, and airways, for example, • chest tube • vascular lines • artificial airway

4. Laboratory results, for example, • CBC • electrolytes • coagulation studies • sputum culture and sensitivities • cardiac biomarkers

5. Blood gas analysis and / or hemoximetry (CO- oximetry) results

6. Pulmonary function testing results, for example • spirometry • lung volumes • DLCO

7. 6-minute walk test results

8. Imaging study results, for example, • chest radiograph • CT scan • ultrasonography and / or echocardiography • PET scan • ventilation / perfusion scan







Items Cognitive

Level

Ethics

R

ecall

Integration*

Totals

9. Maternal and perinatal / neonatal history, for example, • APGAR scores • gestational age • L / S ratio

10. Sleep study results, for example, • apnea-hypopnea index (AHI)

11. Trends in monitoring results

a. fluid balance

b. vital signs

c. intracranial pressure

d. ventilator liberation parameters

e. pulmonary mechanics

f. noninvasive, for example, • pulse oximetry • capnography • transcutaneous

g. cardiac evaluation / monitoring results, for example, • ECG • hemodynamic parameters

12. Determination of a patient's pathophysiological state

B. Perform Clinical Assessment 1 1 2 1. Interviewing a patient to assess

a. level of consciousness and orientation, emotional state, and ability to cooperate

b. level of pain

c. shortness of breath, sputum production, and exercise tolerance

d. smoking history

e. environmental exposures

f. activities of daily living

g. learning needs, for example, • literacy • preferred learning style • social / cultural







Items Cognitive

Level

Ethics

R

ecall

Integration*

Totals

2. Performing inspection to assess

a. general appearance

b. characteristics of the airway, for example, • patency • Mallampati classification • tracheal shift

c. cough, sputum amount and character

d. status of a neonate, for example, • APGAR score • gestational age

e. skin integrity, for example, • pressure ulcers • stoma site

3. Palpating to assess

a. pulse, rhythm, intensity

b. accessory muscle activity

c. asymmetrical chest movements, tactile fremitus, crepitus, tenderness, tactile rhonchi, and / or tracheal deviation

4. Performing diagnostic chest percussion

5. Auscultating to assess

a. breath sounds

b. heart sounds and rhythm

c. blood pressure

6. Reviewing a chest radiograph to assess

a. quality of imaging, for example, • patient positioning • penetration • lung inflation

b. presence and position of airways, lines, and drains

c. presence of foreign bodies

d. heart size and position







Items Cognitive

Level

Ethics

R

ecall

Integration*

Totals

e. presence of, or change in,

(i) cardiopulmonary abnormalities, for example, • pneumothorax • consolidation • pleural effusion • pulmonary edema • pulmonary artery size

(ii) diaphragm, mediastinum, and / or trachea

C. Perform Procedures to Gather Clinical Information

1 0 1

1. 12-lead ECG

2. Noninvasive monitoring, for example, • pulse oximetry • capnography • transcutaneous

3. Peak flow

4. Mechanics of spontaneous ventilation linked to tidal volume, minute volume, maximal inspiratory pressure, and vital capacity

5. Blood gas sample collection

6. Blood gas analysis and / or hemoximetry (CO- oximetry)

7. Oxygen titration with exercise

8. Cardiopulmonary calculations, for example, • P(A-a)O2 • VD / VT • P / F • OI

9. Hemodynamic monitoring

10. Pulmonary compliance and airways resistance

11. Plateau pressure

12. Auto-PEEP determination

13. Spontaneous breathing trial (SBT)

14. Apnea monitoring

15. Apnea test (brain death determination)







Items Cognitive

Level

Ethics

R

ecall

Integration*

Totals

16. Overnight pulse oximetry

17. CPAP / NPPV titration during sleep

18. Cuff management, for example, • tracheal • laryngeal

19. Sputum induction

20. Cardiopulmonary stress testing

21. 6-minute walk test

22. Spirometry outside or inside a pulmonary function laboratory

23. DLCO inside a pulmonary function laboratory

24. Lung volumes inside a pulmonary function laboratory

25. Tests of respiratory muscle strength - MIP and MEP

26. Therapeutic bronchoscopy

D. Evaluate Procedure Results 0 1 1

1. 12-lead ECG


3. Peak flow

4. Mechanics of spontaneous ventilation linked to tidal volume, minute volume, maximal inspiratory pressure, and vital capacity

5. Blood gas analysis and / or hemoximetry (CO- oximetry)

6. Oxygen titration with exercise

7. Cardiopulmonary calculations, for example, • P(A-a)O2 • VD / VT • P / F • OI


9. Pulmonary compliance and airways resistance

10. Plateau pressure

11. Auto-PEEP







Items Cognitive

Level

Ethics

R

ecall

Integration*

Totals

12. Spontaneous breathing trial (SBT)

13. Apnea monitoring

14. Apnea test (brain death determination)

15. Overnight pulse oximetry

16. CPAP / NPPV titration during sleep

17. Cuff status, for example, • laryngeal • tracheal

18. Cardiopulmonary stress testing

19. 6-minute walk test

20. Spirometry outside or inside a pulmonary function laboratory

21. DLCO inside a pulmonary function laboratory

22. Lung volumes inside a pulmonary function laboratory

23. Tests of respiratory muscle strength - MIP and MEP

E. Recommend Diagnostic Procedures 0 0 0

1. Testing for tuberculosis

2. Laboratory tests, for example, • CBC • electrolytes • coagulation studies • sputum culture and sensitivities • cardiac biomarkers

3. Imaging studies

4. Bronchoscopy

a. diagnostic

b. therapeutic

5. Bronchoalveolar lavage (BAL)

6. Pulmonary function testing


8. Blood gas and/or hemoximetry (CO-oximetry)

9. ECG







Items Cognitive

Level

Ethics

R

ecall

Integration*

Totals

10. Exhaled gas analysis, for example, • CO2 • CO • FENO


12. Sleep studies

13. Thoracentesis

II. TROUBLESHOOTING AND QUALITY CONTROL OF DEVICES, AND INFECTION CONTROL

3 4 7

A. Assemble / Troubleshoot Devices 1 4 5

1. Medical gas delivery interfaces, for example, • mask • cannula • heated high-flow nasal cannula

2. Long-term oxygen therapy

3. Medical gas delivery, metering, and /or clinical analyzing devices, for example, • concentrator • liquid system • flowmeter • regulator • gas cylinder • blender • air compressor • gas analyzers

