Following on from a comment I made in the "return of infusion devices" thread I would like to know how big is your Library? How many staff have you got, what equipment, how many of each etc I’ve put in the information for Hereford below if you could put your details in and any comments; I think this could be a useful resource and might help others when looking for answers.

At Hereford (a small rural General Hospital with approx. 340 beds) we look after the equipment below and manage all of the static mattresses keeping a rolling replacement stock of 20. All items are cleaned on the Wards by the nursing staff before pick up and are then cleaned /disinfected in a room specially set up for the purpose. The Library also looks after slings, resus rolls and bags, as well as a few “odds and sods“ it is manned during office hours and there is a key at the closest staff base for out of hours.


Staff 3
Clean and disinfect Yes

Equipment
Infusion Pump 68
Mains Syringe Drivers 41
Battery Syringe Drivers 22
Pressure Relief Mattresses 71
Static Mattresses 20
Feed Pumps 23
Nebulisers 11


Lee

Interesting. Any other data? Things like:-

1) The average amount of kit "out" at any time (90%+?)
2) The average stay on the wards (a couple of days, a week or more?)
3) How much kit gets taken out after hours?
4) How much of the kit is "missing"?

... and stuff like that.

And, on operational policy:-

1) Do your staff collect, and deliver (or do the ward staff collect and return)?
2) Do they "patrol" the wards looking for "over stayers" (kit, that is) ... and "missing" items?
3) Do you have a maximum stay limit for each item (or can wards hang on to kit indefinitely, without being challenged)?
4) Are borrowers required to give an estimate how long they are taking the kit for (to enable Library staff to plan ahead)?
5) How does the out-of-hours service work? Who is permitted access (to the Library)? Is the system ever abused?

... and stuff like that!

1)Always
2)When there is time to get the database running i could tell you (currently paper based system)
3)A bit less than a third
4)Very little (good relations at the moment)

On operational policy:-
1)yes Library staff deliver and collect
2)fortunately this is not currently a problem
3)No limit, but each item is lent out specifically for one patent then put out for return
4)No typically these are short term loans
5)The key is held at a staff base, nursing staff have been advised to send an experiance member of staff so that they get what they need first time, however a Guidance folder has been supplied to each Ward/Department with photos of every item held.

Staff are requested to ring and leave a message giving the area, equipment type and patient RLQ (patient identification number)
before taking an item, under each item is a T card which should be put under the relevant section in a T card board when removing the item.

Having invented the simplest system we can, most staff have been supportive but you always get one (or two).

Lee

Thanks for that. It looks the key point to be stressed there is that kit is loaned out for the patient, rather than to the ward etc. So that could provide a route to tracking in case kit does go astray. That is, when, and from where, was the patient discharged, etc.

We've just started up and are only doing infusion devices at the moment. We have 2 full time and 2 part time staff who look after 512 volumetric pumps and 475 syringe drivers. The trust are looking to introduce a second library at the other major hospital here which will probably hold a similar number of devices. The trust are happy with the library and are thinking of adding more equipment types to the library. We may become a victim of out own success.

Bill

I am reasonably sure that there are more than two Equipment Libraries in the UK!

Don't be shy.

Please spend a couple of minutes you can even cut and paste the list below (please put in your numbers etc).

Hereford
Hospital size 340 beds
Library Staff 3
Library staff deliver and collect equipment
Clean and disinfect Yes

Equipment
Infusion Pump 68
Mains Syringe Drivers 41
Battery Syringe Drivers 22
Pressure Relief Mattresses 71
Static Mattresses 20
Feed Pumps 23
Nebulisers 11


Lee

They're probably all busy out there hunting down missing infusion pumps, Mate, I should imagine!

By the way, I've re-discovered that the way to elicit feedback (on this forum, on others, and in other matters) is to offer an incentive of some kind. The stick and the carrot. Or, put another way, threat and reward.

I rekon there's not many libraries out there, it took us more than 20 years to get the funding. Most people would have given up long ago.

I've been to Equipment Libraries at Redditch, Wolverhampton, Cardiff and Blackpool.

I recall somebody from Wigan used to advertise his Library regularly on this site

Each of the following has mentioned Libraries on this site
Dicky from Cumbria
John Sandham
Roberth from Chesterfield
Mark.N at Taunton
I could go on (and often do).

Surely the big advantages of a site like one, is the ability to share information.

Okay nobody can answer or help resolve every problem posted (although Geoff gives it a good go) but if nobody tries its a bit of a shame.

Lee

Lee,
We are currently working at setting up libraries in the two largest hospitals in Belfast. I have been working on procedure recently, as yet no equipment is assigned to the library.

