EEG Tech

EEG Tech

Name
First Last
Date
MM slash DD slash YYYY
Self-Assessment Rating Scale
No Experience
Theory or observation only during the past 12 months

Limited Experience
Performed less than 12 times within the past 12 months and may need a review

Experienced
Performed at least once per month within the past 12 months and may need minimal assistance

Highly Skilled
Performed on at least a weekly basis over the past 12 months; proficient

General

	No Experience	Limited Experience	Experienced	Highly Skilled
10-20 electrode placement
Portable recording in adult ICU
Portable recording in pediatric ICU
Portable recording in neonatal ICU
ECI-Brain death recording
Ambulatory EEG
Sleep deprived EEG
Sleep EEG
EMG

Evoked Potentials

	No Experience	Limited Experience	Experienced	Highly Skilled
Somatosensory evoked potentials (SSEP)
Motor evoked potentials
Visual evoked potentials
Auditory evoked potentials
Assist with nerve conduction studies/electromyography

Equipment
No Experience Limited Experience Experienced Highly Skilled
Xltek
Nihon Koden
Biologic
Grass
Other
Specify Other Equipment:
Documentation
No Experience Limited Experience Experienced Highly Skilled
Obtain patient history
Changes in patient status
Stimulation
Hyperventilation
Post hyperventilation
Interpreting EEG patterns
Miscellaneous
No Experience Limited Experience Experienced Highly Skilled
National patient safety goals
Computerized charting
Third row
Fourth row
Fifth row
Experience With:
No Experience Limited Experience Experienced Highly Skilled
Adult inpatient
Adult outpatient
Pediatric inpatient
Pediatric outpatient
Neonatal
Management
Rehabilitation
Intraoperative monitoring experience

Age Specific Experience

	No Experience	Limited Experience	Experienced	Highly Skilled
Newborn/neonatal (Birth-30 days)
Infant (30 days-1 yr)
Toddler (1-3 yrs)
Preschooler (3-5 yrs)
School age children (5-12 yrs)
Adolescents (12-18 yrs)
Young adults (18-39 yrs)
Middle adults (39-64 yrs)
Older adults (64+ yrs)

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