4. CPAP / NPPV with patient interfaces

5. Humidifiers

6. Nebulizers

7. Metered-dose inhalers, spacers, and valved holding chambers

8. Dry-powder inhalers (DPI)

9. Resuscitation equipment, for example, • self-inflating resuscitator • flow-inflating resuscitator • AED

10. Mechanical ventilators

11. Intubation equipment







Items Cognitive

Level

Ethics

R

ecall

Integration*

Totals

Second Quarter of the Calendar 10

12. Artificial airways

13. Suctioning equipment, for example, • regulator • canister • tubing • catheter

14. Blood analyzers, for example, • hemoximetry (CO-oximetry) • point-of-care • blood gas

15. Patient breathing circuits

16. Hyperinflation devices

17. Secretion clearance devices

18. Heliox delivery device

19. Portable spirometer

20. Testing equipment in a pulmonary function laboratory

21. Pleural drainage

22. Noninvasive monitoring, for example, • pulse oximeter • capnometer • transcutaneous

23. Bronchoscopes and light sources


a. pressure transducers

b. catheters, for example, • arterial • pulmonary artery

B. Ensure Infection Prevention 1 0 1

1. Adhering to infection prevention policies and procedures, for example, • Standard Precautions • donning/doffing • isolation







Items Cognitive

Level

Ethics

R

ecall

Integration*

Totals

2. Adhering to disinfection policies and procedures

3. Proper handling of biohazardous materials

C. Perform Quality Control Procedures 1 0 1

1. Blood analyzers

2. Gas analyzers

3. Pulmonary function equipment for testing

a. spirometry results

b. lung volumes

c. diffusing capacity (DLCO)

4. Mechanical ventilators

5. Noninvasive monitors

III. INITIATION AND MODIFICATION OF INTERVENTIONS

3 22 25

A. Maintain a Patent Airway Including the Care of Artificial Airways

0 3 3

1. Proper positioning of a patient

2. Recognition of a difficult airway

3. Establishing and managing a patient’s airway

a. nasopharyngeal airway

b. oropharyngeal airway

c. esophagealtracheal tubes / supraglottic airways

d. endotracheal tube

e. tracheostomy tube

f. laryngectomy tube

g. speaking valves

h. devices that assist with intubation, for example, • endotracheal tube exchanger • video laryngoscopy

4. Performing tracheostomy care

5. Exchanging artificial airways

6. Maintaining adequate humidification

7. Initiating protocols to prevent ventilator-associated infections

8. Performing extubation







Items Cognitive

Level

Ethics

R

ecall

Integration*

Totals

B. Perform Airway Clearance and Lung Expansion Techniques

0 1 1

1. Postural drainage, percussion, or vibration

2. Suctioning, for example, • nasotracheal • oropharyngeal

3. Mechanical devices, for example, • high-frequency chest wall oscillation • vibratory PEP • intrapulmonary percussive ventilation • insufflation / exsufflation

4. Assisted cough, for example, • huff • abdominal thrust

5. Hyperinflation therapy

6. Inspiratory muscle training

C. Support Oxygenation and Ventilation 1 3 4

1. Initiating and adjusting oxygen therapy

2. Minimizing hypoxemia, for example, • patient positioning • secretion removal

3. Initiating and adjusting mask or nasal CPAP

Third Quarter of the Calendar 10

4. Initiating and adjusting mechanical ventilation settings

a. continuous mechanical ventilation

b. noninvasive ventilation

c. high-frequency ventilation

d. alarms

5. Recognizing and correcting patient-ventilator dyssynchrony

6. Utilizing ventilator graphics

7. Performing lung recruitment maneuvers

8. Liberating a patient from mechanical ventilation







Items Cognitive

Level

Ethics

R

ecall

Integration*

Totals

D. Administer Medications and Specialty Gases 1 0 1

1. Aerosolized preparations

a. antimicrobials

b. pulmonary vasodilators

c. bronchodilators

d. mucolytics / proteolytics

e. steroids

2. Endotracheal instillation

3. Specialty gases, for example, • heliox • inhaled NO

E. Ensure Modifications are Made to the Respiratory Care Plan

0 8 8

1. Treatment termination, for example, • life-threatening adverse event

2. Recommendations

a. starting treatment based on patient response

b. treatment of pneumothorax

c. adjustment of fluid balance

d. adjustment of electrolyte therapy

e. insertion or change of artificial airway

f. liberating from mechanical ventilation

g. extubation

h. discontinuing treatment based on patient response

i. consultation from a physician specialist

3. Recommendations for changes

a. patient position

b. oxygen therapy

c. humidification

d. airway clearance

e. hyperinflation

f. mechanical ventilation







Items Cognitive

Level

Ethics

R

ecall

Integration*

Totals

Fourth Quarter of the Calendar 10

4. Recommendations for pharmacologic interventions

a. bronchodilators

b. anti-inflammatory drugs

c. mucolytics and proteolytics

d. aerosolized antibiotics

e. inhaled pulmonary vasodilators

f. cardiovascular

g. antimicrobials

h. sedatives and hypnotics

i. analgesics

j. narcotic antagonists

k. benzodiazepine antagonists

l. neuromuscular blocking agents

m. diuretics

n. surfactants

o. changes to drug, dosage, administration frequency, mode, or concentration

F. Utilize EvidenceBased Practice 0 1 1

1. Classification of disease severity

2. Recommendations for changes in a therapeutic plan when indicated

3. Application of guidelines, for example, • ARDSNet • NAEPP • GOLD

G. Provide Respiratory Care in HighRisk Situations 0 2 2

1. Emergency

a. cardiopulmonary emergencies, excluding CPR

b. disaster management

c. medical emergency team (MET) / rapid response team

2. Interprofessional communication







Items Cognitive

Level

Ethics

R

ecall

Integration*

Totals

3. Patient transport

a. land / air between hospitals

b. within a hospital

H. Assist a Physician / Provider in Performing Procedures

0 4 4

1. Intubation

2. Bronchoscopy

3. Specialized bronchoscopy, for example, • endobronchial ultrasound (EBUS) • navigational bronchoscopy (ENB)

4. Thoracentesis

5. Tracheotomy

6. Chest tube insertion

7. Insertion of arterial or venous catheters

8. Moderate (conscious) sedation

9. Cardioversion

10. Withdrawal of life support

I. Conduct Patient and Family Education 1 0 1

1. Safety and infection control

2. Home care and related equipment

3. Lifestyle changes, for example, • smoking cessation • exercise

4. Pulmonary rehabilitation

5. Disease / condition management, for example, • asthma • COPD • CF • tracheostomy care • ventilator dependent

Totals 1 10 30 40

* Each test form will include 1 item that engages thinking about ethics to select the best answer. * This item also will

• include content from a task that shows an open cell under the Ethics column. • be written to a cognitive level permitted for the task to which the item is linked.



