Safety In The Sleep Center

This is an area that is often overlooked by Sleep Centers, especially smaller ones in satellite locations where there is only one technologist and they have not gone through or prepared for AASM Accredition. I feel that the following recommendations should be made if not already in place. This is to protect not only the patient, but the technologist. The cost is minimal to the Sleep Center compared to one bad incident.

  1. Make sure all employees have current CPR cards and have posted Sleep Center Emergency Procedures including Fire Procedures as well as Medical Emergencies.
  2. Have an ambu bag and ambu attachments and mouthpieces for ventilation of patients in respiratory arrest. Have a backboard to place under patients chest to do CPR. CPR done on a bed is ineffective. If you do not have a backboard you must pull the patient to the floor to have something solid to push against. Backboards are not expensive, but a necessity.
  3. Have back up 02 E tanks available with tubing attached. Check tanks each day to make sure the O2 level is adequate. Concentrators are good but do not provide the 100% O2 and if necessary can be transported with patient to ambulance.
  4. Keep wheelchairs available for patients who cannot ambulate well. They could fall and take you with them. Also have a cart available for the items the patient brings with them. Some bring just a little, some bring a lot and you should not be carrying them or the patient in the center. Someone could lose their balance and fall.
  5. Have walkers available for patients to go to the restroom if necessary. You should be there to help, but again, with wires, etc. it is sometimes better to have something to balance with. This also applies to getting patients in and out of bed. Let them grab the walker while you steady it. This way you are in control of the weight and balance and cannot be pulled around.
  6. Have a bedside commode and urinals for those who need it. Be sure and get an X-Large bedside commode to accommodate all sizes. The more large patients walk, usually the more they sweat especially if it stresses them. Then, guess what? Wires come off almost everywhere. This also decreases the chance of falls.
  7. Use a back brace if necessary when dealing with patients. I know it can be a hassle and uncomfortable, but so can back surgery.
  8. DO NOT WASH BED LINENS AT HOME. This is not your responsibility and you could be taking home germs that ordinary laundry detergent cannot kill. These linens need to be done by a linen service that knows how to treat medical linens. Do not risk your health or the health of your family. Our information does not always include complete medical histories so there is no need to take chances. There is always head lice and body lice to worry about too.
  9. Test your equipment before patients arrive to make sure it is working properly and needs no repair or replacement.
  10. Be sure and wear gloves when working with patients and wash your hands before and after patient care.

If you do not have these things in your center, approach your supervisor and ask for them. These are very cheap compared to the chances they are taking in liability for not having them. I feel they will agree.

2009 RPSGT Exam Dates

The calendar for 2009 exam dates is set.  Make sure you’re aware of the these dates:

February

Feb 13: Application Deadline for the March RPSGT Exam.

March

March 16-28: RPSGT Exam Window.

May

May 15: Application Deadline for the June RPSGT Exam.

June

June 15-27: RPSGT Exam Window.

August

Aug 14: Application Deadline for the September RPSGT Exam.

September

Sept 14-26: RPSGT Exam Window.

October

Oct 30: Application Deadline for the November-December RPSGT Exam.

November

Nov 30-Dec 12: RPSGT Exam Window.

December

Nov 30-Dec 12: RPSGT Exam Window.

Technologist Sleep Scoring vs. Automated Sleep Scoring

I would like to introduce myself.  I am a RPSGT and have worked as a Respiratory Therapist, Certified Cardiac Technologist and Neurodiagnostics Technologist at varying times since 1977.  Before that I was an EMT (first woman in my county in Georgia to be certified) and a Cardiac Technologist for the fire department.  Before that I was in the Nursing Program at FSU.  I tell you this to let you know I have experience over many years and have seen the changes-good and bad-take place.  I am talking from a broad prospective—I am not the new girl on the block with all the fancy new gizmos.

In Sleep, I started out in an OJT job, got my registry and have since worked as an Acquisition Technologist, Scoring Technologist, and have managed two Accredited Sleep Centers.  I know the industry much better than most.  I was also Director of Respiratory at a nation wide DME.

My first real concern is automated scoring whether it is in your computer software program or being sent out to a large firm.  This is one area man definitely wins over machine.  I say these things for the following reasons:

1.       Even in automated scoring a technologist must go back over the study and epochs to make sure there is no discrepancy between what has been autoscored and correct its miscalculations.  Why not do it manually the first time—waste of time and confusing at best?

2.       Many times (in fact most times) the computer cannot interpret the video which corresponds to the study.  It is necessary in diagnosing many parasomnias and also just being able to see what the exact problem is with the patient if they are arousing or awakening.  Also the video is extremely helpful in CPAP and BIPAP titration.

3.       Heart arrhythmias are often if not entirely missed in automated scoring.  Unfortunately I have seen technologists manually scoring on a 30 epoch screen which totally obscures any cardiac activity.  This is unfortunate as they are finding every day more links between heart disease and sleep apnea.  I would say this is on of the weakest links in Respiratory and Sleep training.  They are taught the basics and really don’t understand the implications of any.  They usually are only aware of the like threatening ones and really can’t interpret the others.  They also cannot distinguish the breathing patterns such as periodic breathing, Cheynes-Stokes, etc.  Some of these along with arrhythmias, i.e. arterial fibrillation are indicators of heart disease.  You should be able to print these out for the record and the doctors—automated scoring does not do  that. 

4.       Another area is Neurodiagnostics.  I have seen many experienced technologists interpret seizure activity as artifact.  Sad but true.  I feel every technologist should be able to do a complete EEG hook-up and be very aware of seizure activity.  Automated scoring also misses this from my experience.  It is usually dismissed as artifact.  Mild seizure activity or major seizure activity is extremely important to interpret.

5.       Biocals are often not done or not done properly, so neither machine nor technologist has a baseline in case of questions.  This is bad technique on the part of the technologist.

6.       Leaks on CPAP or BIPAP masks can be misleading if a constant vigil is not kept on the patient video and leakage data.  This can make or break a patient’s compliance with this treatment.  High leaks are just not acceptable no matter what.  If the mask is not fitted properly or moves in sleep it gives false information on the readout—machine or no machine.  This is where a good, observant technologist comes in.  Just get up and go fix it.

This is only a few of my conflicts with “automated scoring”.  It definitely leaves the human element out and unfortunately that is usually the patient and possibly his compliance with a device that could literally save his life. 

If you have any questions please contact me at this website. 

“Sleep is the golden chain that ties health and our bodies together.”

                                            -Thomas Dekker