Entrustable Professional Activities

LG7: Acute paediatric respiratory care

Learning Goal 7

Acute paediatric respiratory care

Assess and manage the care of acutely unwell paediatric respiratory patients

This activity requires the ability to:

  • recognise instability and medical acuity in clinical presentations
  • provide assessment and initial stabilisation of airways, breathing, and circulation
  • elicit histories, including relevant history, and perform relevant physical examinations
  • select and/or interpret appropriate investigations
  • develop and implement management plans
  • liaise with paediatric intensive care or neonatal intensive care units, retrieval services, and referral centres when appropriate
  • 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 and manage typical and atypical respiratory presentations
  • integrate and synthesise clinical information and results of investigations to assess clinical status
  • initiate and manage respiratory support, including oxygen therapy, high flow, and non-invasive and invasive ventilation (with the support of ICU physicians as required)
  • monitor respiratory status in the acute setting, including clinical observations, oximetry, capnography, and blood gases
  • manage patients with central venous access devices, PICCs, gastrostomy tubes, and other in situ medical devices, in liaison with other subspecialty teams

direction
Requires some supervision

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

The trainee may:

  • recognise deterioration, and know how to escalate treatment
  • perform the sequence of resuscitation as per established protocols
  • use appropriate tools for monitoring acutely unwell patients
  • develop management plans for immediate treatment
  • select and use diagnostic techniques to differentiate the underlying causes and precipitating factors of respiratory disease, and to evaluate respiratory status

Communication

confident
Ready to perform without supervision

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

The trainee will:

  • convey information to other medical professionals involved in patients’ care, including ICU, retrieval services, and other teams (e.g., general surgery, thoracic surgery, cardiology, neurology, sleep medicine, general paediatrics)
  • facilitate early sensitive communication with patients and families during escalation and resuscitation to allow shared decision making
  • explain procedures clearly to patients, families, and carers, including reasons for procedures, potential alternatives, and possible risks, to facilitate informed choices
  • accurately document procedures in the clinical notes, including informed consent, indication for procedures, medicines given, aseptic technique, difficulties encountered, and aftercare
  • support health professionals in remote settings to manage acutely unwell patients
  • support multidisciplinary teams to achieve the best health outcomes for acutely unwell patients

direction
Requires some supervision

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

The trainee may:

  • document information to outline the rationale for clinical decisions and action plans
  • convey information to families about diagnosis and prognosis clearly, compassionately, and in a timely manner
  • demonstrate communication skills to sufficiently support the function of multidisciplinary teams

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:

  • consider alternative strategies if complications arise or treatment is ineffective
  • participate in organisational quality and safety activities, including morbidity and mortality reviews and clinical incident reviews
  • 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:

  • review and reassess acute management plans
  • 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:

  • demonstrate learning behaviour and skills when educating junior colleagues, and organise education and learning opportunities for colleagues and students
  • regularly reflect upon and self-evaluate professional development
  • where appropriate, obtain informed consent before turning clinical activities into teaching opportunities

direction
Requires some supervision

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

The trainee may:

  • self-reflect infrequently
  • set unclear goals and objectives for self-learning
  • participate in in-service training on new technology

Research

confident
Ready to perform without supervision

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

The trainee will:

  • lead and/or participate in clinical research that aims to improve patient outcomes, where applicable

direction
Requires some supervision

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

The trainee may:

  • refer to evidence-based clinical guidelines
  • search for and critically appraise the evidence to resolve clinical areas of uncertainty
  • demonstrate an understanding of the limitations of the evidence and the challenges of applying research in daily practice

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:

  • take steps to help support Aboriginal and Torres Strait Islander and Māori peoples in a culturally safe way
  • negotiate health care decisions in a culturally appropriate way by considering variation in family structures, cultures, religion, or belief systems
  • 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:

  • understand the impact of cultural and psychosocial perspectives of the family
  • practice cultural competency

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 lifesaving treatments and patients’ and families’ rights to decide on care management, including withdrawal of care
  • engage appropriate colleagues in decision making (e.g., when withdrawing care or continuing to provide care despite patient or parent wishes)
  • 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:

  • establish, where possible, patients’ wishes and preferences about care
  • consider discrepancies between parents' or carers’ wishes and decisions around what is best for patients based on their personal comfort and life expectancy

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:

  • determine the setting of care appropriate for patients’ current care needs
  • balance risk, effectiveness, and priority of intervention in the presence of multiple comorbidities and/or other features of case complexity
  • 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:

  • integrate best evidence and clinical expertise into decision making
  • participate in decisions to admit, discharge, or transfer patients from the ICU
  • recognise personal limitations, and seek help when required (including escalation of care)
  • 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 in the acute care of patients, as appropriate
  • determine the need and timing of referrals to other physicians and surgeons
  • 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:

  • present patient cases to health care teams, and understand the respiratory management plans
  • encourage an environment of openness and respect to lead effective teams
  • determine the need and timing of referrals to other specialists (including general paediatricians and relevant adult health services)

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:

  • apply the principles of efficient and equitable allocation of resources to meet individual, community, and national health needs, balancing costs against outcomes
  • collaborate with emergency medicine staff, general paediatric teams, and other colleagues to develop policies and protocols for the investigation and management of common acute presentations (including acute complications of chronic respiratory conditions)
  • advocate for public health policies and strategies to promote lung health, such as climate change mitigation strategies and air pollution reduction policies, and education and interventions targeted at tobacco-free and nicotine-free environments

direction
Requires some supervision

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

The trainee may:

  • understand 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
  • apply knowledge of local protocols and resources