Additional Specifications Patient Type Maximum Pediatric – 1 month to 17 years of age 1 Neonatal – birth to 1 month of age 1 Adult or General balance

Total 40

Item Codes and Keywords about Patient Conditions

01- GENERAL

02- COPD

03- ASTHMA

04- HEART FAILURE

05- POST-SURGICAL

06- GERIATRIC

07- CARDIOVASCULAR

08- INFECTIOUS DISEASE

09- PULMONARY VASCULAR DISEASE

10- TRAUMA

11- IMMUNOCOMPROMISED HOST

12- NEUROLOGIC

13- ARDS

14- PEDIATRIC

15- DISORDERS OF PREMATURITY

16- PULMONARY EMBOLISM

17- SHOCK

18- BARIATRIC

19- NEONATAL

20- BRONCHIOLITIS

21- NEUROMUSCULAR

22- PSYCHIATRIC

23- CONGENITAL DEFECTS

24- CYSTIC FIBROSIS

25- BURN/INHALATION INJURY

26- LUNG TRANSPLANTATION

27- APNEA

28- INTERSTITIAL LUNG DISEASE

29- DRUG OVERDOSE

30- TRAUMATIC BRAIN INJURY (TBI)

31- SEPSIS

32- LUNG CANCER





Pulmonary Function Technologyü


Effective January 2019



Pulmonary Function Technology Assessment Detailed Content Outline

Multiple-choice items are linked to open cells.


Items Cognitive

Level

Total

Recall

Integration*


I. INSTRUMENTATION / EQUIPMENT 1 4 5

A. Set Up, Maintain, Calibrate 1 2 3 1. Blood gas analyzers 2. CO-oximeters / hemoximeters 3. Spirometers (for example, diagnostic, screening, portable) 4. Peak flow meters 5. Aerosol delivery devices (for example, bronchodilator / bronchial

challenge, dosimeters)

6. Metered dose or dry powder inhalers 7. Valves (for example, directional, demand) 8. Gas analyzers

a. DLCO (for example, gas chromatograph, infrared) b. gas dilution techniques (for example, nitrogen, helium,

oxygen)

c. exercise (for example, CO2, O2) 9. Body plethysmographs

10. Exercise equipment (for example, treadmill, cycle or arm ergometer)

11. ECG monitors (for example, 3-lead, 12-lead) 12. Metabolic measurement systems for exercise testing 13. Gas delivery systems (for example, blenders, flowmeters) 14. Pressure measuring devices (for example, manometers,

transducers, strain gauges)

15. Gas and water absorbers (for example, Drierite®, Permapure® tubing)

16. Emergency management equipment (for example, defibrillator, crash cart)

17. Flexible bronchoscopes and associated equipment 18. Arterial / venous blood collection equipment 19. Information systems equipment (for example, computers, data

backup, networks, printers, security)

20. Quality control devices (for example, calibration syringes, manometers, isothermal lung analog)

21. Gas exchange validation device or DLCO simulator

http://intranet.goamp.com/Logos/AMP%20and%20NBRC%20Logos/For%20Print/High%20Resolution%20JPGs/NBRC%20Seal%202012_HR.jpg







Items Cognitive

Level

Total

Recall

Integration*

22. Infection control materials / methods (for example, sterilization devices, gowns, gloves, masks, filters)

23. Monitors a. pulse oximeters b. blood pressure (for example, manual cuff, automated)

B. Troubleshoot 0 1 1 1. Blood gas analyzers 2. CO-oximeters / hemoximeters 3. Spirometers (for example, diagnostic, screening, portable) 4. Peak flow meters 5. Aerosol delivery devices (for example, bronchodilator / bronchial




oxygen)



11. ECG monitors (for example, 3-lead, 12-lead) 12. Metabolic measurement systems for exercise testing 13. Gas delivery systems (for example, blenders, flowmeters) 14. Pressure measuring devices (for example, manometers,

transducers, strain gauges)

15. Gas and water absorbers (for example, Drierite®, Permapure® tubing)

16. Emergency management equipment (for example, defibrillator, crash cart)

17. Flexible bronchoscopes and associated equipment 18. Arterial / venous blood collection equipment 19. Information systems equipment (for example, computers, data

backup, networks, printers, security)

20. Quality control devices (for example, calibration syringes, manometers, isothermal lung analog)








Items Cognitive

Level

Total

Recall

Integration*

21. Gas exchange validation device or DLCO simulator 22. Infection control materials / methods (for example, sterilization

devices, gowns, gloves, masks, filters)

23. Monitors a. pulse oximeters b. blood pressure (for example, manual cuff, automated)

C. Perform Quality Control 0 1 1 1. Blood gas analyzers 2. CO-oximeters / hemoximeters 3. Spirometers (for example, diagnostic, screening, portable) 4. Peak flow meters 5. Aerosol delivery devices (for example, bronchodilator / bronchial




oxygen)



11. ECG monitors (for example, 3-lead, 12-lead) 12. Metabolic measurement systems for exercise testing


II. PROCEDURES 2 6 8

A. Select Test Protocols and Equipment 1 2 3 1. Spirometry (for example, VC, FVC, FEV1, MVV, flow-volume

loop)

2. Bronchodilator delivery (for example, MDI, DPI, small volume nebulizers)

3. End tidal CO2 4. Blood sample collection (for example, arterial, capillary)

5. Sputum sample collection








Items Cognitive

Level

Total

Recall

Integration*

6. Blood gas analysis (for example, pH, PO2, PCO2)

7. CO-oximetry / hemoximetry

8. Static lung volumes a. gas dilution methods b. body plethysmography

9. DLCO 10. Smoking cessation counseling 11. Patient education (for example, medication delivery, travel,

asthma)

12. Oxygen titration at rest and / or exercise 13. Exercise (stress) testing

a. timed walking test (for example, 6MWT, shuttle walk) b. monitored (for example, ECG, blood pressure, SpO2) c. cardiopulmonary exercise test (for example, VO2max

anaerobic threshold, VO2, VCO2, VD / VT)

d. inspiratory capacity and flow-volume loops during cardiopulmonary exercise testing

14. 12-lead ECG at rest 15. Pulse oximetry 16. Airway responsiveness

a. bronchodilation studies b. bronchial provocation studies (for example, methacholine,

exercise, EVH, mannitol)

17. Airways resistance / conductance measurements by plethysmography

18. Respiratory muscle strength (for example, MIP, MEP) 19. Flexible bronchoscopy assistance (for example, patient

monitoring, specimen preparation, topical anesthesia)

20. Patient safety (for example, standard precautions, adverse events / incidents, cross contamination)

B. Perform the Procedure 1 2 3 1. Spirometry (for example, VC, FVC, FEV1, MVV, flow-volume

loop)


3. End tidal CO2








Items Cognitive

Level

Total

Recall

Integration*

4. Blood sample collection (for example, arterial, capillary) 5. Sputum sample collection 6. Blood gas analysis (for example, pH, PO2, PCO2) 7. CO-oximetry / hemoximetry 8. Static lung volumes

a. gas dilution methods b. body plethysmography


asthma)









