ASET Position Statement
Long-term Monitoring (LTM)
LTM Patient Observer and Advanced LTM Analyst
LTM Neurodiagnostic Patient Observer:
Patients in the Epilepsy Monitoring Unit (EMU) are admitted for classification of spells, seizure characterization and quantification, medication management, or evaluation for surgery. During the admission, patients are subject to activation procedures that may include sleep deprivation, photic stimulation, hyperventilation, and antiepileptic drug manipulation in an attempt to capture their typical events. While we recognize that a variety of models are currently in practice, it is ASET’s position that in order to promote and maintain a safe patient environment and best practice in the EMU, the patient should never be left unattended.
The LTM Neurodiagnostic Patient Observer is responsible for continuous observation of the patient, being either physically present in the patient’s room or via real-time remote video. This is necessary in order to recognize behavior changes, events, or other activity requiring response by Epilepsy Monitoring Unit staff. The LTM Neurodiagnostic Patient Observer must possess knowledge of the video monitoring system and camera controls and maintain communication with Epilepsy Monitoring Unit personnel as defined in the facility’s policies and procedures. Critical events must be defined and a written protocol for reporting critical events must be detailed in the facility’s policies and procedures. The LTM Neurodiagnostic Patient Observer meets competency and supervision requirements as defined by each facility.
The LTM Neurodiagnostic Patient Observer meets criteria for the Neurodiagnostic Assistant practice level and is not qualified to analyze EEG data unless the R. EEG T.® credential has been attained.
ASET recognizes the value of a well-trained, experienced and credentialed Neurodiagnostic professional in the analysis of EEG data being collected and the time sensitivity when this information is needed in the early diagnosis and treatment of electrographic events. Therefore, for optimal LTM services, the Advanced LTM Analyst, as defined below, is the preferred staff position providing continuous patient observation in LTM for epilepsy, critical care, and intensive care units (ICU).
Advanced LTM Analyst:
It is ASET’s position that qualified, credentialed EEG Technologists (R. EEG T.®) are responsible for EEG data review, analysis, and reporting as detailed in the facility policy and procedures. The additional training and responsibility needed to analyze EEG data in LTM for epilepsy, critical care, and ICU should be recognized as an advanced, specialized field. EEG technologists working in LTM have added responsibility and must recognize detrimental changes in recorded electrographic data which may indicate alarm criteria conditions.
The Advanced LTM Analyst monitors the patient video and EEG in order to analyze and report behavioral and electrographic activity that may require initiation of urgent intervention and rapid response by the EMU or ICU staff. Acting as a physician extender in collaboration with the supervising physician and other healthcare staff therefore requires the Advanced LTM Analyst to be certified in Long Term Monitoring (CLTM®). The Advanced LTM Analyst may or may not also act as the Neurodiagnostic Patient Observer.
The Advanced LTM Analyst position is an advanced practice level from the Neurodiagnostic Specialist II as defined in ASET’s Neurodiagnostic Practice Levels and has proven competence by successfully passing the ABRET Neurodiagnostic Credentialing and Accreditation examinations for obtaining both a credential in Electroencephalography (R. EEG T.®) and Long-Term Monitoring (CLTM®). Critical events must be defined and a written protocol for reporting critical events must be detailed in the facility policy and procedures. The Advanced LTM Analyst meets competency and supervision requirements as defined by each facility’s policies and procedures. For a detailed position description, please refer to ASET’s Handbook of Neurodiagnostic Job Descriptions and Competencies.
-- Approved by the ASET Board of Trustees May 24, 2017
© Copyright 2017 by ASET – The Neurodiagnostic Society