EBME Forums Forums Management Medical Equipment Management Reliability centred maintenance

Gentlemen, I have just spent three hours in a top level meeting because a Shrader on a portable O2 carrier in an ambulance failed. (not one of our ambulances of course) but the portable ventilator that was connected at the time was our responsibilty. The hose blew off and hit the paramedic in his right eye and he is not very happy about it The blame was placed on our departments humble shoulders. On inspection of the equipment it came to light that the O2 Regulator/Shrader had nay been serviced since day one (1982). Excuse by the ambulance bods:- "This item is always unavailable when we come to check it". The O2 probe on our vent was in good order. On top of that we where able to prove its complete and upto date maintenence/service history. (cue big round of applause). I suppose even the humble Shrader can be a lethal weapon if incorrectly maintained.

Seymour.

I recently sat in a Court room (as an observer ), please note! In this case, the hospital engineering department decided to change the periodicity of servicing for a simple piece of equipment, I am sure they too thought they were carrying out unnecessary servicing. This particular device subsequently caused serious injury.

I am sure they did this with the best of intention in mind, i.e. efficiency, saving time and money. Strangely, both prosecuting and defence counsels did not see it this way and completely destroyed the poor sod (ebme manager) whilst he stood on the stand, not a pretty site.

To make matters worse, neither he nor any of his department had received up to date specific training on this device and the very idea that through individual experience alone, knew better than the manufacturer did not wash in court.

If the manufacturer states daily, weekly, monthly, qtly or annual servicing, then you must do precisely that unless given dispensation by the manufacturer.

Ignoring the manufacturer, regardless of whether you believe there is a case of over servicing or not is not good advice, hot topic of conversation or not.

Rob,
I totally agree that technicians should receive
good training.
I recently sat in a court room where the ebme manager was a trained professionally registered engineer able to present agument in a court of law in such a fashion that all present were completely convinced. His approach was sound as a pound and he walked off without a blemish on his character.
(This may be a fictional account )

I meet hundreds of technicians and engineers at various events. Very few have ever been to court (other than for drunk and disorderly - or was that just me )

Lets not go overboard. The chance that you will ever go to court is minimal (for not servicing equipment). If you do, you must have 'evidence' to argue your case. Courts DO take reasoned argument into consideration, and justice is basically down to common sense. Did he take 'reasonable care' M'Lud. That is the question....

Also these words came out of service manuals:
...suggest servicing every 12 months by suitably qualified...
...recommend service on an annual basis or every 1000hrs...
...you must carry out planned maintenance every 12 months...,
and many other service manuals do not state a service period.(Take a look through your service library)

Anyway , the point I am making is we must make decisions (Rational, one hopes) that meet our own code of conduct (in accordance with best engineering practice).

John, I have also met many hundreds of technicians in this field and have been in this field for quite some time (still learning)

Fact: Technicians do end up in court in relation to faulty medical devices and are held to account more often than you would think. However, I do not believe it is something they would wish to tell the World about, not even John Sandham.

Stick to what the manufacturer states in all that you do, or get written dispensation from him. Do your own thing and I will look forward to hearing your argument in court.

This would be funny if it was not so serious.

I can understand to some extent as to what you are attempting to achieve, however you could reach the same goal by being more inclusive and involving the manufacturers in your process, 'belts and braces'. You will be surprised at their response.

I am currently running an MOD course with a number of manufacturers delivering device training, Datex-Ohmeda (GE), Alaris, Simms Pnuepac (Smiths), Welch Allyn, Zoll etc as is required and stated in respective servicing manuals......I will discuss this subject with them and forward their responses to this site.

John,
I read your article with interest. Unfortunately here in Ireland ( 2nd most letigious country after usa ) RCM would be like a red rag to a bull.

Das
Could you apply RCM to devices that may require service, but no service interval is suggested by the supplier?

For those you who have not read the article:
Click here.... Reliability centered maintenance

For some years I've followed with interest the debate over whether we should allways follow manufacturers recommendations or 'do our own thing'. To add wood to the fire, here in the Yorkshire area we approached several manufacturers (as part of our Benchmarking Club)asking them for their service engineers work instructions as we all know what the manufacturers engineers do is not the same as it stated in the service manual. In many cases the engineers do not even carry the tools or test equipment specified. To carry out a full service as specified would take many hours - but their engineer can service 4 in a few hours. Most of the manufacturers would admit this verbally but would not make the schedules available to us as the official line was that work should be done as specified in the manual. Oh and by the way I have been to court to give evidence and we do still 'do our own thing' though this is usually based on manufacturers recomendations. Whatever you do be prepared to justify the decision! Professional judgment is what we're paid for- make sure you include it when evaluating job responsibilities.

Graham, What was the response of the service engineers employer after pointing out that his staff were not using the correct test equipment or tools as per their own recommendations; for which you (the trust) are paying (through the nose)for?

Come to think of it, what did your employer say? Or your own risk management team? Or were you confident that the machine was still safe to be used on patients? Little or no risk? How did you come to that conclusion? Good time to read up on controls assurance and CNST criterion.

Presumptuous bit: Why would you want the servicing schedules? I am presuming you are not trained hence the reason for a manufacturers service technician being there in the first place? So surely unless permission to carry out servicing or training is given direct from the manufacturer you couldn’t use them anyway?
Plus they would be uncontrolled copies and therfore pretty much useless.

The mind boggles?

Rob

Isn't it justifiable enough that we are paying the bills to have a copy of the service schedules / work instructions.

It doesn't mean you are going to work on the equipment yourself, but as a means of checking your "bangs for bucks".

I think it is perfectly acceptable to have a complete breakdown of what the company is providing you with in the form of a schedule or procedure.

What have companies to hide?

If they say a service should take 4 hours and the engineer "legs it" after two does that mean he is 200% efficient or has only done half the job?

We had an engineer recently doing a contracted service visit, the company will remain nameless because I am pursuing it to a higher level, after showing up to have his paperwork signed off he explained "..er.. I haven't done the safety test as I haven't got a tester..and we don't do that anyway..and anyway your lads do it as well.."

Bit surprising then that he had ticked the box on his service report saying that he had done a safety test..which shouldn't be there if they "don't safety test" ???

If you get a builder in Rob to get some extension work done at home, wouldn't you insist on a breakdown of everything that was taking place and that all relevant standards had been acheived.

Or would you accept " ..yes mate your extension is gonna cost £20k and trust us we'll do everything you think should happen.."

I know I wouldn't

THE MORE DETAIL YOU ASK FOR AND GET THE MORE CHANCE YOU HAVE OF GETTING THE JOB DONE CORRECTLY
FIRST TIME.