Paediatric Certificates Information Booklet June 2017

Transcription

1 Paediatric Certificates Information Booklet June 2017 Page 1 of 26 1

2 NZAS Paediatric Certificates Version 8 Updated 08/07/2017 Contents 1. Overview Obtaining a Paediatric Certificate Applying for a Paediatric Certificate... 6 Option A: Grand Parenting... 6 Option B: Full MNZAS members Completing requirements... 6 Paediatric Certification Activities... 7 Portfolio Chart reviews... 8 On-site Peer Review Maintaining a Paediatric Certificate Maintenance Requirements... 9 On-going activities to maintain competence... 9 On-site Peer Review Further Requirements... Error! Bookmark not defined. 4. Appealing a Chart Review or Peer Review Inactive Membership Appendix A: Declaration of Hours Appendix B: Application Form Appendix C: NZAS Paediatric Specialisation Certificates Checklists Visual Reinforcement Audiometry (VRA) (Observation and Discussion) Auditory Brainstem Response (ABR) (Observation and Discussion) Paediatric Habilitation (Observation and Discussion) Visual Reinforcement Audiometry (VRA) (Chart) Auditory Brainstem Response (ABR) Testing (Chart) Paediatric Habilitation (Chart) Appendix D: Template for log book of supervised hours Glossary 2

3 ABR Auditory Brainstem Response APC Annual Practising Certificate CCC Clinical Certificate of Competency CEPs - Continuing Education Points DHB District Health Board ENT Ear Nose and Throat Specialist MNZAS Member (full) of the New Zealand Audiological Society NZAS New Zealand Audiological Society VRA Visual Reinforcement Audiometry 3

4 1. Overview The Purpose of Paediatric Certificates is to provide a structured peer review process for MNZAS members who are currently working in paediatric audiology. Certificates ensure both experienced audiologists and those who lack experience in paediatrics gain clinical competency. These will also ensure a uniform standard of care across is achieved across the county, which will benefit both patients and clinicians. Paediatric certificates also enhance opportunities for all audiologists to further their continuing education in the field of paediatrics, such opportunities and benefits are listed below in Table 1. Table 1: Summary of Benefits Benefits New skills Up-skilling Collaboration Confidence for the audiologists and DHBs Increased patient outcomes Benchmarking for the paediatric audiology services Protection for audiologists and the NZAS Ability to identify gaps and inequities around the country Efficient clinical practices Improved relationships with paediatric and ENT teams Reduced risk to the patients, the audiologists, and the DHBs Reduced complaints made by patients Reduced subjectivity in interpretation of results Reduced isolation for small DHBs Paediatric certificates cover the following three areas: 1. Visual Reinforcement Audiometry (VRA) Compliance with the VRA certificate is necessary for audiologists involved with the VRA style of testing on any age. This includes VRA done on older individuals whose developmental age or intellect mean that VRA is the most suitable test type. 2. Auditory Brainstem Response (ABR) Audiometry Compliance with the ABR certificate is necessary for audiologists doing the ABR style of testing on any age. 3. Paediatric Habilitation Compliance with the Paediatric Habilitation certificate is necessary for audiologists doing hearing habilitation for any child five years or below. Each certificate is achieved independently. An NZAS audiologist can hold one, two or all three of these certificates 4

5 A summary of the process for certification is shown in the diagram below. Figure 1: Paediatric Certification Process MNZAS CCC as at 30/3/16 MNZAS CCC from 31/3/16 Apply to NZAS for grand-parenting submitting a declaration by 31/12/16 No Register interest to complete a paediatric certificate Yes Commence portfolio by submitting one chart for review Begin 80 hours of paediatric certificate activities Complete log & submit Receive feedback 1 satisfactory chart per certificate Satisfactory on-site peer review (direct observation) Paediatric certificate awarded Maintain each Certificate. Per CEP cycle complete: - 80 hours of activity - Onsite peer review (by any individual who holds a paediatric certificate in that area) 5

