Does anyone remember how they got all staff to comply with giving up thier infusion devices without tears and tantrums?
I have a problem with staff hiding pumps, some have been missing for months.

When we set up our Equipment Library we had already convinced the users of the advantages ie they could find them, they would be clean, tested, charged and delivered.

Before the Library when we encountered resistance, we would point out that they as the users of equipment would be held responsible in court, for using equipment that had not been serviced (in the event of a serous incident)and "think how much support you would get from the Trust", was generally enough.

Mind you it also helped that we set service dates in the pumps to act as an aid memoir.

Lee

Do (did) you mean the difficulties experienced in collecting pumps to populate the Equipment Library in the first instance ... or a day-to-day reluctance by the wards to surrender pumps borrowed from the Library?

In either case, the issue is best solved through "interpersonal skills", I would have thought. Let's face it, some folk are good at that sort of thing, whilst others are better off, shall we say, shuffling about at the back of the workshop!

If the staff are hiding pumps, surely this can only be an indication that (for some reason or another) they are unhappy with the service afforded them by the Equipment Library. Why not have a chat with them and find out what the real problem is?

Not enough pumps. Never one available when they need one. Stuff like that, I should imagine. Then address the problems squarely once they have become clear.

There is also the problem of wards and staff incorrectly believing that they "own" the infusion devices. This is possibly a hangover from the days of ward budgets. One way to get round this is to give them the option of hanging on to "their" equipment but charging them for all maintenence and servicing. I think you will find that they will then reluctantly give up their equipment for the Library.

Don't wards have budgets these days, then? Is this the "new model", the general case?


Oh yes! The Zero-Budget Department!

The main problem is the Library is too far from clinical areas, and is locked after hours, with the key availlable only from the main reception desk. This takes time, and the night staff ask the porters to raid the library after 4:30pm so they dont have to find a security person during the night to give them the key.
But, then they hide the surplus machinery and dont tell the morning shift. So that member of staff goes on holiday and forgets all about the hidden machinery........
Thats the sort of scenario I am faced with, out of 69 infusion pumps, 49 syringe divers and 49 MS26 drivers I am working with
over half missing.

OK, so you've identified the problems clearly enough.

It sounds like kit has gone out (been taken out) of the Library without any record of who borrowed it. A fundamental breakdown of procedure, then. Not good.

So, what about the solutions?

An access key pad for out-of-hours collections?

A registered "swipe-card" (to allow access to the Library) issued to each ward and/or trusted staff member?

Cameras in the library?

I'm sure there could be a whole number of ways of going about it, depending really upon the details of the set-up where you are.

But "far from the clinical areas" sounds like a difficult one to address. How far, I wonder? It sounds like the only answer there is the obvious one ... move the Equipment Library to a move suitable location!

Meanwhile, how do you generally operate? During the day time, do you deliver and collect the kit, or do you have the staff come to the Library to collect? If so, that could be yet another bone of contention.

At many of the Libraries I have seen, the Librarian spends a fair amount of time each day "out on patrol", as it were. That is, not only delivering the kit, but also dragging it back off the wards!

At sunny Hereford the “Out of Hours” key is kept in the ward office of the Ward closest to the Library.

Experienced nurses are encouraged to get the item they want to avoid the time wasted when the wrong item is delivered by an Auxiliary or Porter.

When this is not possible, photos of every item the Library holds are shown on the last page of a “Library User folder”, this folder explains the processes to be used when dealing with the Library and there is one in each Ward office.

We have similar numbers of Infusion Pumps and Syringe Drivers Availability of this equipment and the support we receive from the Matrons has so far prevented Wards from stock piling equipment; however we reserve the right to inspect cupboards.

Lee

Why dont you just use the swipe cards, that they all have to open the door. Seems strange to have it locked. Equipment should be signed out to one patient and then returned or it is pointless having the space used as an equipment library. Surely the clinical director has put together a work instruction or policy statement that is to adhered to. But then again they listen to noone else so why them.

As has already been stated, put the responsibility on the ward not to use out of date equipment. They are liable for any patient problems and not the enguineering department.