Thanks

Ian

Hello Ian,

If you feel in need of moral support or "sarky" comments you know where i am.

Lee

Addenbrookes
Hospital size 1100 beds
Library Staff 3
Library staff deliver and collect equipment
Clean and disinfect Yes

Equipment
Infusion Pump 386
Mains Syringe Drivers 183
Battery Syringe Drivers 26
Feed Pumps 182
Defibrillators 6
ECG machines 5
Vital Sign Monitors 65
Blanket Warmers 5
TENS Machines 91
Miscellaneous 13

Max

Hello Max,

What arrangements do you have in your Trust for Pressure and Static mattress cleaning and their management?

Lee

Withybush
Hospital approx 285 beds
Library staff x2 ELA's, part of EME.
ELA's deliver, collect and record use of equipment
Clean - yes, disinfect - sometimes

Equipment
Volumetrics - 106
Syringe pumps - 49
MS 16 drivers - 18
Pressure mattresses - 77
NG feed pumps - 23
Nebulisers - lots
Vena pumps 23

Hi Lee

Those devices are contracted out to Huntleigh.

Max

Hospital size 660 beds
Library Staff 2.5
Library staff deliver and collect equipment
Clean and disinfect Yes

Equipment
Infusion Pump 128
Mains Syringe Drivers 56
Battery Syringe Drivers 28
Pressure Relief Mattresses 135
Pressure Relief Cushions 23
Feed Pumps 41
ECG Monitors 5

Library staff 2.5 ? Does your hospital employ vertically challenged people?

No, just a big fat bloke that ate all the pies but he is sensitive about his size issues so watch out.

2 full time people and one part timer mornings only.

And there we all were, wondering what had become of the Fat Controller!

Hello Charlie

Do you clean/disenfect your Pressure mattresses or do you send them away?

And are you brave enough to tell us which Trust you work for?

Lee

Hello Mike

Same question do you clean/disenfect your Pressure mattresses or do you send them away?

Lee

Lee - awkward one to answer. The 'party line' is that all mattresses are cleaned on the Wards prior to coming back to the Library. However there have been recent instances where the ELA's have had to clean mattresses in EME here. (approx 6 in the last year).

Hire mattresses can go back to the Supplier for deep cleaning - up to 4 per year. However, we have a mixture of hospital owned, hire and lease pressure mattresses.

Wards that have mattresses on 'long stay' have their own cleaning facilities where the top covers are washed in a machine at the discretion of the Ward Sister. We don't get involved in this.

The whole scenario is up for discussion at the moment and there is a project going on to standardise and expand. Finance is the holdback factor at the moment unfortunately.

Lee

Top sheets in washing machine, bottom sheets and between cells all done by hand. Particularly badly contaminated by "nasty bugs" sent away at most half a dozen per year.

Which trust? Well we are not a foundation trust as after going down that route with the associated costs and flannel for 16 months the board itself pulled out as "time was not right". Latest edict from on high in June "A new application will be submitted in the Autumn" Now mid November and a stony silence.

Hopefully not too far off-topic (I trust).

Can someone offer a clue as to why there are so many of these "alternating pressure mattress" type beds in service these days? It didn't used to be the case.

What has changed? Nursing practices? Patient "management"? Some previously unknown affliction amongst the population at large?

OK, pressure sores, and all the rest. But they have always been there. Could it be down to obesity now, I wonder.

The tech support of hospital beds in general has become "big business", and (it seems to me that) many hospitals have yet to catch up, as it were. It appears to be becoming (or, has become) a sub-discipline (speciality) of biomed in its own right. And yet it seems to be the case that the whole issue of beds per se is seen as, shall we say, a bit of a burden in many biomed sheds. Perhaps I should also lump in the whole business of patient hoists, LOLER and all the rest, here as well.

I am prompted to mention all this as I was approached only recently for some advice in setting up a private venture keen to "address" this "market". I may have dampened the guy's spirits somewhat when I reminded him of the difficulties of servicing beds with patients still in residence!

It sounded like he was hoping to carry out a "quick PM and safety check" whilst the old dear was out on a mission to the toilet! OK for a "one-off" perhaps ... but what about all the other beds in the ward (hospital)? Was he planning to camp out in the corridor, standing by ready to rush in with his checklist, toolkit, and Rigel* each time he (or more accurately, a bed-bound patient) "got the call"?

* Other electrical safety testers are available.

Yet again and at the risk of upsetting Andy AKA Kawasaki it is to do with money.

Patients developing bed sores have much longer stays in hospital (we haven't got enough beds as it is) and cost the NHS an extra £11K to £40K each patient I am told. I have seen the figure £2.1 billion quoted as a cost to the NHS.

Lee

OK, that I can understand (and thanks for responding).