18. Respiratory muscle strength (for example, MIP, MEP)


19. Flexible bronchoscopy assistance (for example, patient monitoring, specimen preparation, topical anesthesia)









Items Cognitive

Level

Total

Recall

Integration*

C. Evaluate Validity of Result 0 2 2 1. Spirometry (for example, VC, FVC, FEV1, MVV, flow-volume

loop)


3. End tidal CO2 4. Blood sample collection (for example, arterial, capillary) 5. Sputum sample collection 6. Blood gas analysis (for example, pH, PO2, PCO2) 7. CO-oximetry / hemoximetry 8. Static lung volumes

a. gas dilution methods b. body plethysmography


asthma)






a. bronchodilation studies

b. bronchial provocation studies (for example, methacholine, exercise, EVH, mannitol)










Items Cognitive

Level

Total

Recall

Integration*

19. Flexible bronchoscopy assistance (for example, patient monitoring, specimen preparation, topical anesthesia)


III. DATA MANAGEMENT 1 6 7

A. Calculate Results, Select Reference Ranges and Data 1 1 2

1. Blood gas results (for example, pH, PO2, PCO2)

2. CO-oximetry / hemoximetry results (Hb, O2Hb, COHb, MetHb)

3. Spirometry data (for example, VC, FVC, FEV1, MVV, flow-volume loops)

4. Static lung volumes a. gas dilution b. body plethysmography

5. DLCO 6. Home pulmonary function data (for example, spirometry, peak

flow)

7. Oxygen titration at rest and / or exercise 8. Exercise (stress) test

a. timed walking test (for example, 6 MWT, shuttle walk) b. monitored (for example, ECG, blood pressure, SpO2) c. cardiopulmonary exercise test (for example, VO2max



9. Blood pressure monitoring 10. ECG analysis (for example, arrhythmia, rate, pattern) 11. Pulse oximetry 12. Airway responsiveness











Items Cognitive

Level

Total

Recall

Integration*

14. Respiratory muscle strength (for example, MIP, MEP) 15. Safety data (for example, hand hygiene compliance, event

management)

16. Quality control procedures (for example, mechanical or biologic) 17. Serial pulmonary function testing (for example, trending a single

patient)

18. Clinical history and demographics (for example, age, race, sex, smoking history, medication, clinical indication)

19. Laboratory quality management (for example, customer satisfaction, inventory control, standard operating procedures, department records)


B. Evaluate Reliability of Results 0 2 2 1. Blood gas results (for example, pH, PO2, PCO2) 2. CO-oximetry / hemoximetry results (Hb, O2Hb, COHb, MetHb) 3. Spirometry data (for example, VC, FVC, FEV1, MVV,

flow-volume loops)



flow)





9. Blood pressure monitoring 10. ECG analysis (for example, arrhythmia, rate, pattern) 11. Pulse oximetry








Items Cognitive

Level

Total

Recall

Integration*

12. Airway responsiveness a. bronchodilation studies b. bronchial provocation studies (for example, methacholine,




15. Safety data (for example, hand hygiene compliance, event management)


patient)



C. Evaluate Clinical Implications 0 3 3 1. Blood gas results (for example, pH, PO2, PCO2) 2. CO-oximetry / hemoximetry results (Hb, O2Hb, COHb, MetHb) 3. Spirometry data (for example, VC, FVC, FEV1, MVV,

flow-volume loops)



flow)












Items Cognitive

Level

Total

Recall

Integration*

9. Blood pressure monitoring 10. ECG analysis (for example, arrhythmia, rate, pattern) 11. Pulse oximetry 12. Airway responsiveness




14. Respiratory muscle strength (for example, MIP, MEP) 15. Safety data (for example, hand hygiene compliance, event

management)


patient)



Totals 4 16 20

Specifications by Patient Age Patient Maximum items per form Pediatric 2 General balance

Total 20







ü


Effective Date: January 2019

© 2019. NBRC. All rights reserved. - 1 -


Adult Critical Care Specialty Assessment

Detailed Content Outline



Items

Ethics

Cognitive Levels

Total

Recall

Integration*


I. RESPIRATORY CRITICAL CARE 0 6 6 A. Manage Airways 0 2 2

1. Airway clearance techniques 2. Difficult airway recognition and techniques 3. Advanced techniques during intubation, for example,

• cricoid pressure • tube changers

• specialty visualization devices

4. Artificial airways a. specialty endotracheal tubes, for example,

• subglottic suction • wire-reinforced

• double lumen

b. exchanging endotracheal tubes c. specialty tracheostomy tubes

B. Administer Specialty Gases 0 1 1 1. Nitric oxide, for example,

• initiation • withdrawal 2. Helium-oxygen, for example,

• indications C. Manage Ventilation/Oxygenation 0 3 3

1. Initial settings 2. Advanced modes, for example,

• techniques to enhance ventilation • techniques to enhance oxygenation • techniques to enhance synchrony

3. Noninvasive, for example,

• high flow nasal cannula • mask CPAP

• NPPV

4. Waveform analyses 5. Rescue techniques

a. recruitment maneuvers b. inhaled vasodilators, for example,

• nitric oxide • prostacyclin c. high frequency ventilation

http://staff.goamp.com/Logos/AMP%20and%20NBRC%20Logos/For%20Print/High%20Resolution%20JPGs/NBRC%20Seal%202012_HR.jpg








Items

Ethics

Cognitive Levels

Total

Recall

Integration*

d. prone patient positioning e. extracorporeal life support, for example,

• ECMO


6. Strategies a. liberation (weaning) from mechanical ventilation b. prevention of lung injury from mechanical ventilation c. management of ARDS d. treatment of patients with traumatic injuries, for

example,

• head • cervical spine • chest

• abdomen • long bone fractures • burn/inhalation

e. exercise and rehabilitation while receiving ventilatory support

f. PEEP management, for example,

• mild hypoxemia • severe hypoxemia

7. Differential / independent lung ventilation, for example,

• indications • techniques

8. Intrahospital transport of unstable and high-risk patients 9. Optimizing patient-ventilator interaction

D. Deliver Pharmacologic Agents 0 0 0 1. Aerosolized agents other than bronchodilators, for example,

• vasodilators • antimicrobials 2. Airway instillations other than for ACLS, for example,

