EBME Forums Forums Management Medical Equipment Management Reliability centred maintenance

As a matter of interest:
"A risked based approach to medical devise(sic) maintenance" is a talk being given to the National Performance Advisory Group 1st Annual EBME Conference.
The National Patient Safety Agency, PASA, MHRA and DoH Controls Assurance and Quality Unit are attending so I think this has official backing and weight.
So may be the rigid adherence to manufacturers recommendations will have had its day...with official blessing, and our a**es are safe if we do make a reasoned, documented decission.
Robert

Also see IPEM Clinical Engineering SIG Jan 2004 in York. "Skating on thin ice". Looks very interesting.

I am not surprised about the 'heated debate' this raises. I have spoken to many engineers who say they use reporting facilities from their database to prove that they are carrying out uneccessary maintenence. We do not have unlimited resources, and when done in a thoughtful and consultative manner (including users and suppliers) RCM can improve overall reliability by focussing efforts on the most important device groups with the highest potential risks.

John,You say
"have worked at, and visited many depts that over-maintain, or don't maintain. The reality is that both scenarios are wrong."
In your opinion they are wrong. Whos to say that you as and individual are right. The other depts may be in just the same mind as you. That is that they are right in what they do.
At the end of the day I know if something went wrong where I was involved I could stand up and say I did the maintenance to the standard that the manufacturer states in their documentation. If I didnt have the resources to do the work to that level I shouldnt have taken it on in the first place.

Exactly

Seymour

KM, Seymour,
I agree both scenarios are wrong. In which case there is a middle path.

• Some devices should be maintained to the letter.
  Some should be on contract.
  Some should be on an inspection basis.
  Some should only be maintained when they break down.

Do you maintain 'everything' either on contract or in-house? Has equipment become more reliable?
How do you know?

I am always willing to learn.

The big question is how do you assess the reliability of a piece of equipment? I don't mean just by calculating the hours between failure, like I was taught at big-school, I mean by what yard-stick we use - the expectations of the user, by risk management, the manufacturer or the critical nature of the application? e.g. use in the critical-care or OR environment.

Plus how is damage and abuse factored-in with reliability? It certainly has a bearing on the continued safe-operation of equipment which is, I guess, what most people think reliability should be all about - the equipment being there and working when required.

I think we're lucky that the average Nurse has little interest in the reliability of a piece of kit - it just gets shuffled off to the little man to be fixed when it stops working. You and I probably have greater expectations for the reliability of our videos or cameras than we do for medical equipment that we know takes a real hammering.

The environment the kit is used in and how it is used, or abused, makes the difference. Ideas of reliabilty tend to fall apart when there are other influences. The other thing is the reluctance of users to report damage and other minor faults with equipment so it looks, on paper to be more robust and "reliable" than it actually is.

Regular audit or physical inspection, at predetermined intervals, is a good method of acquiring reliable data on the availability and condition of equipment. Problems with use and abuse are picked up on before they become hazards.

How reliable is a mains-lead on average? Has anybody assessed this?

RL,
I totally agree that regular audit and inspection is a valuable tool. We use it regularly. By reducing PM period 'due to lack of resources' (my concession) we are more able to audit, inspect, and train nurses. That is a better use of resources and minimises risk.

John, RL

I detect your train of thought coming round to my previous suggestion:-

“the introduction of equipment libraries, where the majority of the hospital's medical equipment is routinely visually inspected by skilled or semiskilled staff, would strengthen the case for rationalised maintenance schedules.”

A frequent/routine quality inspection by a skilled/semiskilled MTO is I suggest a superior ppm maintenance schedule.

· Manufacturer recommends a six monthly ppm check on an infusion pump.

· EBME provide one ppm check and 6 to 12 quality visual inspections (library) per year.

As you have indicated John, you operate an equipment library so may well be in a strong position to rationalise your maintenance schedules.

I'm also with you on nurse training being a high priority, particularly with regard to infusion devices.

Bill

Difficult with the more critical equipment used in OR, ICU, HDU and Theatres. However a library could take the routine inspections away from others involved with troubleshootoing fault-finding and repair. Worrying aspect is the tendency for non-technical staff to be employed in such libraries, to reduce staffing cost, I assume. I cannot see how these staff could, or should be, expected to accept responsibilities for training clinical staff in the use of equipment and also inspect equipment for faults and damage - without training to train and technical-support being provided for them.