POLYSOMNOGRAPHY TECHNOLOGIST SKILLS CHECKLIST

		POLYSOMNOGRAPHY TECHNOLOGIST SKILLS CHECKLIST
NAME

LAST 4 OF SSN

DATE

	I hereby certify that ALL information I have provided to IMCS Group on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.
Proficiency Scale:	1 = No Experience 2 = Need Training 3 = Able to perform with supervision 4 = Able to perform independently

Rating Stars (Click)	Sleep Technologist		1	2	3	4
	Assess physician’s request
	Assess the patient’s history for appropriateness of testing
	Select appropriate equipment
	Identify the need for alterations to standard electrode placement
	Identify the need for alterations to the standard montage
	Identify patient’s needs prior to & during testing
	Follow standard & lab-specific PSG protocols & procedures
	Operate PSG data acquisition system
	Apply PSG recording electrodes according to the international 10-20 system of electrode placement
	Apply additional electrodes according to the international 10-20 system of electrode placement
	Apply sensors for ancillary recording equipment
	Operate & troubleshoot ancillary recording equipment
	Identify the need for medical intervention
	Perform a diagnostic polysomnogram
	Identify qualifications for, & perform, a split-night polysomnogram
	Perform a therapeutic polysomnogram
	Identify the need for therapeutic intervention according to accepted standards
	Apply & titrate CPAP
	Apply & titrate bi-level PAP
	Apply & titrate supplemental oxygen
	Perform a multiple sleep latency test (MSLT) according to standards
	Perform a maintenance of wakefulness test (MWT) according to standards
	Perform child polysomnography < 12 years of age
	Perform infant polysomnography < 1 year of age
	Identify & respond to parasomnias
	Identify & respond to sleep disordered breathing
	Identify & respond to movement disorders
	Identify & respond to cardiac abnormalities
	Identify & respond to epileptiform activity (recorded seizure activity)
	Identify & correct artifacts during data acquisition
	Identify & respond to emergency situations & life-threatening events
	Use positional therapy, as appropriate
	Follow standard precautions for infection control
	Clean & disinfect all reusable equipment and supplies
Rating Stars (Click)	PSG Scoring		1	2	3	4
	Perform sleep-stage scoring
	Score arousals according to AASM guidelines
	Score periodic limb movements according to AASM guidelines
	Score breathing events according to AASM guidelines
	Score cardiac events according to AASM guidelines
	Differentiate artifact from physiological data
	Differentiate abnormal variants of the EEG
	Use clinical judgment to adapt scoring to individual patient data
	Summarize data & generate a final report
Rating Stars (Click)	Knowledge of:		1	2	3	4
	Electrophysiology
	Computer operations
	Signs & symptoms of sleep disorders
	Medical, neurological, and psychiatric disorders
	Instrumentation theory of operation
	Basic patient care
	Clinical reasoning
	Cardiopulmonary & neuro anatomy & physiology
	PSG protocols & procedures
	PSG-specific equipment operating procedures
	Sleep-related affects of medication
	Biopotential recording techniques
	Waveform pattern recognition
	Practice parameters, guidelines, & standards
	AASM Scoring Manual
	Patient assessment
Rating Stars (Click)	PSG Data Acquisition Systems:		1	2	3	4
	Nicolet
	Grass
	Sandman
	Digitrace
	Alice
	Stellate
	Rembrandt
	Cadwell
	Sensormedics (Viasys)
	XLTEK
	Bio-logic
	Nihon kohden
Rating Stars (Click)	Ancillary Equipment		1	2	3	4
	Oximeter
	Actigraph
	End-tidal CO2 monitor
	Transcutaneous CO2 monitor
	Transcutaneous O2 monitor
	Allscripts
	Respiratory inductance plethysmography (RIP)
	Esophageal pressure monitor
Rating Stars (Click)	General Skills		1	2	3	4
	Patient/family teaching
	Patients in restraint
	Patients in isolation
	Lift/transfer devices
	Specialty beds
	End of life care/palliative care
Rating Stars (Click)	Computerized Charting		1	2	3	4
	Cerner
	EPIC
	McKesson
	Meditech
Rating Stars (Click)	National Patient Safety Goals		1	2	3	4
	Accurate patient identification
	Effective communication
	Pain assessment & management
	Infection control
	Universal precautions
	Minimize risk of falls
	Prevention of pressure ulcers
Rating Stars (Click)	EMR		1	2	3	4
	Epic
	Cerner
	Eclipsys
	McKesson
	Meditech
	Other Computerized System
	Computerized Physician Order Entry
	Bar Coding for Medication Administration
MY EXPERIENCE IS PRIMARILY IN:
Unit	No. of Years	Unit	No. of Years
BURN		POST PARTUM
CRITICAL UNIT		LABOR & DELIVERY
PACU		NEWBORN NURSERY
NEUROLOGY		LEVEL II NICU
TELEMETRY		LEVEL III NICU
MEDICAL		PICU
SURGICAL		PEDIATRICS
ONCOLOGY		OB/GYN
ORTHOPEDICS		PSYCHIATRY
OPERATING ROOM		RRT
EMERGENCY ROOM		CRT
TRAUMA CENTER LEVEL 1
COMMUNITY ER
RURAL ER
Rating Stars (Click)	Age Specific Competencies		1	2	3	4
	Newborn/Neonatal (birth – 30 days)
	Infant (30 days-1 year)
	Toddler (1-3 years)
	Preschool (3-5 years)
	School Age Children (5-12 years)
	Adolescent (12-17 years)
	Young Adults (18-44 years)
	Middle Adults (45-64 years)
	Older Adults (>65 years)