6 2. Obtaining a Paediatric Certificate Version 8 Updated 08/07/2017 Only full members of the New Zealand Audiological Society (MNZAS) are eligible to hold a New Zealand Audiological Society (NZAS) Paediatric Certificate. Once an audiologist has completed their Certificate of Clinical Competency (CCC) and becomes a full member of the NZAS, they can apply to hold one or more paediatric certificates. 2.1 Applying for a Paediatric Certificate There are two options available to obtain paediatric certification. An outline of each pathway can be seen in Figure 1. Option A: Grand Parenting Audiologists who are MNZAS-CCC held as at 30 March 2016 may apply for certification using grand parenting. This option is available for applications received up until 31 December Grand parenting recognises the experience of a currently practising paediatric audiologist. Individuals who have submitted their application for grand parenting entry need to have submitted their charts prior to 31st December To apply for certification under the grand parenting agreement, applicants: Sign a declaration (Appendix A) stating that they have a minimum of 80 hours current experience working with children in the certification area (i.e. this is 80 hours over the last 3 year cycle) Apply for each certificate being obtained Submit charts for review using the following process: o Submit a chart for review, based on the exemplars provided. o Once successful feedback has been provided by the assigned peer reviewer on the chart the onsite peer review will be arranged Successfully complete an onsite peer-review by a NZAS Peer Reviewer (within the CEP cycle). Option B: Full MNZAS members This option is for audiologists who do not hold a MNZAS-CCC as at 30 March 2016 or who hold MZNAS- CCC as at 30 March 2016 but are not eligible to apply under the grand parenting scheme. After being awarded their CCC applicants will: Register interest with the NZAS administration (Appendix B). Begin 80 hours of approved Paediatric Certificate activities (see table below for specifics). Submit charts for review, following the same process as described above. Apply and undergo an onsite peer review by an NZAS peer reviewer following successful completion of chart reviews. 2.2 Completing requirements Unless grand parenting applies, there are three requirements to obtain a paediatric certificate: Paediatric activities to gain experience Portfolio of chart(s) Demonstrated competence through an on-site peer review 6

7 Paediatric Certification Activities Audiologists who apply for paediatric certificates using grand parenting entry do not need to complete paediatric certification activities described in this section. This section applies to all other applications. A minimum of 80 hours of paediatric certification activities need to be logged in each clinical area relevant to the paediatric certificate being sought. The vast majority of these hours will be made up of direct at the elbow supervision, as this provides a facilitated learning experience to introduce new clinicians to this area of clinical work. Hours include direct supervision, clinical case discussions and other supplementary activities as shown in the table below. Table 2: Paediatric activities Activity Description Minimum Required Direct Supervision Includes at- the-elbow and in the-building supervision performed by another clinician who holds a paediatric certificate in that area. 70 Clinical Case Discussions Chart Review NZAS Paediatric Up-skilling days Online Paediatric Lectures Case Presentation Time spent with another clinician who has their paediatric certificate in that area: Phone calls Face to face discussion Skype discussion This could be time sent discussing cases on . For example ABR trace review group. There must be someone in the review group who has their certificate in this area. Note the separate requirement for chart review prior to doing on the onsite review below. As organised by the Paediatric Technical Advisory Group Online courses must be paediatric or have relevance to paediatric practise. They must have learning outcomes, and at least two postcourse questions that attendees need to answer. Hours spent creating and conducting a presentation for: Case conferences within the department or workplace (e.g. hospital with ENT) Regional meetings International meetings 8 Optional (no minimum requirement) Optional (no minimum requirement) Optional (no minimum requirement) Optional (no minimum requirement) Note: The main topic of the activity determines which certification the hours will count towards. For example: a one hour online lecture which is half about VRA and half about paediatric hearing aids could contribute half an hour towards the VRA certificate and half an hour towards the Hearing Aid Habilitation certificate. 7

