Don’t Sleep on It! Does Your Polysomnography Program Meet Current Standards? Tom Smalling, EdD, RRT, RPFT, RPSGT, FAARC Executive Director

Conflict of Interest I have no real or perceived conflict of interest that relates to this presentation. Any use of brand names is not in any way meant to be an endorsement of a specific product, but to merely illustrate a point of emphasis. AARC Congress 2011

Objectives Learning objectives for this presentation: Identify the entry pathways into the PSG accreditation system; Describe the changes to the CoARC Standards relevant to the PSG program option; Recognize the steps necessary to start a PSG program option. AARC Congress 2011

4 Overview of Accredited PSG Programs Entry Pathways into the PSG Accreditation System Current Status of CoARC Programs Changes to CoARC Accreditation Standards Curricular Strategies Sample program outlines Sample instructional units How do I get started? Resources Question and answers What’s Covered

5 Pathways into the PSG Accredited System 1. Commission on Accreditation for Respiratory Care (CoARC)  Add-on component to respiratory care (base) program; 2. Committee on Accreditation for Education in Electroneurodiagnostic Technology (CoA-END)*  Add-on component to END (base) program; 3. Committee on Accreditation for Polysomnographic Technologist Education (CoA-PSG)*  Stand-alone program * CoA-END and CoA-PSG are Committees within the Commission on Accreditation of Allied Health Education Programs (CAAHEP) Overview of Accredited PSG Programs

6  Commission on Accreditation for Respiratory Care (CoARC) Must be current student or graduate of a CoARC-accredited program to enroll; Graduates receive certificate of completion in addition to degree from RC program; Graduates are eligible to take the Registered Polysomnographic Technologist Exam (RPSGT) administered by the Board of Registered Polysomnographic Technologists (BRPT) without additional on-the-job training (Pathway #3). Other credentialed RTs must complete 6 months FT OJT experience to become eligible. Graduates are eligible to take the Sleep Disorders Specialty Exam (SDS) administered by the NBRC. Other credentialed CRTs must complete 6 months FT OJT experience to become eligible. RRTs must complete FT 3 months OJT experience. Overview of Accredited PSG Programs

7  Committee on Accreditation for Education in Electroneurodiagnostic Technology (CoA-END) Must be current student or graduate of a CoA-END-accredited program to enroll; Graduates of the add-on receive certificate of completion and may also earn a degree from END program (not required); Graduates are eligible to take the Registered Polysomnographic Technologist Exam (RPSGT) administered by the Board of Registered Polysomnographic Technologists (BRPT) without additional on-the-job training (Pathway #3). Graduates are not eligible to take the NBRC SDS Exam. Overview of Accredited PSG Programs

8  Committee on Accreditation for Polysomnographic Technologist Education (CoA-PSG) Program enrollment is open to students in post-secondary academic institutions and accredited sleep centers; Graduates receive a certificate of completion and may also earn a degree from PSG program (not required); Graduates are eligible to take the Registered Polysomnographic Technologist Exam (RPSGT) administered by the Board of Registered Polysomnographic Technologists (BRPT) without additional on-the-job training (Pathway #3). Graduates are not eligible to take the NBRC SDS Exam. Overview of Accredited PSG Programs

9 Current Numbers/Types of PSG Programs 1. Commission on Accreditation for Respiratory Care (CoARC)  8 Total (4 Associates; 5 Baccalaureate) 2. Committee on Accreditation for Education in Electroneurodiagnostic Technology (CoA-END)*  13 Total (1 Diploma; 6 Certificate; 10 Associate; 1 on-line/distance) 3. Committee on Accreditation for Polysomnographic Technologist Education (CoA-PSG)*  39 Total (31 Certificate; 13 Associates; 6 on-line/distance) Overview of Accredited PSG Programs

Purpose of Standards Outlines the minimum requirements to which an accredited respiratory care program is accountable. Used for the development, evaluation, and self-analysis of respiratory care programs. Provides the basis on which the CoARC confers or denies program accreditation.

Standard I – Program Administration and Sponsorship Institutional Accreditation Consortium Sponsor Responsibilities Program Location Substantive Changes Affiliate Agreements

Standard II – Institutional and Personnel Resources Institutional Resources Personnel Resources Key Program Personnel Program Director Director of Clinical Education Medical Director Instructional Faculty Administrative and Support Staff

CoARC Policy 6.01 E – Primary PSG Instructor There must be a Sleep Disorders Specialist (CRT-SDS or RRT- SDS) or a Registered Polysomnographic Technologist (RPSGT), (who is preferably also a Registered Respiratory Therapist), designated as the primary instructor for that portion of the program. While this individual may be either of the two Key Personnel noted above, (should s/he meet sleep specialist qualifications), under those circumstances the program must show that these additional responsibilities are not adversely affecting the education of those students enrolled in the base Respiratory Care program.

