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Curriculum standards

Entrustable Professional Activities

LG7: Acute care and procedures

Learning Goal 7

Acute care and procedures

Assess and manage acutely unwell paediatric and neonatal patients

This activity requires the ability to:

  • assess seriously unwell paediatric and neonatal patients, and initiate management
  • perform paediatric and neonatal resuscitation
  • plan, prepare for, perform, and provide aftercare for procedures expected of a general paediatrician, as listed in this EPA
  • manage ongoing care of acutely unwell paediatric and neonatal patients suitable for inpatient ward and not needing intensive care
  • recognise and respond to clinical deterioration
  • escalate care where appropriate
  • participate in and, where appropriate, lead the resuscitation team
  • liaise with paediatric intensive care or neonatal intensive care units, retrieval services, and referral centres
  • safely prepare and handover acutely unwell patients at change of shift or change in patient status or location
  • communicate with family and carers regarding acute situations and plans

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • recognise immediate life-threatening paediatric and neonatal conditions and critically unwell patients, and respond appropriately
  • prepare for, and perform, effective advanced paediatric life support and neonatal resuscitation
  • recognise and respond to clinical deterioration
  • assess, diagnose, and initiate management of acute undifferentiated clinical presentations
  • select investigations that exclude or diagnose critical patient issues
  • manage acutely unwell children and neonates suitable for the inpatient ward and not requiring intensive care
  • perform common procedures confidently and consistently, such as:
    • lumbar puncture
    • manual intermittent positive pressure ventilation via bag mask and T piece
    • nasogastric tube placement
    • paediatric and neonatal cannula insertion
    • sterile urine collection via suprapubic and/or catheter
  • troubleshoot and manage patients with difficult intravenous access
  • demonstrate knowledge and skills in safe airway management on a mannequin and/or patient, such as:
    • endotracheal intubation
    • laryngeal mask and oropharyngeal / nasopharyngeal airway insertion
  • demonstrate knowledge and skills on a mannequin and/or patient in:
    • intercostal catheter insertion
    • intra-osseus needle
    • needle thoracostomy
    • umbilical venous catheterization
  • demonstrate knowledge of the principles and complications of midline, percutaneous long line (PICC) and central venous access insertion, and, where appropriate, practice insertion
  • demonstrate knowledge of the role for point of care ultrasound (POCUS) in diagnostic and procedural applications, and, where appropriate, practice on phantom models and/or patients
  • manage patients, in liaison with subspecialty teams, with:
    • central venous access devices
    • gastrostomy tube
    • other in situ medical devices
    • PICCs
    • ventriculoperitoneal shunts
  • recognise and effectively manage complications arising during and after procedures
  • initiate care of seriously unwell paediatric and neonatal patients requiring surgery and/or transfer to intensive care unit
  • initiate ventilation and inotropic support of paediatric and neonatal patients, with support from appropriate intensive care specialists or emergency staff
  • systematically identify causes of acute deterioration in health status
  • develop plans of multidisciplinary treatment, rehabilitation, and secondary prevention following acute events
  • optimise medical management before and after operations, where appropriate
  • effectively manage acute pain and distress
  • demonstrate knowledge and skills in procedural pain management, such as sedation and analgesia, as well as non-pharmacological strategies
  • demonstrate an awareness of the process for accurate collection of forensic samples for children with acute sexual assault concerns, in liaison with child maltreatment specialist paediatricians, child protection agencies, and police
  • document treatment given without consent in an emergency according to local guidelines

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • recognise seriously unwell patients requiring immediate care
  • initiate paediatric and neonatal resuscitation as indicated
  • identify potential causes of current deterioration, and comply with escalation protocols
  • facilitate initial tests to assist in diagnosis
  • develop management plans for immediate treatment
  • document information to outline the rationale for clinical decisions and action plans
  • assess patients and identify indications for procedures
  • consider risks and complications of procedures
  • demonstrate knowledge and skills in:
    • lumbar puncture
    • manual intermittent positive pressure ventilation via bag mask and T piece
    • nasogastric tube placement
    • paediatric and neonatal cannula insertion
    • sterile urine collection via suprapubic and/or catheter