8 Portfolio Chart reviews The audiologist will submit one chart per paediatric certificate type. The contents of the chart should fulfil the portfolio requirements seen in Appendix B. Please refer to the exemplar charts on the NZAS website to guide you through this process. The charts will be submitted and verified by an NZAS approved peer reviewer who will ensure the chart meets the competencies listed in Appendix B. If an audiologist is working in more than one paediatric field, they can submit one patient chart to fulfil the requirements of any number of certificates. For example, one single chart may include ABR, VRA and Paediatric Habilitation and therefore be counted as one chart for each of the three certificate areas. If the chart includes ABR, VRA and Paediatric Habilitation, only one chart needs to be submitted. All charts must be complex cases showing a hearing loss; conductive, sensorineural or ANSD. (Note: the ABR chart must show threshold seeking, therefore a profound loss with no waves is not suitable. The hearing aid charts must show the use of real ear measures. The type of hearing aid in the chart needs to be one that can have real ear measures performed on it (i.e. not a BAHA). On-site Peer Review The audiologist will need to successfully complete a direct observation peer review by a NZAS approved peer reviewer. This will be arranged following completion of a successful portfolio. Peer reviews are performed by NZAS paediatric certificate peer reviewers. Criteria used by peer reviewers can be found in Appendix B. These checklists should be revised in preparation for the on- site peer review. The audiologist should also be very familiar with the UNHSEIP diagnostic and amplification protocols for the provision of audiologic assessment and amplification which can be downloaded from the UNHSEIP diagnostic and amplification guidelines link on the NZAS website. The NZAS approved peer reviewer will attend the audiologist s clinic for direct clinical observation in each certificate. The audiologist will be expected to book patients where the audiologist can demonstrate the clinical skills of each certificate. The NZAS peer reviewer needs to observe the following clinical skills: Visual Reinforcement Audiometry (VRA) Presentation of VRA Control of distraction as a presenter* Auditory Brainstem Response (ABR) Application of electrodes Maintenance of interference Tone-burst ABR testing Click ABR testing ^ DPOAE testing Immittance testing Paediatric Habilitation Hearing aid fitting (including Real ear measures and an RECD measurement)# Aided testing Tympanometry Paediatric Hearing Aid questionnaire (if time permits) 8

9 Notes: * If time does not permit a separate distraction assessment (if all three certificates are being reviewed), then assessment of control as a distractor need not be formally reviewed. ^ Should some Click ABR testing skills be unable to be reviewed on the day, due to for example the baby waking up during the test, then these skills might be discussed on the day following the appointment. Alternatively they may be reviewed at a later date using skype or video recording. # Assessment of Hearing aid fitting (including Real ear measures and an RECD measurement) need not be a new fitting, but could be a follow-up appointment where real-ear measures are required. 3 Maintaining a Paediatric Certificate Once an audiologist has been awarded a paediatric certificate they are required to complete the following over a three year period (each NZAS CEP cycle): Paediatric activities to maintain competence (see table 3). Maintenance of CEP points (please see the CEP section of the NZAS website for details on this). Demonstrated competence through an on-site peer review. - this can be done by anyone who also holds a paediatric certification. - the peer reviewer can be internal or external to the candidate s place of work. - this is sufficient for the peer review for the NZAS annual practicing certificate, and a second adult peer review is not needed. - the peer reviewer cannot be the same individual for two consecutive CEP cycles. 3.1 Maintenance Requirements On-going activities to maintain competence An MZNAS-CCC who holds a paediatric certificate must complete 60 hours of direct patient contact in that certification area over the three year CEP cycle. The current requirement for CEPs remains and it is sensible that a significant proportion of these CEPs relate to activities which are paediatric focused. 9