CoARC Policy 6.01 E – Primary PSG Instructor In addition to the CRT-SDS, RRT-SDS, or RPSGT credential, this individual must possess at least an Associate Degree, and have at least two (2) years of clinical experience in sleep technology. It is recommended that the individual should have at least one (1) year’s experience in an appropriate teaching position.

Standard III – Program Goals, Outcomes, and Assessment Statement of Program Goals Assessment of Program Goals Assessment of Program Resources Student Evaluation Assessment of Program Outcomes Reporting Program Outcomes Clinical Site Evaluation

Standard III – Program Goals, Outcomes, and Assessment Standard 3.01 – Standard 3.01 – …For programs offering the polysomnography option, the program must have the following additional goal defining minimum expectations: “To prepare sleep disorder specialists with demonstrated competence in the cognitive (knowledge), psychomotor (skills), and affective (behavior) learning domains of polysomnography practice as performed by sleep disorder specialists (SDS).”

Standard III – Program Goals, Outcomes, and Assessment Standard Standard Program goals must be compatible with nationally accepted standards of roles and functions of registered respiratory therapists and registered sleep disorders specialists for programs offering the polysomnography option.

18 1. Facilitate the entry of working therapists wishing to cross-train into this specialty. 2. Provide graduates with the opportunity to obtain specialized training and be eligible to take the national credentialing exam upon completion of the certificate. Optional PSG Program Goals

Standard III – Program Goals, Outcomes, and Assessment Standard Standard The program must, at a minimum, meet the assessment thresholds established by CoARC for the following program outcomes, regardless of location and instructional methodology used: a) Graduate performance on the national credentialing examination for entry into practice; b) Programmatic retention/attrition; c) Graduate satisfaction with program; d) Employer satisfaction with program; and e) Job placement.

Standard IV– Curriculum Minimum Course Content Minimum Competencies Length of Study Equivalency Clinical Practice

Standard IV– Curriculum Standard Standard …For the polysomnography option, curricular content must be periodically reviewed and revised to ensure its consistency with the competencies and duties performed by sleep disorder specialists in the workforce, as established by the national credentialing agency through its periodic job analysis and outlined in its credentialing examination specifications. These nationally accepted standards provide the basis for formulating the objectives and competencies of the program’s curriculum…

NBRC SDS Detailed Content Outline Comparison with Curriculum

23 Curriculum content and length, and documentation of student progress must be designed to enable achievement of program goals and objectives. Curricular content must be designed to supplement as well as take advantage of the comprehensive didactic, laboratory, and clinical instruction already established in a respiratory care curriculum. For instance, while respiratory care program curricula provide significant instruction on positive airway pressure (PAP) therapy, respiratory therapy students enrolled in an optional polysomnography program would learn about the distinct application of PAP devices within the context of the sleep laboratory. Curricular Strategies

24 Learning and clinical resources must be appropriate to the program’s goals and should be available to students outside of regular classroom hours. Physician input, preferably those who are Board-certified in sleep medicine, should also be adequate. Program competencies should provide the basis for deriving the objectives and activities constituting the program's curriculum. The competencies stated and the curriculum objectives derived should be consistent with the level of practitioner preparation delineated in the program's goals, and should encompass the knowledge, technical expertise and behavior expected of graduates. Curricular Strategies

25 The curriculum must include an appropriate sequence of learning experiences consisting of classroom and laboratory presentations, discussions, demonstrations, and supervised laboratory and clinical practice that progresses in sequence from entry-level cognitive, psychomotor, and affective components of instruction to more advanced levels. Clearly written course syllabi which describe learning objectives and competencies must be developed for each of the didactic, laboratory, and clinical components. Clinical affiliates should conform to professional standards, such as those established by the AASM, JCAHO, and by other health care accrediting entities where appropriate. Curricular Strategies

26 The above strategies are not meant to be all-inclusive, but are attentive and consistent with current accreditation standards and practices. The polysomnography curriculum should be designed in such a way as to addresses the unique characteristics and constraints of each respiratory therapy program. What works well for a university-based, baccalaureate respiratory therapy program with 10-week modular curricula, for example, will not necessarily work for a semester-based, associate degree community college program. Curricular Strategies