• epinephrine • lidocaine

• cold saline • topical thrombin

3. Optimization of aerosol delivery, for example, • during mechanical

ventilation • NPPV

• high flow nasal cannula









Items

Ethics

Cognitive Levels

Total

Recall

Integration*

II. GENERAL CRITICAL CARE 2 12 A. Assess Patient Status and Changes in Status 0 3 3

1. Difficult airway issues, for example, • patency • Mallampati classification

• protection • thyromental distance

2. Chest imaging, for example,

• radiograph • CT • echocardiograph

• ultrasound • ventilation/perfusion

scan

3. Indices of respiratory physiology and mechanics, for example,

• oxygenation • ventilation • capnography

• capnometry • work of breathing

4. Neurologic, for example,

• EEG • level of consciousness • respiratory function • brain death criteria

• neuromuscular function • seizures • stroke

5. Cardiovascular, for example,

• physical assessment • coronary artery disease • diagnostic testing • pulmonary hypertension

• dysrhythmias • systemic hypertension • CHF

6. Hemodynamics, for example,

• preload • afterload • contractility

• rate control • cardiac output • oxygen delivery

7. Differentiation among types of shock, for example,

• anaphylactic • cardiogenic • septic

• hypovolemic • neurogenic

8. Recognition of respiratory failure mechanisms a. ARDS b. aspiration c. atelectasis









Items

Ethics

Cognitive Levels

Total

Recall

Integration*

d. drug-induced e. hypoventilation syndromes f. neuromuscular

g. obstructive lung disease h. pneumonia i. post-surgical j. pulmonary contusion

k. pulmonary edema, for example,

• cardiogenic • noncardiogenic

l. pulmonary embolism m. restrictive lung disease n. sleep apnea o. transfusion-related lung injury p. upper airway obstruction

9. Renal function, for example,

• fluid status • acute kidney injury

• acid-base balance • urine output

10. Metabolic, for example, • respiratory quotient

• acid-base balance • nutrition/feeding • endocrine disorders

11. Gastrointestinal, for example,

• abdominal compartment

syndrome • ileus

• feeding tube placement • GI bleeding / endoscopy

12. Coagulation, for example,

• indices • platelet count

• risk for deep vein thrombosis

13. Musculoskeletal, for example,

• spinal cord injury • rhabdomyolysis

• ICU myopathy • muscle atrophy

14. Therapeutic hypothermia, for example,

• targeted temperature

management • methods

• indications and contraindications

• complications









Items

Ethics

Cognitive Levels

Total

Recall

Integration*

B. Anticipate Care Based on Laboratory Results 0 0 0 1. Albumin 2. CBC, for example,

• transfusion trigger • transfusion refusal 3. Cardiac markers, for example,

• troponin • BNP 4. Non-cardiac biomarkers, for example,

• d-dimer • lactate

• procalcitonin

5. Electrolytes, magnesium, calcium, and phosphate 6. Acid-base status, anion gap, ketones, and lactate level 7. Coagulation studies, for example,

• platelets • PTT

• PT • INR

8. Culture and sensitivities, for example,

• blood • stool

• sputum • urine

9. Sputum Gram stain 10. Hemoximetry (CO-oximetry), for example,

• carboxyhemoglobin • methemoglobin 11. Endocrine assessment, for example,

• cortisol • glucose

• thyroid function

12. BUN and creatinine 13. Liver function, for example,

• bilirubin • ammonia

• AST • ALT

14. Fluid analyses, for example,

• pleural • urine

• CSF • peritoneal

C. Anticipate Care Based on Imaging and/or Reports of Imaging 0 0 0

1. Plain radiographs, for example,

• chest • spine

• abdominal









Items

Ethics

Cognitive Levels

Total

Recall

Integration*

2. CT, for example,

• brain • chest

• abdomen

3. MRI 4. Ultrasound, for example,

• lung • pleural • abdominal

• vascular • echocardiography

5. Nuclear scans, for example, • ventilation/perfusion • cerebral blood flow

6. Angiography, for example, • pulmonary • coronary • bronchial

• gastrointestinal • cerebral

D. Anticipate Effects of Pharmacologic Agents 0 1 1 1. Sedatives / hypnotics, for example,

• continuous or intermittent • dexmedetomidine

• propofol • benzodiazepine

2. Analgesia, for example,

• continuous or intermittent • regional or systemic

• opioids • ketamine

3. Neuromuscular blocking agents, for example,

• vecuronium • cisatracurium

• succinylcholine • rocuronium

4. Reversal agents, for example,

• naloxone • flumazenil • sugammadex

• neostigmine • edrophonium

5. Vasoactive and inotropic agents 6. Drugs that may induce methemoglobinemia, for example,

• lidocaine • dapsone • nitric oxide

• nitroprusside • benzocaine

7. Prophylaxis for a. deep vein thrombosis b. stress ulcers









Items

Ethics

Cognitive Levels

Total

Recall

Integration*

c. delirium 8. Diuretics 9. Drug interactions

10. Influence of co-morbid conditions on drug metabolism and excretion, for example,

• renal failure • hepatic failure


E. Anticipate Care Based on Nutritional Status 0 1 1 1. Complications of malnutrition, for example,

• protein wasting • hypoglycemia

• respiratory muscle catabolism

2. Complications of nutritional support, for example,

• aspiration • central line infection • refeeding syndrome

• malplacement of feeding tube

3. Route of feeding, for example,

• enteral • parenteral

4. Morbid obesity 5. Metabolic study, for example,

• caloric requirements • exhaled gas analysis F. Prevent Ventilator-Associated Events 1 1 2

1. Oral care 2. Bed position 3. Minimizing intubation time, for example,

• aggressive weaning protocols

• NPPV

4. Ventilator circuit care, for example,

• minimizing disruption • optimal position

• closed suction • heated wire/HME

5. Using specialty airways, for example,

• polyurethane cuff • subglottic suction

endotracheal tube

6. Assessment of endotracheal / tracheostomy cuff integrity and pressure









Items

Ethics

Cognitive Levels

Total

Recall

Integration*

G. Recognize and Manage Patients with Infections and/or Sepsis 0 2 2

1. Recognition of clinical and laboratory signs consistent with infections and severe sepsis, for example,

• catheter-associated • culture data

• CBC

2. Management of patients with infections and sepsis, for example,

• pneumonia • catheter-associated 3. Prevention measures, for example,

• standard and advanced

precautions • isolation procedures • skin integrity

• personal protective equipment

• catheter care


H. Manage End-of-Life Care 0 0 0 1. Types of end-of-life care, for example,

• palliative • advance directive

• hospice

2. Determination of brain death 3. Withdrawal of life support 4. Care of organ donor

I. Prepare for Disaster and Mass Casualty Events 1 0 1 1. Procedures for patient movement and protection 2. Triage procedures 3. Equipment and supply management