10 Table 3: On-going activities Activity Description Minimum Required Direct patient contact Chart Review NZAS paediatric elearning Module Includes any hours of testing in the specialised area of paediatric testing. Time spent with another clinician who has their paediatric certificate: Checking charts i.e. ABR trace reviews Discussing results or case management for difficult cases This could be on the face to face, on the phone or via . Successful completion of the NZAS paediatric elearning module (ABR, VRA, Paediatric H.aid when available) 60 ABR requires 100% chart review. Case discussion for other areas is encouraged but has no minimum requirement. 1 per certificate area Annual practicing certificate (APC). NZAS requires 3 hours for the APC. If an individual is only sitting one paediatric certificate, then we suggest that they can make up the rest of the 3 hours with appointment types which reflect their main area of work. For example, someone doing VRA and adult diagnostic and hearing aid work, may spend 1.5 hours on VRA and 1.5 hours on an adult hearing test and hearing aid fitting to make up their Annual Performance Review. These are some examples of activities which earn CEPs and have a paediatric focus: 1. NZAS Paediatric Up- skilling days 2. Online Paediatric Lectures 3. Case Presentations a. Case conferences within the department b. Case conferences outside of the department (with ENT, paediatrics, education sector) c. Regional meetings d. International meetings On-site Peer Review The audiologist will need to successfully complete a direct observation by an audiologist who holds a paediatric certificate in the area being reviewed within the CEP cycle. The peer reviewer can be internal or external to the individual s place of work (this requirement differs from the NZAS requirements for an adult peer review). An individual cannot be peer reviewed by the same person for two consecutive CEP cycles. That peer reviewer will use the checklists found in Appendix B, and will use the outcomes rating noted at the beginning of each checklist when reviewing. The NZAS peer reviewer will ensure that all criteria are being performed to a clinically safe level. If this is not achieved, the audiologist must complete further development in the relevant area and then have another peer review in that specific area. A direct clinical observation peer review must take place for each certificate. The audiologist will be expected to book patients where the audiologist can demonstrate the clinical skills of each certificate. The NZAS peer reviewer needs to observe the following clinical skills: Visual Reinforcement Audiometry (VRA) Presentation of VRA 10

11 Control of distraction as a presenter* Auditory Brainstem Response (ABR) Application of electrodes Maintenance of interference Tone-burst ABR testing Click ABR testing ^ DPOAE testing Immittance testing Paediatric Habilitation Hearing aid fitting (including Real ear measures and an RECD measurement)# Aided testing Tympanometry Paediatric Hearing Aid questionnaire (if time permits) 4. Appealing a Chart Review or Peer Review Applicants who have an unsuccessful chart review or peer review will be provided details on specific aspects that require improvement. If there is dispute regarding the result of an on-site peer review a different peer reviewer will be assigned for a second on-site review to offer a second opinion. Please note on-site peer review results are discussed by the peer review panel prior to the decision being made. 5. Inactive Membership According to the constitutional rules of NZAS membership, any member may become inactive for any length of time. In order to reactivate paediatric specialisation certificates when 80 hours cannot be gained in the three year cycle surrounding the period of inactivity the following process must be followed: Read and familiarise themselves with the current version of the UNHSEIP diagnostic and amplification protocols for the provision of audiologic assessment and amplification. Request access to the paediatric e-learning materials on the NZAS website and complete this training Organise a supervisor who holds a paediatric certificate in the area/s of the certificate(s) you wish you reactive. The audiologist may then commence clinical work in those areas under your supervisor s guidance. It is recommended that initially direct at the elbow supervision takes place until the audiologist and supervisor agree to another arrangement, such as in the building or chart sign off. Successfully submit one portfolio to an NZAS peer reviewer. 11

12 Appendix A: Declaration of Hours Name: NZAS: Membership number: I hereby declare (by signing this document) that I have had at least 80 hours of practical experience in the following areas, over the last three year period and would like to apply for certificates in the follow areas: Please tick those which apply to you. Paediatric Habilitation Visual Reinforcement Audiometry (VRA) Auditory Brainstem Response (ABR) I agree and comply with the Code of Ethics. Signed: 12 By sending this form into the NZAS you are giving NZAS consent to share information about the outcome, or progress through, the paediatric certificate process with your employer and the NSU.