27 LAST SEMESTER (YEAR 1) OBSERVATIONAL CLINICAL IN A SLEEP LABORATORY FIRST SEMESTER (YEAR 2) PSG LECTURE I contact hours PSG LAB I contact hours PSG CLINICAL I contact hours SECOND SEMESTER (YEAR 2) PSG LECTURE II contact hours PSG LAB II contact hours PSG CLINICAL II contact hours TOTAL CONTACT HOURS: 260 Sample Program Curriculum

28 Sample Program Curriculum Professional-Technical RESP 250Beginning Polysomnography2 RESP 251Intermediate Polysomnography3 RESP 252Polygrphy Directed Practice I3 RESP 253Neurophysiology of Sleep2 RESP 254Intermediate Polysomnography II3 RESP 255Intermediate Polysomnography II3 Professional-Technical: 16

29 Sample Program Curriculum First Term Course Title Credits PSG 1000 Polysomnographic Technology I 3 PSG 1000L Polysomnographic Technology Laboratory I 1 PSG 1800L Polysomnographic Technology Clinical Practicum I 1 Total Credits 5 Second Term Course Title Credits PSG 1001 Polysomnographic Technology II 3 PSG 1001L Polysomnographic Technology Laboratory II 1 PSG 1801L Polysomnographic Technology Clinical Practicum II 1 Total Credits 5 Total Certificate Credits 10

30 Medical Terminology related to Sleep Patient and Laboratory Safety Issues Procedures/Documentation for Initiating Sleep Studies Electrode Theory/Instrumentation Patient Preparation Procedures/International System Neuroanatomy and Physiology Intro to sleep architecture/sleep stages Ancillary equipment application Signal processing Montage selection/Equipment calibration Physiologic Calibrations/Lights Out Procedures Sleep disorders pathophysiology Typical Sequence of Instructional Units

31 Monitoring procedures Sleep microanatomy and architecture Sleep pathophysiology PSG record staging (R&K/AASM) Event recognition ( Limb movement; Respiratory; Cardiac; Neuro) Sleep Pharmacology Sleep Calculations Pediatric PSG MSLT/MWT Data archiving/Report generation Therapeutic Interventions (PAP, surgical, non-surgical) Sleep lab/center management Treatment plans (development/implementation/evaluation) Typical Sequence of Instructional Units

Standard V– Fair Practices and Recordkeeping Disclosure Non-discriminatory Practice Safeguards Academic Guidance Student Identification Student Records Program Records

How do I get started? CoARC Policy 2.01 All sponsors must have an accredited base program. A base program holding continuing accreditation with no pending progress reports may expand its offerings by adding a Polysomnography Specialty, or Satellite (U.S. or International).

Accreditation Policy Change CoARC Policy Change to go into effect as of March 2012: Polysomnography Program Option referred to as Sleep Specialist Program Option (SSPO); More accurate/appropriate description of the respiratory therapist’s role in the sleep field; Alignment with description used by NBRC.

How do I get started? Initiation of Accreditation (CoARC Policy 2.03) Initiation of Accreditation (CoARC Policy 2.03) Letter of Intent Application- SSPO Advisory Committee support; Letters of support from affiliates; Establishes maximum enrollment. $250 application fee Action by CoARC Board (Approval/Denial of Intent) Enrollment of students for the first class must occur within six (6) months of the date of the Approval of Intent.

How do I get started? Initiation of Accreditation (CoARC Policy 2.03) Initiation of Accreditation (CoARC Policy 2.03) Submit a CoARC Accreditation Services Application; Sleep Specialist Initial Accreditation Self Study Report (ISSR- Sleep) – submitted within 3 months after enrollment of first class; $500 self-study fee; On-Site Review – conducted within 3-5 months after ISSR; Action by CoARC (Initial Accreditation or Withhold of Initial Accreditation); Initial Accreditation for 5 years $500 annual fee.

37 Perform a needs assessment; Interest from the community; Assess your resources; Find a qualified primary PSG instructor/facility;facility Obtain support/feedback from administration, advisory committee, and medical director; co-medical director? Go to download and review the Letter of intent application and self study; Network with colleagues. How do I get started?

Application for Accreditation Services Policies and Standards List of currently accredited PSG-add on programs List Specialty sections in sleep & education SDS exam content and administration; state practice acts SDS RPSGT exam content and administration RPSGT What resources are at my disposal???

CoARC Executive Office For any questions, contact the Executive Office at: 1248 Harwood Road Bedford, TX (817)

Questions and Answers