J. Interact with Members of an Interdisciplinary Team 0 1 1 1. Suggested modifications to the care plan based on the

respiratory assessment

2. Response to modifications to the care plan from other team members

K. Perform Procedures 0 1 1 1. Arterial line insertion and monitoring 2. Mini-BAL









Items

Ethics

Cognitive Levels

Total

Recall

Integration*

3. Esophageal probe, for example,

• transpulmonary pressure

monitor • NAVA

L. Troubleshoot Systems 0 2 2 1. Chest tube drainage 2. Bronchoscopy 3. Hemodynamic monitoring, for example,

• arterial pressure • CVP 4. Inhaled vasodilator delivery, for example,

• nitric oxide • prostaglandins

Totals 2 18 20

*Each test form will include 1 item that engages thinking about ethics to select the best answer. The item also will





Additional Specifications by Patient Item content also will be classified by a patient’s condition or disorder. Condition or Disorder Maximum items per form GENERAL No specific condition or disorder balance ARDS 2 COPD 2 CARDIAC 2 POST-SURGICAL 2 ASTHMA 2 TRAUMA 1 INFECTION/SEPSIS 1 PULM EMBOLISM (pulmonary embolism) 1 SHOCK 1 BARIATRIC 1 NEUROLOGIC/NEUROMUSCULAR 1 PULM HYPERTENSION (pulmonary hypertension) 1 GERIATRIC 1 IMMUNOCOMPROMISED 1 PSYCHIATRIC 1 MASSIVE HEMOPTYSIS 1 BURN/INHALATION (burn/inhalation injury) 1 CYSTIC FIBROSIS 1 TRANSPLANTATION 1

Total 20






üSleep Disorders Specialty




Neonatal/Pediatric Specialty Assessment Detailed Content Outline


* Test takers will be asked to integrate (apply or analyze) information.

Items

Ethics

Cognitive Level

Total

Recall

Integration*


I. COMPETENCIES SHARED BETWEEN CRITICAL AND GENERAL CARE 3 7 10

A. Assess Patient Information 0 2 2 1. Patient history, for example,

• immunizations • pre-existing conditions

• environmental

2. Physical examination 3. Laboratory, for example,

• blood gas analyses • CBC

• cultures

4. Imaging, for example,

• chest radiograph • cardiac catheterization

and angiography • echocardiography

• fluoroscopy • MRI • CT

5. Indices of respiratory physiology and mechanics, for example,

• oxygenation • work of breathing

• sleep study results

6. Neurologic, for example,

• respiratory function • level of consciousness 7. Cardiovascular, for example,

• physical assessment • pulmonary hypertension

• hemodynamics • congenital heart

disease 8. Recognition of respiratory failure mechanisms

a. primary pulmonary and airway diseases, for example, • atelectasis

• pneumonia • asthma • croup

b. other, for example, • neuromuscular

• respiratory control • flail chest • apnea of prematurity








Items

Ethics

Cognitive Level

Total

Recall

Integration*

9. Renal, metabolic, endocrine, and nutrition, for example,

• fluid status • electrolytes • inborn errors of

metabolism

• acid-base balance • nutrition / feeding • diabetic ketoacidosis

10. Gastrointestinal, for example,

• congenital anomalies • feeding tube placement

• abdominal distension • necrotizing

enterocolitis 11. Musculoskeletal, for example,

• spinal cord injury • myopathy

• scoliosis • myelomeningocele

B. Evaluate Pulmonary Status 0 1 1 1. Gas exchange, for example,

• SpO2 • end-tidal CO2 tension

• blood gases

2. Pulmonary function, for example,

• spirometry • MIP

• peak flow

C. Assess and Manage Airways 0 1 1 1. Airway devices, for example,

• established tracheostomy tubes • oral and nasopharyngeal

2. Airway clearance devices and techniques, for example,

• high-frequency chest wall

oscillation • PEP

• postural drainage • IPV • cough assist

3. Airway challenges, for example,

• acute upper airway

obstruction • unplanned extubation /

decannulation

• difficult / critical airway

• congenital anomalies








Items

Ethics

Cognitive Level

Total

Recall

Integration*

D. Select and Manage Equipment 0 1 1 1. Oxygen administration devices, for example,

• heated high flow nasal cannula • patient-appropriate sizing

2. Aerosol delivery devices, for example,

• intermittent • continuous

3. Airway devices, for example,

• oral and nasopharyngeal • endotracheal

• tracheostomy tubes • speaking valves • LMA

4. Transcutaneous monitoring systems 5. Airway clearance devices, for example,

• insufflator-exsufflator • high-frequency chest wall oscillation

6. Home care devices, for example, • mechanical ventilators • CPAP • humidifiers • apnea monitor

• oxygen delivery • portable oxygen

concentrators


E. Facilitate Procedures and Evaluate Efficacy 1 0 1 1. Bronchoscopy and associated procedures, for example,

• lavage • biopsies

• brush

2. Sputum culture, for example,

• nasal swab • tracheal aspirate

3. Blood gas sampling, for example,

• CBG

F. Manage and/or Anticipate Effects of Medication Administration

0 1 1

1. Aerosolized agents 2. Sedatives, hypnotics, and analgesia 3. Neuromuscular blocking agents








Items

Ethics

Cognitive Level

Total

Recall

Integration*

4. Reversal agents, for example,

• naloxone • neostigmine

5. Vasoactive and inotropic agents 6. Diuretics 7. Systemic smooth muscle relaxants, for example,

• magnesium sulfate • terbutaline 8. Drug interactions 9. Influence of co-morbid conditions

• renal failure • hepatic failure G. Anticipate Care Based on Laboratory Results 0 0 0

1. Hematologic, for example,

• CBC • Hgb electrophoresis

2. Chemistry, for example,

• electrolytes • albumin

• glucose • sweat test

3. Microbiology, for example,

• nasal swab • Gram stain

• culture

4. Toxicology, for example,

• drug overdose • neonatal abstinence syndromes

5. Blood gas analyses and hemoximetry (CO-oximetry) H. Anticipate Care Based on Imaging and/or Reports of

Imaging 0 0 0

1. Radiographs, for example,

• sail sign • lateral views

• cardiac silhouette with CHD

2. Other, for example,

• CT • MRI

• ultrasound

I. Manage Care Based on Nutritional Status 0 0 0 1. Complications of feedings, for example,

• intolerance • aspiration

• malposition of feeding tube








Items

Ethics

Cognitive Level

Total

Recall

Integration*

2. Morbid obesity, for example,

• airway management • sleep disordered

breathing

J. Assist with or Perform Resuscitation 0 1 1 1. Selection of appropriate equipment, for example,

• T-piece resuscitator • flow-inflating resuscitation bag

2. Following the appropriate protocol, for example,

• NRP • PALS

K. Prepare for Disaster and Mass Casualty Events 1 0 1 1. Procedures for patient movement and protection 2. Triage procedures 3. Equipment and supply management