13 Appendix B: Application Form Name MNZAS Number Employer Please complete the boxes below to apply for the appropriate certificates by placing a ticking under the Apply for column for the relevant certificates. Please place a tick in the Grand parenting column if you have completed at least 80 hours of practice in the relevant area over the past 3 year cycle. Paediatric Habilitation Visual Reinforcement Audiometry (VRA) Auditory Brainstem Response (ABR) Apply for Grand parenting If applying without Grand parenting please complete the following. My supervisor is: Supervisor Signature: Date: Signed (Candidate): Date: 13 By sending this form into the NZAS you are giving NZAS consent to share information about the outcome, or progress through, the paediatric certificate process with your employer and the NSU.

14 Appendix C: NZAS Paediatric Specialisation Certificates Checklists On Site Peer Review Checklists These checklists are the criteria which the peer reviewers use to assess two sections of the paediatric certificates the Peer Review (Observation and Discussion). Below are the outcomes possible for each criterion of the checklist. Peer Review (Observation and Discussion) Clinically Safe (C) Marginal (M) Needs further development (FD) Not observed (NO) Chart Review Checklists Always in chart unless adequate reasoning (A) Usually in chart (U) Rarely in chart (R) Never in chart (N) 14

15 Visual Reinforcement Audiometry (VRA) (Observation and Discussion) Version 8 Updated 08/07/2017 Clinically Safe (C) Marginal (M) Needs further development (FD) Not observed (NO) Criteria Case 1 Case 2 Case 3 Clinician facilitates session in a professional and efficient way Essential case history obtained and appropriate follow-up questions (reflecting appropriate clinical reasoning) Clear explanation of test procedures Manages test session: proceeds to next test when appropriate with reference to case history information Performs otoscopy safely and integrates findings (e.g. wax, grommets) into test battery Distraction*: appropriate for developmental level of child, able to realise when under or over distracted, good rapport Presentation: follows protocol, determines thresholds in a timely manner, confident in directing distractor. Screened to 20 db HL at 500, 2000 and 4000 Hz or thresholds obtained as required. 1000Hz tested as required. Performs MLV speech testing and results interpreted correctly Bone conduction is performed if thresholds are equal to or greater than 25 db HL Performs and accurately interprets tympanometry Performs and accurately interprets acoustic reflex testing Performs and accurately interprets DPOAE testing An appropriate cross-check is performed Results of different assessments are integrated to inform diagnosis and management recommendations Parents/caregivers are informed of the result accurately in a clear and logical manner Case is managed appropriately including referral for further testing or medical management Appropriately communicates results with family, giving parent/caregivers opportunity to respond and ask questions Has access to appropriate and relevant resources to support explanation (brochures, booklets, familiar sounds audiogram) KEY; *may not be observed if clinician uses an assistant for this role Grey rows indicate criteria which are essential for the peer reviewer to see in order for the candidate to pass. 15

16 Comments: Case 1 Case 2 Case 3 16

17 Auditory Brainstem Response (ABR) (Observation and Discussion) Version 8 Updated 08/07/2017 Clinically Safe (C) Marginal (M) Needs further development (FD) Not observed (NO) Criteria Case 1 Case 2 Case 3 Clinician facilitates session in a professional and efficient way Appropriate decisions are made about test order with consideration of baby s state, including cursory otoscopy if appropriate Case history obtained and follow-up questions (reflecting clinical reasoning) asked in reasonable timeframe Clear explanation of test procedures Correct parameter settings are used^ Sensible test setup and positioning of baby, transducers and cables Obtain low and balanced impedances <5kΩ routinely (preferably 1-3kΩ) Follows protocol for initial test ear Follows protocol for frequency order Appropriate threshold seeking technique (repeatability and growth) Solves interference issues Distinguishes the difference between noise and a true response Appropriate placement and maintenance of bone vibrator position Performs bone conduction testing appropriately Can perform and interpret a click ABR to check for ANSD^^ Performs and interprets tympanometry, if abandoned documents why Performs and interprets acoustic reflex, if abandoned documents why Performs and accurately interprets DPOAE testing An appropriate cross-check is performed Parents/caregivers are informed of the result accurately/clearly and logically giving parent/caregivers opportunity to respond and ask questions Case is managed appropriately including referral for further testing or medical management Has access to appropriate and relevant written resources to support explanation (brochures, booklets, familiar sounds audiogram) KEY: ^ Software access to parameter settings may be discussed with clinician. ^^ If not able to be performed during testing session will be discussed following appointment. Grey rows indicate criteria which are essential for the peer reviewer to see in order for the candidate to pass. 17