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • use closed-loop and clear communication with other health care team members during resuscitation and escalation
  • facilitate early sensitive communication with patients during escalation and resuscitation to allow shared decision making
  • explain procedures clearly to patients, including reasons for procedures, potential alternatives, and possible risks, to facilitate informed choices
  • accurately document procedures in clinical notes, including informed consent, indication for the procedure, medicines given, aseptic technique, difficulties encountered, and aftercare
  • liaise appropriately with paediatric and neonatal intensive care specialist and retrieval services
  • provide clear and effective clinical handover during change of shift or change in patient status or location

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • demonstrate communication skills to sufficiently support the function of multidisciplinary teams
  • communicate with patients in a timely and appropriate manner
  • provide timely and safe handover during escalation and transitions of care
  • explain the process of procedures to patients without providing a broader context
  • discuss postprocedural care with patients
  • complete relevant patient documentation

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • set up all necessary equipment required for procedures, and consistently use universal precautions and aseptic technique
  • confirm patients’ identification, verify the procedure, and, where appropriate, the correct position / site / side / level for the procedure

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • comply with safety requirements of the health service

Teaching and learning

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • maintain up-to-date certification in advanced paediatric life support and neonatal resuscitation
  • participate in multidisciplinary practice of resuscitation skills, including simulation where available
  • seek guidance and feedback from supervisors and other health professionals to reflect on clinical deterioration or resuscitation events and improve future patient care
  • refer to and/or be familiar with relevant published procedural guidelines prior to undertaking procedures
  • organise or participate in in-service training on new technology
  • provide appropriate supervision to learners carrying out procedures

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • maintain life support requirements of the health service

Cultural safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • negotiate health care decisions in a culturally appropriate way, considering variation in family structures, cultures, religion, and belief systems
  • use qualified language interpreters or cultural interpreters where appropriate
  • integrate culturally safe care of Māori and Aboriginal and Torres Strait Islander peoples into patient management
  • consider cultural, ethical, and religious values and beliefs in leading multidisciplinary teams

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • practise cultural safety

Ethics and professional behaviour

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • apply ethical principles to life-saving treatments and patients’ and family members’ rights to decide management, including withdrawal of care
  • facilitate interactions within multidisciplinary teams, respecting values, encouraging involvement, and engaging all participants in decision making
  • hold information about patients in confidence, unless the release of information is required by law or public interest

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • communicate medical management plans as part of multidisciplinary plans
  • establish, where possible, patients’ wishes and preferences about care
  • contribute to building a productive culture within teams

Judgement and decision making

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • recognise the need for escalation of care or patient transfer, and escalate to appropriate staff or services
  • use appropriate guidelines, evidence sources, and decision support tools
  • identify roles and optimal timing for diagnostic procedures
  • select appropriate investigations on the samples obtained in diagnostic procedures
  • reconcile conflicting advice from other specialties, and support shared clinical decisions in the presence of uncertainty
  • use care pathways effectively, including identifying reasons for variations in care

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • involve additional staff to assist in a timely fashion when required
  • recognise personal limitation, and seek help in an appropriate way when required
  • assess personal skill levels, and seek help with procedures when appropriate

Leadership, management, and teamwork

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • collaborate effectively with staff in the emergency department, paediatric and neonatal intensive care units, and other subspecialty inpatient units
  • demonstrate effective leadership and followership in acute care situations, including appropriate role allocation of team members
  • explain critical steps, anticipated events, and equipment requirements to team members before planned procedures
  • provide staff with clear procedural aftercare instructions
  • explain how to recognise possible procedural complications
  • identify relevant management options with colleagues, according to their level of training and experience, to reduce error, prevent complications, and support efficient teamwork
  • manage transitions of care of acute medical patients
  • check in and support team members’ wellbeing, and, where necessary, support psychological first aid and formal debriefing

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • collaborate with other team members, based on their roles and skills
  • ensure appropriate multidisciplinary assessment and management
  • encourage an environment of openness and respect to lead effective teams
  • involve appropriate team members to undertake procedures safely

Health policy, systems, and advocacy

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • use a considered and rational approach to the responsible use of resources, balancing costs against outcomes
  • prioritise patient care based on need, and consider available health care resources
  • collaborate with emergency medicine staff and other colleagues to develop policies and protocols for the investigation and management of common acute medical problems

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • understand the systems for the escalation of care for deteriorating patients
  • understand the role of clinician leadership and advocacy in appraising and redesigning systems of care that lead to better patient outcomes