L. Interact with Members of an Interdisciplinary Team 0 0 0 1. Suggested modifications to the care plan based on the

respiratory assessment

2. Responses to proposed care plan modifications from other team members

M. Evaluate Patient and Family Understanding of Education

1 0 1

1. Discharge and home, for example,

• tracheostomy care • monitoring

• CPR • car seat challenge

2. Equipment and procedure instruction, for example,

• set-up • operation

• troubleshooting

3. Medication administration


II. COMPETENCIES SPECIFIC TO CRITICAL CARE 2 8 10

A. Evaluate Pertinent Information 1 0 1 1. Maternal history, for example,

• amniotic fluid index • maternal medication








Items

Ethics

Cognitive Level

Total

Recall

Integration*

2. Fetal and neonatal assessments, for example,

• biophysical profile • Apgar score

• fetal lung maturity indices

3. Other diagnostic results, for example,

• transillumination • oxygen challenge test

B. Assess and Manage Airways 0 2 2 1. Establishment of a patent airway, for example,

• bag-mask ventilation • oral / nasal airway placement

2. Performing or assisting intubation, for example,

• equipment selection • CO2 verification

3. Performing or assisting advanced intubation techniques, for example,

• specialty laryngoscopic visualization devices 4. Artificial airways

a. laryngeal mask airway b. endotracheal tube, for example,

• securement • positioning c. newly placed tracheostomy tube

C. Manage Specialty Gas Administration 0 1 1 1. Nitric oxide 2. Helium-oxygen 3. Other, for example,

• isoflurane / sevoflurane • subambient D. Manage Ventilation and Oxygenation 0 3 3

1. Selection of initial settings 2. Conventional modes 3. High-frequency ventilation, for example,

• HFJV • HFOV 4. Alternative modes, for example,

• volume-targeted • APRV

• NAVA








Items

Ethics

Cognitive Level

Total

Recall

Integration*

Fourth Quarter of the Calendar

5

5. Noninvasive, for example,

• CPAP • bi-level

6. Adjunct techniques a. lung recruitment maneuvers b. prone positioning c. extracorporeal life support, for example,

• ECMO • CO2 removal

• coagulation management

7. Monitoring a. measures of lung disease severity, for example,

• PaO2 / FIO2 • SaO2 / FIO2

• OI

b. airway pressures and volumes, for example,

• mean airway pressure • minute ventilation

c. ventilator waveforms, for example,

• NAVA catheter positioning

d. ventilator-patient interaction, for example

• synchrony

e. pulmonary mechanics, for example,

• compliance • resistance

• VD / VT • MIP

f. effects of mechanical ventilation on cardiac function g. cerebral oximetry, for example,

• near infrared spectroscopy 8. Strategies

a. weaning from mechanical ventilation, for example,

• spontaneous

breathing trials • protocols

b. prevention of ventilator-induced lung injury c. lung-protective ventilation, for example,

• permissive hypercapnia








Items

Ethics

Cognitive Level

Total

Recall

Integration*

9. Optimizing patient-ventilator interaction E. Facilitate Procedures and Evaluate Efficacy 0 1 1

1. Inter-hospital or intra-hospital transport 2. Intravascular catheter insertion, for example,

• through an umbilical or peripheral site 3. Intubation 4. Extubation, for example,

• planned decannulation • endotracheal tube 5. Chest tube management, for example,

• insertion • troubleshooting 6. Needle decompression of pneumothorax 7. Therapeutic hypothermia, for example,

• total body / head cooling • passive / active cooling

F. Manage and/or Anticipate Effects of Medication Administration 0 1 1

1. Surfactant replacement therapy, for example,

• compliance changes • airway obstruction

2. Airway instillations, for example,

• lidocaine • epinephrine

G. Prevent Hospital-Acquired Conditions 1 0 1 1. Ventilator-associated pneumonia

a. oral care b. bed position c. minimizing intubation time, for example,

• determining extubation readiness

• NPPV

d. ventilator circuit care, for example,

• closed suction • heated wire

2. Device-related pressure ulcers








Items

Ethics

Cognitive Level

Total

Recall

Integration*

H. Manage End-of-Life Care 0 0 0 1. Types of end-of-life care, for example,

• palliative • hospice

• advance directive

2. Determination of brain death 3. Withdrawal of life support 4. Care of organ donor

Totals 5 15 20

* Each test form will include 1 item that engages thinking about ethics to select the best answer. * This item also will





Additional Specifications by Patient Item content also will be classified by a patient’s condition or disorder. Condition or Disorder Maximum items per form GENERAL No specific condition or disorder balance NEO PULMONARY (Neonatal pulmonary, for example, meconium aspiration, pneumonia, PPHN)

2

INFECT DISEASE (Infectious disease, for example, pneumonia, croup)

2

CHRONIC LUNG (Chronic lung disease of prematurity) 2 ASTHMA 2 PREMATURITY (Prematurity acute phase, for example, surfactant deficiency apnea)

2

BRONCHIOLITIS 1 CON DEFECTS (Congenital defects that require surgical correction)

1

CON HRT DISEASE (Congenital heart disease) 1 NEUROLOGIC (for example, seizures, brain tumors, hydrocephalus)

1

PED AIRWAY (Pediatric airway, for example, tracheomalacia, vocal cord paralysis, vascular ring)

1

IMMUNOCOMPROMISED 1 SHOCK 1 TRAUMA 1 HEART FAILURE 1 CYSTIC FIBROSIS 1 NEUROMUSCULAR (for example, spinal muscle atrophy, muscular dystrophy)

1

SLEEP RELATED (sleep related disorders, for example, obstructive sleep apnea, central hypoventilation)

1

INHALATION (Inhalation injuries) 1 Total 20






ü Sleep Disorders Specialty


Copyright © 2019. NBRC. All rights reserved ~ 1 ~


Sleep Disorders Specialty Assessment Detailed Content Outline



Items Cognitive

Level Total

Recall

Integration*


I. PRE-TESTING 1 2 3

A. Identification and Care of At-Risk Individuals 0 1 1 1. Recognize signs and symptoms associated with sleep

disorders as revealed by history, interview, or clinical assessment

2. Identify special factors and co-morbid conditions affecting individuals with potential sleep disorders

3. Identify the appropriate diagnostic modality based on patient factors and co-morbid conditions

a. polysomnography with or without PAP titration b. maintenance of Wakefulness Test c. multiple Sleep Latency Test d. home sleep apnea testing e. actigraphy

4. Communicate with members of the health care team regarding findings and recommended

a. diagnostic studies b. therapeutic intervention

B. Study Preparations 1 1 2 1. Identify critical information from a patient’s medical

record

2. Select the appropriate study montage 3. Set up equipment to achieve the desired data collection 4. Set high and low filters, and sensitivity settings 5. Evaluate equipment calibrations to ensure accuracy and

linearity of amplified signals

6. Confirm adequate audiovisual signals 7. Recommend modifications to the physician’s order when

necessary

8. Assess a patient’s current clinical condition 9. Explain testing procedures and potential interventions to

a patient

10. Determine a patient’s expectations about the study








Items Cognitive

Level Total

Recall

Integration*

11. Recognize special needs associated with a patient’s psychological, physical, cultural, language, and cognitive status