18 Comments: Case 1 Case 2 Case 3 18

19 Paediatric Habilitation (Observation and Discussion) Clinically Safe (C) Marginal (M) Needs further development (FD) Not observed (NO) Criteria Case 1 Case 2 Case 3 Clinician facilitates session in a professional and efficient way Case history obtained and follow-up questions (reflecting clinical reasoning) asked in reasonable timeframe Clear explanation of appointment proceedings Performs otoscopy safely and integrates findings for real ear measure and test battery (e.g. wax, grommets) Tympanometry is performed and taken into consideration for fitting Accurate and recent audiogram is used for hearing aid fitting (including separate ear AC and BC thresholds.). Minimum of two points in each ear Selects appropriate hearing aids and can justify choice Uses appropriate prescription formula and can justify its use Uses a safe technique to insert probe tube Measures RECDs. If not achievable justification of average RECD is documented. Justification for type of RECD is given (e.g. insert versus ear-mould) Feedback is controlled without long term gain reduction (if gain is reduced, it is for a maximum of two weeks with a plan in place to overcome the under-aiding (i.e. Refer to CI, ordered more powerful aids or order new ear moulds). Test-box or on-ear real ear measures are recorded and meet targets# Verification (SII) Graph is used and understood The hearing aid settings are chosen appropriately (e.g. noise control settings, microphone modes, and automation of these). Tamper-proofing if required Age appropriate aided speech testing is performed Appropriate follow up questions and counselling addressed with family Case is managed appropriately including referral for further testing or medical management Considers RMHA/FM for child and in selection of hearing aids Appropriate questionnaire is performed LittleEars, PEACH, etc Care and maintenance instruction provided clearly to family Parents/caregivers are informed of the result accurately/clearly/logically giving parent/caregivers opportunity to respond and ask questions Has access to appropriate and relevant written resources to support explanation (brochures, booklets, familiar sounds audiogram) KEY: # Meeting target guidelines can found on the paediatric certificate section of the NZAS website. Grey rows indicate criteria which are essential for the peer reviewer to see in order for the candidate to pass. 19

20 Comments: Case 1 Case 2 Case 3 20

21 Visual Reinforcement Audiometry (VRA) (Chart) E = Evidence documented N= No Evidence seen in chart P= Partial Evidence in chart Criteria Rating Essential case history obtained and appropriate follow-up questions (reflecting appropriate clinical reasoning) Screened to 20 db HL at 500, 2000 and 4000 Hz or thresholds obtained as required Hz tested as required; if testing abandoned reasoning is documented Documented MLV speech testing and results are interpreted correctly; if testing abandoned reasoning is documented Documented bone conduction testing if thresholds are equal to or greater than 25 db HL; if testing abandoned reasoning is documented Documented otoscopy and includes results in interpretation of test results (e.g. wax, grommets) Documented and accurately interprets tympanometry; if testing abandoned reasoning is documented Documented and accurately interprets acoustic reflex testing; if testing abandoned reasoning is documented Documented and accurately interprets DPOAE testing; if testing abandoned reasoning is documented Results of different assessments are integrated to inform diagnosis and management recommendations, this is well documented Case is managed appropriately including referral for further testing or medical management where necessary; this is well documented Clear and concise written report to the GP and/or the referrer when appropriate Comments: 21