As Lee said they hunt through all drawers, so do we here. It is funny when they say 'we were looking for one of them the other day.'

Billy

What I find disappointing (about this thread) is that we have still yet to hear from all the Equipment Library experts from whom we have heard so much in the past.

Wasn't there a Library Conference at Blackpool only last month? How come we haven't heard anything more about that?

Surely by now Equipment Library "best practice" must have been more or less hammered out?

OK ... so let's hear about it, then! Bullet points will do ...

The problem is the old chestnut I’m afraid, every Hospital/Trust is different, no two EBMEs or Libraries appear to be the same.

The management support, equipment range, amount of kit, budget and personnel numbers are all different.

We managed to get a Library because the Quality Care Commission was not happy with the way mattresses were cleaned and records kept. Nothing to do with the multiple benefits that a Library can give.


Lee

Your right, you can talk till you are blue in the face about the benefits but as soon as they wont reach a target its arse twitching session and the funds are available. We find the same with equipment, no money available but you say that a ward has to close due to not enough equipment and hey presto someone found some.

If the ebme departments held an equipment budget it would cut down in a lot of pissing about. We know when stuff is coming to the end of its life and instead of throwing good money after bad replace it.
We spend alot of our time giving the wards scrap notes, over and over again for the same kit.(they keep on losing them) The kit doesnt get bought but there appears another layer of buerocacy sorry I meant management.

Has anyone tried a rental system in an equipment library?

At least then the equipment should be returned and getting funding for replacement equipment would be forthcoming.

For years there was talk of inter-departmental charging with in this Trust but “surprise surprise” we (Med Eng) were never allowed to take part.

Finance were probably worried about the money we would "rake" in.

Lee

Havn't tried a rental system, but we do have an alternate method that seems to work for us.

We have a set amount that we charge the hospital for the maintenance of Infusion devices over the year. This charge is levied against the Wards every month. At the start of each month we produce a pie chart that represents the usage of Infusion devices against each Ward. This information is obtained from our Library database as we record all usage. If you use more devices in that month than another Ward then your bill is higher.

We, (EME) are happy because we get the same income each month. The hospital is happy because other than annual incremental increases, the total charge to the trust remains the same each month. The Wards are happy with the arrangement as well.

Are you an employee of the Trust?

Lee

Certainly am. We are not PFI or anything like that. A normal? NHS EME department with an Equipment Library part of the department.

Did the equipment come from the Wards originally or was the equipment purchased specifically for the Library?

At Hereford it came from the Wards and I can just imagine the screaming if we tried to charge Wards for using kit that they've supplied.

In fact I can imagine them taking the kit back and hiding it; which takes this thread full circle.

Lee

Quick question from this side of the world. Is the normal system within the NHS that the library is set up and contoled by the biomeds?
In the only direct experience I have of this sort of system the library was controled (and I use the term losely) by an independant group with some connection to the clinical management of the hospital. Biomed were kept, very much, at arms length, except of course when they needed equipment tested/fixed in a hurry.

Lee - The equipment did come from the Wards originally, about 9 years ago in fact. We didn't have much of a problem getting then to release the equipment to us at the start but that is another story. However, as we have managed over the years to prove that we can control the use of devices, we have been able to purchase more pumps for the trust when they are needed. It was pretty easy to make the case when you have all the records of use etc.

DaveC - Not sure if there is a normal system or not wrt Biomeds controlling the use of devices via an Equipment Library in the NHS. It works for us here as the Library guys bring the devices straight to us in EME for repair or PM etc without us having to go looking for them.

What about a more radical model (just off the top of my head after reading these recent posts):-

1) A third-party company sets up a Library in a nice location in the hospital (near to the customers, and all the rest).

2) They purchase equipment usually found in a Library (pumps etc.) off the wards at true market value (that is, not much ... for those who don't know what that is - visit the Hilditch auctions to gain an insight).

3) Extra (new, and in sufficient quantity) equipment is purchased as need be. Remember that the Library owns the equipment, literally.

4) The Library is stocked ... then equipment is hired out, as suggested above (just like you do with tool hire).