12. Identify patient medications that may affect test results 13. Document time and dose of medications taken prior to

the study

14. Obtain informed consent 15. Apply electrodes and sensors at optimal locations to

obtain data on airflow, snoring, body position, ECG, respiratory effort, EEG, leg movements, eye movements, chin EMG, and/or SpO2

16. Apply electrodes and sensors at optimal locations to obtain data on exhaled CO2

17. Assess the quality of electrode impedances and physiologic calibration results

18. Document the quality of monitoring signals

II. SLEEP DISORDERS TESTING 2 4 6

A. Signal Maintenance During Testing 0 1 1 1. Recognize an inadequate signal from recording devices 2. Correct inadequate signals as appropriate 3. Recognize artifacts 4. Correct artifacts as appropriate 5. Document corrections to signals and artifacts

B. Sleep-Related Disorders and Therapeutic Interventions 0 3 3 1. Recognize disorders during testing

a. sleep b. cardiac c. neurological d. pulmonary e. gastrointestinal


2. Implement therapy during testing a. CPAP, auto-PAP, bilevel PAP b. other forms of noninvasive ventilation c. supplemental oxygen d. patient positioning








Items Cognitive

Level Total

Recall

Integration*

3. Monitor a patient’s response to therapy during testing 4. Optimize therapy during testing

a. PAP b. oral appliance

5. Coach a patient in cooperative behaviors while adjusting therapy

6. Recommend modifications in therapy to the physician when no protocol applies

7. Recognize medical emergencies (for example, seizures, stroke, life-threatening dysrhythmias, respiratory distress)

8. Implement interventions for a medical emergency 9. Intervene when the testing environment becomes unsafe

(for example, combative patient or family member, fire)

C. Documentation During Testing 1 0 1 1. Record

a. lights out / on clock time b. reason for prolonged awakenings c. staff interventions d. therapeutic interventions

2. Document times associated with events (for example, artifacts, ECG abnormalities, seizure activity, EEG abnormalities, parasomnias)

D. Study Conclusion 1 0 1 1. Evaluate post-study calibrations 2. Remove electrodes and sensors 3. Process nondisposable equipment 4. Review post-study questionnaire 5. Describe the post-study process to a patient 6. Summarize study observations for the interpreting

physician and scoring personnel

III. STUDY ANALYSIS 1 4 5

A. Record Review 1 0 1 1. Identify critical information from a patient’s medical

record

2. Review a summary of study observations








Items Cognitive

Level Total

Recall

Integration*


B. Sleep Staging 0 1 1 1. Score sleep stages for adult patients 2. Score sleep stages for pediatric patients

C. Sleep Event Identification 0 1 1 1. Recognize events from in-lab sleep testing

a. sleep-disordered breathing b. abnormal limb movements c. abnormal cardiac rhythm d. bruxism e. abnormal EEG waveforms (for example, seizure,

voltage changes)

f. parasomnias (for example, night terrors, REM behavior disorder)

g. arousals 2. Recognize events from home sleep apnea testing

D. Sleep Event Reporting 0 2 2 1. Summarize findings from recording about a patient’s

a. behaviors during testing (for example, parasomnias, limb movements)

b. tolerance of therapeutic interventions 2. Summarize evidence of

a. artifacts b. adverse events

c. technical problems, errors, and actions taken to resolve them

3. Verify the accuracy of descriptive statistics generated for a. oxygen saturation b. sleep latency c. REM latency d. sleep efficiency e. total sleep time f. total time in bed

g. total recording time h. sleep stage percentages i. wake after sleep onset








Items Cognitive

Level Total

Recall

Integration*

4. Document descriptive statistics for MSLT and MWT (for example, mean sleep latency, REM periods)

5. Document the frequency or verify accuracy of the following:

a. obstructive, central, and mixed apneas b. obstructive and central hypopneas c. arousals d. periodic limb movements e. snoring f. Respiratory Effort Related Arousals (RERAs)

g. Cheyne-Stokes respirations h. sleep-related hypoventilation i. periodic breathing

6. Verify the accuracy of indices for a. apneas b. hypopneas c. RERAs d. respiratory events from portable monitors e. arousals f. periodic limb movements

g. snoring h. desaturations

7. Document abnormalities in a. EEG activity (for example, spindles, beta, alpha-

delta, alpha-intrusion)

b. REM (for example, density, latency) c. ECG activity

8. Generate a written report including objective and subjective information

9. Confirm the written report is a valid reflection of the study

IV. ADMINISTRATIVE FUNCTIONS 2 0 2

A. Data and Equipment Maintenance 1 0 1 1. Ensure information from each patient is stored according

to government and industry standards

2. Correct problems with data acquisition and recording equipment








Items Cognitive

Level Total

Recall

Integration*

3. Perform a. biomedical equipment quality control b. routine equipment processing

c. preventative maintenance

d. inventory maintenance


B. Management 1 0 1 1. Implement policies and procedures that address

a. accurate data processing b. patient and staff safety c. infection control d. response to an emergency e. patient confidentiality f. staff educational requirements

g. current practice standards 2. Implement quality improvement programs that address

a. inter-scorer reliability b. implementation of a physician’s order c. compliance with protocols d. patient and physician satisfaction

V. TREATMENT PLAN 0 4 4

A. Development 0 2 2 1. Assess a patient’s or caregiver’s educational needs and

barriers to optimal therapy

2. Select equipment and interface to ensure maximum adherence and efficacy

3. Communicate details of assessment to the health care team

4. Assist in the development of an individualized treatment plan (for example, behavior modifications, co-morbid condition management)

B. Implementation 0 1 1 1. Assist in the generation of the prescription 2. Provide education to the patient or caregiver regarding

the therapeutic plan








Items Cognitive

Level Total

Recall

Integration*

3. Coordinate equipment setup 4. Adjust equipment settings to comply with the

prescription

5. Document educational assessments, interventions, and a patient’s comprehension of treatment plan

C. Evaluation 0 1 1 1. Review data downloaded from PAP equipment 2. Evaluate adherence information 3. Document treatment plan outcomes 4. Recommend revisions to optimize the treatment plan 5. Communicate treatment plan results to the physician /

healthcare provider

TOTAL 6 14 20

Specifications by Patient Age Patient Maximum items per form Pediatric 6 years of age or younger 1 Pediatric 7 to 17 years of age 1 General balance

Total 20


Documents

Credential Maintenance Program...Credential Maintenance Program Assessment Content Outline As a credentialed practitioner, you already know maintaining and enhancing the knowledge