EBME Forums Forums Management Medical Equipment Management Reliability centred maintenance

Oh, thanks for that Dave There I was, under the impression that Graham would be using these secret unofficial servicing instructions, too as he states "do our own thing" i.e. service the kit himself as per these unofficial instructions? Not as you have pointed out and use them purely to confirm the technicians work?

Which of course he never could do, because, as Graham also states "we all know what the manufacturers engineers do is not the same as stated in the service manual". So there I was presuming Graham already had a copy of the tech manual, in order to make such a bold sweeping statement? Still with me?

So now that Graham has confirmed that the manufacturer is not carrying out work in accordance with the servicing schedule/manual, but that they are using a shorter unofficial version, should he as you have done pursue this to a higher level? or maybe confirm this new version is an update to the service manual?

How common is this practice Graham?

and if the manufacturer never admits to this practice on paper, how could you possibly use these instructions as opposed to the official tech manual recomendations.

Dave, no wonder the roof on my extension leaks.

My earlier point re the work carried out by manufacturers service staff differing from that described in the service manual has more to do with the fact that the service manual frequenty does not describe the work required in a routine service. It may conatain, for example, a calibration procedure but this is the full business which would be carried out after manufacture or major repair. When I say we 'do our own thing' this is documented and based on the manufacturers recomendations, but not necessarily to the letter of their recomendations. To give an example when testing volumetric pumps we use an IDA 4 to carry out rate and occlusion tests. The manual may specify another method but the end result should be the same. This is a never ending subject - at the end of the day we all have to make best use of limited resources to reduce risks 'as far as reasonaby practical'. Oh how the lawyers just love that phrase.

I agree with Graham on this one. If we worked to the letter of the Manufacturers Service Manual we would either never get through the work or employ so many people that we would become totally un-economic. The manufacturers engineers obviously don't work to the manual because they do six machines in a day (arriving at 10.00 and finishing at 3.00) when it would take at least three hours to do one machine if you did every test in the manual !

We've also asked for copies of the engineers work instructions and been refused. Our Supplies Department have asked for details of exactly what is done to the machines which are under contract and been told that the service report tells us - but all that usually says is "carried out service" !

So we know that the company engineers don't work to the service manual - or at least don't carry out all the tests and calibration adjustments detailed in them on a routine visit - and we can't get a copy of the "official" worksheet. We know it's unnecessary to carry out all the tests every time - unless there's a problem with the equipment - so we utilise our own worksheet, based entirely on the manufacturers information (nothing added or tweeked) and then monitor the reliability of the equipment.

Surely all that is part of a good Quality Control system ? If we're registered to ISO9000 - 2000 then our procedures have been inspected and approved. Work Instructions form part of the QC system, so they have to be evaluated and updated as dictated by the feedback from the reliability analysis.

The major difficulty is that I suppose to be REALLY safe, you have to use the official manual as the starting point and then reduce the number of tests on the worksheet and prove that it doesn't have any detrimental effect. There's still the chance that the first time you have a failure (which may then persuade you that you've reduced things too far) may also cause someone injury. Maybe it's a case of deciding what is an acceptable level of risk and then getting it approved - but if that has to be done at Board level, we're going to be kept busy writing and presenting reports to the Trust Board in a way that can be understood by non-technicians.

To sum up ; -
If you've been trained by the manufacturer to service it, then service it - exactly as you've been shown.
If you've got to repair it, then carry out the tests in the manual before putting it back into service. If there isn't a manual (because the machine is too old) then write a test schedule / worksheet, verify it and then stick to it.
If you haven't been trained to service it and you don't have a manual, then don't service it. Get the Trust to pay for a service contract or accept the risk of not servicing it.

We should advise them what course of action is sensible or required, but should we really be accepting the risk of putting those recommendations into practice without approval ? I know I have to make decisions every day which might prove, in the long run, to be wrong and to have put people at risk. That's why I'm manager of the department and not an MTO2 technician ! I have to be prepared to admit when I'm wrong and not be afraid to change things that I've done or put in place.

No one is never wrong ! The people to worry about are the ones who say they aren't !

Pull up a sandbag! As a suggestion, one way of solving this could be to use the Military system of engineering support. Unlike the NHS, the Military EBME departments are controlled by just one engineering authority 'Workshop Support Services' (WSS). They produce a joint service publication' similar to MDA DB9801 (JSP473?), however the difference being that it states policy not guidelines, and you have no choice but to follow it. It is in effect an engineering bible.

By having such a group, it can help control how all EBME departments work, from spares procurement to servicing policy. It tells you how you will do it as opposed to how you think you should do it.