22 Auditory Brainstem Response (ABR) Testing (Chart) E = Evidence documented N= No Evidence seen in chart P= Partial Evidence in chart Criteria Rating Essential case history obtained with appropriate follow-up questions: UNHSEIP results entered, babies state of health noted, responsiveness to sound, etc. All ABR parameter settings are included for each result (from equipment printout including test date and masking if used) All test printouts are in the file (including immittance, DPOAEs, ABR traces); if testing is abandoned the reason for this is documented ABR test frequency selection is in line with current diagnostic protocols and accurate ABR thresholds are chosen in an efficient manner. Bone conduction is performed when AC thresholds are elevated; if testing is abandoned the reason is documented Where AC and BC thresholds are elevated, click ABR results are displayed and labelled appropriately to allow interpretation of ANSD if present ; if testing abandoned reasoning is documented ABR traces have been audited Results of all assessments are summarised and integrated to inform diagnosis and this is clearly documented Case is managed appropriately in line with the current diagnostic and amplification protocols, referral for further testing or medical management is noted, i.e., ORL, AODC, and DND form completed A report is included that summarises the results of all testing in an easily understood format and sent to all appropriate parties; parents/caregivers, newborn hearing coordinator (if necessary), ORL, AODC etc. Comments: 22

23 Paediatric Habilitation (Chart) Version 8 Updated 08/07/2017 E = Evidence documented N= No Evidence seen in chart P= Partial Evidence in chart Criteria Rating Essential case history obtained and appropriate follow-up questions: UNHSEIP results entered, babies state of health noted, responsiveness to sound, etc. An accurate and recent audiogram is used for the hearing aid fitting (including separate ear AC and BC thresholds) with a minimum of two points in each ear, if not there is justification and future planning in place to obtain this Selects appropriate hearing aids, if not justification is documented Uses appropriate prescription formula, if not justification is documented Tympanometry is routinely performed in appointments where audiometric and real ear measures are performed, if not there is a clear and reasonable justification as to why it has not been performed Measures RECDs bilaterally routinely. If not achievable a decision and justification of averaged or other ear RECD is documented. Type of RECD measure (e.g. insert versus earmould) is documented. RECD curve and table of numbers should be printed on file. Test-box or on-ear real ear measures are recorded. Printouts in file, with documentation of type of measure insert versus ear-mould. These meet targets appropriately # Electroacoustical Verification (SII) Graph in file and appropriate The hearing aid settings are chosen appropriately (e.g. noise control settings, microphone modes, automation of microphone modes etc). The hearing aid settings need to be printed from the computer and included in the chart for the purposes of the chart review Tamper-proofing is appropriate for age, and documented in the file Appropriate aided speech testing is performed Appropriate referrals have been or will be made from this appointment (including AODC, ENT, Paediatrics or CI if appropriate) 23

24 Considers the need for RMHA/FM compatibility for child and in selection of hearing aids Appropriate questionnaires have been performed LittleEars, PEACH etc Care and maintenance instruction is documented in file Documents the counselling provided to the family on hearing loss, hearing aids, amplification and other Appropriate written material given to family; (Getting started booklet, familiar sounds audiogram, mild/unilateral hearing loss handout, information on how to access batteries etc) Documentation of family/whanau questions or concerns and how these are addressed Data logging is recorded from the software and discussion with family regarding use is noted. If data logging appears unrealistic or low a plan to improve this should be included A formal report can be included however it is not essential. If a report is not included please include a summary paragraph of the case that outlines the results so far and the goals of the subsequent appointments Comment: 24

25 Version 8 Updated 23/6/2017 Appendix D: Template for log book of supervised hours Week ending (date) VRA Hours spent under direct supervision Candidate s signature Supervisor s signature By sending this form into the NZAS you are giving NZAS consent to share information about the outcome, or progress through, the paediatric certificate process with your employer and the NSU.

26 Version 8 Updated 23/6/2017 Week ending (date) Paediatric Habilitation Hours spent under direct supervision Candidate s signature Supervisor s signature By sending this form into the NZAS you are giving NZAS consent to share information about the outcome, or progress through, the paediatric certificate process with your employer and the NSU.

27 Version 8 Updated 23/6/2017 Week ending (date) ABR Hours spent under direct supervision Candidate s signature Supervisor s signature By sending this form into the NZAS you are giving NZAS consent to share information about the outcome, or progress through, the paediatric certificate process with your employer and the NSU.