Productivity. Throughput.

So now the (rhetorical, perhaps) question arises ... do we see a proportionate amount of the money "saved" being ploughed back into resources for tech support?

No

OK. Next topic, please ...

Which was until you "nicked the thread" How big is your Library?

Lee

>700 Bed hospital

2.5 staff - Supervisor(ebme tech), pressure mattress maintenance tech and equipment collector/deliverer,

We supply and maintain -

Volumetric pumps
Syringe drivers, including MS26
Patient monitors
NG pumps
BP and pulse ox
Portable suction
Pressure mattresses and cushions.
Bariatric bedside chairs, comodes and wheelchairs.
Nebulisers
DVT pumps
Portable dopplers

Cheers
Mark

Hello Mark

Any ideas on quantities (for the equipment) and can I ask you the new official "Lee Stockton question" do you clean/disenfect your Pressure mattresses or do you send them away?

Lee

Lee,

>200 volumetrics
>100 syringe drivers
80 NG's
>140 pressure mattresses
>30 pressure cushions
Handful or two of every other product.

We launder mattress covers ourselves. We send mattresses away for deep-cleaning to either Huntleigh or Karomed.

Cheers
Mark

Geoff
One reason for the increased usage of pressure relieving matress is the lack of a tissue viability nurse coupled with a lack of understanding by nursing staff in the advances in static matress technolgy i.e. Tempura. The standard criteria for deciding on the need for expensive therapeutic devices is based solely on the age of the patient.

Thanks for that, Charlie.

Perhaps that helps to explain also the recent announcement that all those entering the field of nursing from 2013 shall be required to come armed with a degree.

So it seems I was on the right lines regarding the "old dears", then. That is, the increase in the use of APM's is all down to the aging population. That, and the other reasons you mention!

(apologies to Lee for the digression)

Waterlow scoring http://www.judy-waterlow.co.uk/the-waterlow-score-card.htm A nurse from Taunton!

The nurses seem to forget/don't know that they are still meant to 'turn' the patients on pressure mattresses as well as statics.

Modern static mattresses will go up tp a Waterlow score of 20.

Cheers
Mark

Judy Waterlow Jones MBE. We need more like her (who, I believe, now gives of her time voluntarily at Musgrove Park).

But nurses "forgetting" ... is it even on the syllabus?

Slightly off topic, but I don't think that the OP minds.

We never seem to have enough pressure mattresses. We've since found out that this is because there is no management of the supply of static mattresses around the hospital.

Wards 'lose' their statics when they use our pressure mattresses because there isn't any storage areas for unused statics.

We don't get our pressure mattresses back because the wards haven't got any statics to replace them with.

Our hospital never seems to have any storage areas for equipment. Hopefully, storage areas have been accounted for in our new to be built surgical building .. building work starts 2010.

Geoff, our WWII buildings plus the tree are being bulldozed.

Anyway, management of pressure mattresses should go hand-in-hand with the management of statics. Efficient use of time and resources.

Cheers
Mark

Mark, don't forget to take the before and after pictures

Philistines! That was the best part of the hospital! Have "these people" no sense of history? As I have mentioned before, a thoughtful design would have retained elements of the original buildings (as has been done elsewhere).

After all, they could have stored the mattresses there!

No need to bother with the "after" photo's, Mark. We already have a pretty good idea what the architects will come up with! But if you must take pictures ... wait until ten years time, and see what it looks like then.

I can't help wondering if the graveyard across the road is next on the list.

Meanwhile, did the Multi-Storey Carpark ever get off the ground (yes, a pun), I wonder?

I cannot understand why the cleaning of mattress's come under 'equipment library' surely this should be done by infection control, do you not think also that it is wasting the talents of a BME technician chasing around the hospital collecting and delivering infusion devices?

Sorry to have to say it, Neil ... but once again you demonstrate your lack of awareness of the state of play in UK hospitals.

You don't expect our lovely nurses to have to get their hands dirty, do you?

And "infection control"? Who (and indeed, what) is that?

We have a department that covers this subject, all the policy & procedures, which detergents to use and whose hands get dirty. From my side my policy & procedure regarding items that are covered in blood and snot are not to be touched by my technicians.

Neil

Our library is staffed by people who's job is to run around fetching and carrying and cleaning.So the nurses don't have to worry themselves, but not BME technicians.

Why is it that the UK does not have the foresight in the way that the continent does when building or refurbishing hospitals? They incorporate bed exchange facilities into the structure including bed washing and mattress decontamination which is totally automated.

One word and you mentioned it "foresight" or lack thereof

Because this is Britain, where everything is done on the cheap.

The other reason is that dreaded word:- architects. In general they know sod-all about hospitals, and how they work.