5) Part of the deal is that biomed services the kit at set intervals, and they get paid for this. They also get paid for carrying out repairs to Library equipment on a priority basis.

How does that sound?

If the customers want (demand) more ... like deliveries, collections or even a 24x7 service - no problem. They just get charged at Premium Rates!

Mike - The same here, we have been able to purchase more pumps for the Trust.

The Trust's that I spoke to before we started our Library said they have managed to reduce infusion pumps by 20% whilst we have had to double what we had.

Lee

One of the good things about the introduction of Equipment Libraries in our hospitals is surely that it brings out proper equipment management out into the open, as it were.

That is, it does away with one or more wards hoarding equipment whilst the one next door is struggling.

It also becomes immediately obvious when their isn't enough kit available to meet demand. Frankly, I doubt that any Trust has been able to reduce the amount of infusion pumps available to circulate. If I'm wrong ... let's be hearing from you!

Another of the nice benefits is that, as control of the kit is being managed centrally, and subject to regular date checks and all the rest, routine servicing cannot be easily overlooked!

All of this banter cracks me up. Whose money paid for the equipment? Whose money pays for the maintenance? Whose money pays for the Library?
Essentially at the end of the day, all of the money is coming from the same pot and arguments about who bought what and when are irrelevant.

Yes, the kit is all being paid for by the tax-payer. And that's why we want to see it utilised (not to mention maintained) in the most efficient, beneficial, manner possible.

That is, not hidden away in a cupboard in the domain of some over-powering nursing sister or other!

Oh give it a rest,this notice board is becoming like the bleedin Parliment Speech Campaign

Thank you, Skippy. I think you have already made it clear that I am assured of your vote.

I am having trouble believing what i am reading

Not in our Trust they are not!

An example from the past - we could save a small fortune in the long term switching from Tec 3s to Tec 5 vaporisers. The savings on servicing the units every 3 years instead of annually would pay for the new units and reduce service costs. But the Med Eng Dept can only pay for servicing purchasing the new units would need to come from another budget surprise surprise it took years.

I can believe there are sensible people in every Trust, what I do not believe is that every budget holder is sensible. And as the bean counters are the real power in the NHS arguments about money will always be relevant.


Lee

Lee
Where does your "budget" come from? Is it part of a divisional budget? Is the divisional budget part of a directorate budget? Is the directorate budget part of the hospital budget? Is the hospital budget part of the PCT budget? Where would you like me to stop????
The "internal market" is a nonesense when departments start arguing about whose budget belongs to who and "look at what savings we've made".
There is a finite amount of money available at National, Regional, Hospital, Department level and it is all a matter of not how much you have and how much you spend, but how much Value for Money and Efficiencies you are able to demonstrate with your "budget".

Dare I mention again ... the ZBD?

If you hold a budget in the NHS you are responsible for it especially when its over spent.

One only has to look at the massive over spends in some Trusts to see how far things can go wrong.

However my problem is that the budget has been cut with no consideration of what it means to the service.

Lee

Lee
Yes I agree that if you are a budget holder you should be responsible for the expenditure within that budget.
However, the rest of your post highlights part of the problem.
There are massive overspends in some Trusts, which means that there has to be under spends in other areas to balance the books and ultimately cuts. As I said initially, there is only a finite budget in the grand scheme of things and any argument about departmental budgets are insignificant and a hospital should be able to run a range of services without bickering about who "owns" what equipment.
As I also said, the emphasis should now be on Value for Money and Efficiencies. It is a fact that finance has doubled to the NHS under Labour, however, efficiency has decreased. In addition, next year there are going to be cuts of up to 15% in the overall budget available, but the same services will be expected.

What, so we can expect the same inefficiencies ... but they will cost us 15% less? That sounds like a bargain to me!

Geoff (cynical as ever),
Using logic it would seem that if the budgets are cut, then efficiency will go up! As a doubling of budget in 12 years has resulted in a decrease in efficiency of 4% overall, then a 15% cut in budget will result in an increase of 1% in efficiency.
If only!!!