Imagine amalgamating all of the regional workbench groups into one body? and writing down best working practices as policy?

As a recent example, WSS decided that Military EBME techs required a training course with ZOll, prior to allowing their techs to service this equipment (ZOLL wouldn’t of course go out to IRAQ).

WSS had the clout to negotiate with ZOLL and dictate cost unlike individual NHS EBME departments. In the case of say a SAM 12 suction apparatus, WSS dictates that the Military generic training course on medical devices is sufficient prior to their techs servicing this item, therefore they should service direct from the tech manual. All Military techs are trained to the same standard before being let loose on medical devices; the course is similar to our own courses here at www.cap-medical.co.uk.

This engineering authority are paid to make all 'top heavy' engineering decisions, taking them away from the EBME manager, allowing him/her to get on with the every day running and control of his/her own department.

Maybe a body like PACE, IHEEM, IPEM or IEE could be that engineering authority? It would certainly help matters not just in providing answers to this current subject but for many more which are posted on this site.

Just a thought?...fuse now lit he stands back and waits for the explosion of comment.

A good thought Rob, I'm sure many, like myself, would value such a position of power being able to make rules insread of suggestions.

Surely an organisation such as the MHRA should be able to do this, surely they are in the best position to set out some "best practice"

or are they as we usually find them when asked to lay down some guidance or control, in other words about as much use as (take your pick)
1)An ashtray on a motorbike
2)A chocolate fire-guard
3)Mammory glands on a nun
4)A Physicist with a screwdriver

I really do think the idea of Reliability Centred Maintenance is wonderful. However the huge corporations that run them for their maintenance scheduling have something we don't have: Lots of data.

As do Insurance based maintenance management companies, they have a large database of failure reports and can mathematically assess the risks involved in maintaining to any particular level. Unfortunately we can't.

Such information could probably be purchased but the cost would be prohibitive for any individual bay.

To gather your own data would presumably require one to apply maintenance on a reducing scale until things are seen to go wrong. Then risk assess whether to hold that level of maintenance, step it back up a notch, or continue the experiment.
The data collection over such small samples as an individual NHS trust owns would therefore I guess take place over a number of YEARS to be representative. Isn't that all rather time consuming in itself? Isn't the service bay in a rather exposed position in the interim?

It seems extraordinary that the NHS as a whole can't somehow utilise its own data and do itself a huge favour.

Marc

I suppose the MHRA think that they are providing the necessary guidance by suggesting that we should all stick to the manufacturers written instructions. The problem is they don't operate in the real world and don't apreciate the problems we encounter - apparently. Or at least I hope they don't, because the other explanation is that they are choosing to ignore them and are just leaving us to it !

I don't think the IPEM or PACE or any other such organisation are the right people to lay down the law rather than make suggestions. The MHRA are the right people to do that, but maybe we could help by writing the rules in the first place for them to approve. Maybe that's where IPEM and PACE come into the frame - or maybe this site is the best way to seek a concensus ?

Hello Guys

I have been reading this one for some time and with great interest.

Just one part of it is more appealing to me, that is the issues related to the service schedules utilised by supplier/manufacturer service staff in the field, i.e., our hospitals, etc.

Please note that I have used the praise 'service staff', they are not engineers until proven to be, by many measures I might add.

However to the point of interest, why do you not have the service schedules off these companies?

PPQ form question 7 asks about 'contract repair/maintenace' and the seperate sheet related to the same.

At this stage of an intended purchase the customer, i.e., us, we should request all details including costs, what tasks are to be carried out, electrical safety-test consisting of what, etc.

The replies given should then be assessed against the product type and the recommended schedule for preventative maintenance, (if included) in the service/repair information PPQ question 5. Any special tools and test equipment, delivery times, costs, etc.

Take a product in situ now in our hospitals on a present maintenance contract. At the, or before the renewal we should again obtain what tasks are to be carried out, not just give them the order again.

We aren't chimps, we can think; so why not do what is simple. This is public money and should be wisely spent.

If you can't get the information, take them to task. We often get replies of no electrical testing done or done with a pat or check earth continuity with a megger, disgusting.

Any thoughts on this or examples, chaps?

Jim

Jim, my fellow co-functional, Louis could not concur with you more my friend, The deal should be done at the purchasing stage when we have these extortionists by the short and curlys. It is amazing what one can “get in writing” when you are flashing Wonga at the “Armani Brigade”.

L3

If a trust decides to farm out the work to a third party maintenance company, then what level of service will they insist on and who makes the decision and what do they base it on.