People such as yourself, myself, and Neil would make a better fist of designing healthcare facilities. I know that for sure, having done so myself on a number of occasions (but not in the UK, of course - tut, tut, that would never do) ... and that was whilst fending off architects, "engineers" (and yes, physicians, surgeons and over-bearing "theatre sisters") all at the same time. They all had (and have) vested interests (naturally), but somebody - preferably someone with half a brain - has to pull it all together, and drive the thing to successful fruition.

Much as I support and admire the guiding principles of our National Health Service, let's not kid ourselves when it comes to talk of it being "the envy of the world", and all that clap-trap. As we all know only too well (apart from a few "centres of excellence", perhaps) the reality is something else entirely. That's why we need to keep on fighting!

Some of us did have the foresight to see that we need more than just the space to stand the beds in.

Unfortunately PFI for this Trust meant having to pay an additional mortgage as well as all the other bills we had been paying before, so it should be no surprise that the new build is quite a bit smaller than the old.

Mind you it did not help the situation that once we were in the new build two large store rooms were taken away from the Wards to be used for the Equipment Library.

Lee

Our equipment library has just gone through a refit and is staffed by two, very busy, people. It is currently managed by the Tissue viability nurse(which links to a previous message from someone about managing pressure relieving devices). I have passed this 'thread' onto the staff for their information - it's nice to get support from other Trusts in this fashion, through this forum.

) Hospital size >800 beds over 3 sites
2) Library Staff 2
3) Library staff often have to collect alot of equipment daily(eg syringe drivers/infusion pumps) to ensure its return
4) Clean and disinfect - no seperate area for this in library, ward staff are required to clean before return...

The Library is definately an essential requirement for this Trust, although it is faced with issues such as insufficient items to loan, (we are currently undergoing a pumps need analysis to assess this)

"Private Finance Initiative" ... a system of back-scratching whereby we will forever be paying out for what we could have owned outright for a fraction of the cost.

H'mmm ... that does sound a bit like a mortgage, come to think of it.

Here's another thought to ponder:- how about inviting one of the companies to sponsor the Equipment Library? You could always offer (in return) to display their "message" prominently on your carts!

Don't make me laugh; a PFI company putting something back in to the NHS.

Lee

Only if there's a quid pro quo.

Hinchingbrooke
Hospital size 340 beds
Library Staff 3
Library staff deliver and collect equipment
Clean and disinfect Yes

Equipment
Infusion Pump 79
Mains Syringe Drivers 45
Battery Syringe Drivers 22
Pressure Relief Mattresses 36
Feed Pumps 26
Humidifiers 5
Bair Huggers 2
Fluid Warmer 1
Portable Suction 3
Cardiac Monitors with Invasive Monitoring option 2

Abi

Hello Abi

How do you manage with 36 Pressure mattresses?

Hereford is a similar size Rural Trust etc and we struggle with twice as many.

Lee

Queen Alexandra, Portsmouth
Hospital size 1000+ beds
Library Staff 2
Library staff deliver and collect equipment
Clean and disinfect No

Equipment
Infusion Pump 400+
Mains Syringe Drivers 200+
Battery Syringe Drivers 20+
Pressure Relief Mattresses 300+
Feed Pumps 100+
Nebulisers 50

These are approximate figures, main problem is getting wards to return equipment mainly mattresses.

Stef

What happens out of hours. Do the wards have access.

We are lucky enough to be in a new build, all doors are acces controlled by swipecard.
Out of hours the nurses have swipe card access to MEL. They log what they take on a sheet and the MEL staff update the loan database when they next come in.
Seems to work ok for us.

At the present time we are running a RFID trial with the Library Equipment. Soon it will be able to be logged to the patient notes.
Each infusion pump has a RFID tag located on the device which just needs to be swiped over a black pad which is located in each ward for it to show where the device is on my system.

as per KM with regards to out of hours

When they fill in the sheet that is!!!!!!

Yes ... that's the obvious loop-hole in the process (system) Karl has described.

Unless, that is, there is some sort of cleverness (data logging) inherent in the swipe-card technology being used.

Either that, or how about adding PIR (motion detection) and a web-cam?

I suppose that the ideal "technical solution" might be to have RFID tags fixed (hidden inside, screwed - or glued - on, welded even) onto every piece of kit and have a detector (induction loop?) at the MEL door(s) to enable automatic logging in and out!

Not that I'm really into spying on folk (staff), of course - there's probably far too much of that going on already - but if they keep "forgetting" to make log-book entries (or whatever), how else are you going to enforce a bit of discipline?

Meanwhile:-


There's the weak link, right there. How about having the "black pad" on the counter in the MEL?