EBME Forums Forums Management Medical Equipment Management Planned preventive maintenance

The risk classifications described above are interesting but a bit complex.

I only use 2 classes.
1. Critical.
2. Non-Critical.

Critical includes devices that put current or fluids into patients. They must have regular PPMs. (i.e. Defibs, Infusion pumps, Electro-Therapy units.)

The non-criticals are done on a best effort basis, (hardly ever!) generally simply when they are in for a repair.

Despite 25 years Medical Physics experience I do not feel qualified to "Risk Assess" for PPMs.

Companies like CNA and organisations like ECRI have large databases of information to base their judgmenents upon. You or I can lick a finger, stick it in the air and have a good guess.

If a case ever came to law how would you EXPLAIN your judgement on a Risk score?

Risk Assessment is a continuous and ongoing process. The rating of an item changes with age and with service history. I believe the time spent Risk Assessing NOT doing a PPM would be better spent doing a few more tests.

Marc

Marcel, my contradictor, how did you then define ”non critical”?

Our objective here is to find a way around an age-old problem “short staffed” Vs PPM obligation. This is a reality my friend, pure verisimilitude. We are looking for a formal way to identify “non-criticals” . What is your formula my friend, enlighten us. Did you employ the use of the said megacorp's. what do you define as “non-criticals”

Louis III

Marcel Eve

“The risk classifications described above are interesting but a bit complex.

I only use 2 classes.

1. Critical.
2. Non-Critical.

Critical includes devices that put current or fluids into patients. They must have regular PPMs. (i.e. Defibs, Infusion pumps, Electro-Therapy units.) “

In this context we must not forget that Air, O2, N2O, volatile anaesthetic agents and NO are fluids.

Risk assessment is an essential element in providing an effective healthcare service, for us technologists it should start at the “how can current technology best support patient care and carers” level. Patients do not get electrocuted by faulty equipment, they are all to regularly overdosed and burnt by inappropriately trained and supported carers, Risk assessment requires a much more holistic approach than when and which PPMs we do.
Bill

Dear Louis

As was rightly pointed out by a previous posting people don't get electrocuted in hospitals but they do get drug overdoses or may not recieve a defib shock when needed.


Obviously Non-Critical is a bit of a misnomer. However the system was originally implemented because I ran a trial run PPM on some defibs. I was so horrified by the result that I simply commenced testing items I thought it would be dangerous NOT to check. I was (verbally) instructed to stop doing so, since the cost implications were not acceptable to the hospital.

I therefore wrote stating that I had implemented checks of "Critical" equipment and requested written instructions in order to stop that work (This was a VERY long time ago!)

Hence this little backwater has a documented 19 year history of PPMs on what I beleive are the Critical items.

The basis of the classification is therefore not formal in the manner you seem to be seeking. It depends upon an individuals exercise of common sense (mine actually).

In the event of an incident resulting in a court appearance the only real defense you have is "were your actions reasonable", not have you a sophisticated computerised scoring system to cover your arse.

A "formal" system will still require value judgements which in the end still have to be EXPLAINED. If a system is so wonderfully sophisticated that even you can't understand it then how would you ever justify it?

I doubt any of us can presently test everything.
Therefore it seems reasonable to me to regularly test those items that can immediately cause injury or death to a patient.
I understand this system and feel I can justify it.

Naturally a "Critical" list would vary according to the range of items dealt with by a bay.
Regular PPM checks are mandatory on Critical items. The priority of PPMs on those items is second only to emergency repairs to Critical items (ie it comes higher than emergencey repairs to Non-Critical items).

All the Best
Marc

I have just received a copy of an article submitted to the journal of clinical engineering (Jan-Mar 2003). Called "Equipment Inclusion Criteria Revisited", it basically introduces statistical sampling to the risk based PPM systems in use on both sides of the pond. It is a radical departure from current thinking and looks as though it would be difficult to implement on a small scale, but nontheless illustrates (as usual) how far the US is in terms of this particular aspect of equipment management : .

I would be happy to make a pdf available provided Huw is happy about copyright infringement .

Regards

Paul

I was speaking to our Cardiac Services rep yesterday who indicated that Philips are moving towards 5 year warranties. If a defib, or CTG have a 5 year warranty, should we be carrying out PPM's? He indicated that there is no need.

I still feel an annual ppm inspection is worthwhile? Any thoughts on this?

John,
You are talking about two different issues;

Warranty - 'free from defects of workmanship in construction and component failure in a specified time frame', and

PM/ PV - 'those tasks/checks required in order to ensure device continues to function as intended, and in a safe way.

My car has a 6 year corrosion warranty - but only valid if I have it regularly inspected.

The point is that NO manufacturer will say zero maintenance or PV requirements (in a secondary health care environment) for the simple reason that they cannot control all the environmental variables that the device could be used in.

We are indeed seeing some automatic AED's which do their own checks (but that spend 99.99% of their lives sat doing nothing on BA passenger aircraft/M&S stores, where internal checks are automated and warnings given), but you cannot effectively use this argument where devices are regularly used/need to be ready, and/or exposed to other hazards (such as nurses, porter pushing trollies etc etc)

As always, I reserve the right to disagree with my own views.

Just a query over Paul's definition between Warranty and PPM/PV.

Most places I know don't enter into service contracts on equipment until the warranty has expired.

Using the Philips example here, would you not take out a service contract until Yr6 or do you already put equipment on a service contract from the moment of purchase/installation.

I appreciate that you might not have anything at all on service contract but do you get my drift.

Surely if you don't do it until normally the warranty expires, say after a year, then do you not apply the same logic to a 5 year warranty.

I normally presume that the warranty covers the "service" element and that is what is taken up by EBME Depts afterwards, whether that be by placing it on contract or servicing in-house.

I agree with Paul that the on-going maintenance is crucial, but surely the definition of "warranty" should be clearly defined before purchase.

If it doesn't cover what a service contract would cover then surely it's not worth the paper it's written on.

It is strange how history repeats itself in 1987 we purchased HP 43120A'defibs and they all came with 5 year guarantee's.

Dave,
I agree 'warranty' must be defined, but I say again, that unless stipulated, the 'standard warranties, cover failure of components/workmanship contributing to premature failure.

The 12 warranty on my Porsche (in my dreams) only covers failure/sub standard supply, it does not necessarily mean that the first years service is FOC, nor perhaps more importantly, if it is not done, what the status of the warranty actually is.

To use a good example - the recent purchase of a fleet of anaesthetic machines (the hypoxic guard scam) means I have a full 12 month parts/labour 'warranty' for any failres, but in order to meet compliance, these machines must have 3 quarterly and 1 annual service IRRESPECTIVE of warranty status. So whether EBME or the Co. service them, it must be done. ( for my part, when I renew my maintenance 'contract' with the Trust I base it on a % of replacement value of existing equipment maintained + half of that % for equipment purchased in the current year to reflect the fact that not all equipment requires maintenance in the first year.