EBME Forums Forums Management Medical Equipment Management Implementing standardisation

Geoff,
Sorry to disagree, but I don't think allowing complete freedom to purchase is the answer, it makes our job much harder. I do agree that competition is healthy, and keeps choice open for the buyer (and prices lower). I do not codone standardisation across the whole of the NHS, just at a local level (Trustwide). I do mind putting noses out of joint, but unfortunately it is not practicle to consult everyone. As long as the decision made is representative, there can be no argument.

The point I was getting at is that standardisation can have pitfalls.

Richard,
I agree, but some Hospitals carry up to 30 different types of of the same device. i.e. infusion device, syringe drivers, nibp etc. Standardisation needs to be done in a rational way, but does reduce cost and risk.

Yes, John, you're right. But, isn’t this all part of Equipment Management?

But I still maintain, that if user departments insist on not “towing the line” (by ignoring Trust etc. policies), then they should be made to “pay”. In these ill-disciplined times, surely it’s the only way? Why should we keep on “making it fit”?

Centralising the budget for maintenance reduces bureaucracy and costs. Centralising capital purchase and putting processes in place for purchase aids standardisation, but does not neccessarily reduce bureaucracy.
I don't think any one Hospital looks at Standardisation in the same way. We had a nurse demand to buy an infusion pump of a different type and model to the trust 'standard'. We refused to let her buy it. We have authority from the Trust board to standardise. My question is not about whether we should - How should the process work, who should be involved. Does the Trust board need to make the final decision on what goes into the trust list of standard equipment, etc. or should the EBME user group be given the authority to make these decisions? At the moment, we produce a business case, involving users from all directorates (but not all users), trial devices for up to 3 months in various locations, sit down decide which one to go with, present the business case to the trust board.
If approved, the EBME department orders the new equipment and disposes of the old equipment. Once acceptance tested, EBME also organises the training for the devices which is carried out as they are delivered.
This is the bare bones of our process. What do you do?

As a distributor of equipment, particularly pulse oximeters, I have often come across different forms of "standardisation" policy, some more sensible than others. I hope the views of an "outsider" will be taken, as they are meant, as being constructive and objective.

Over the years, several hospitals have told me they've standardised on one particular oximetry technology and won't allow any others into the hospital, only to proceed to complain about the high cost and poor design of their "chosen" oximetry sensor! It begged the question at the time "if they're so bad, why stick with them?" but I never did get a answer!

Another hospital I visited refused to allow a department to trial an oximeter because it wasn't from the manufacturer their trust had standardised on, even though the essential feature the department required to interface with an exercise test system wasn't available from that manufacturer!

I think the most sensible policy I've come across was a trust that had a "preferred" equipment list. For example, if a department asked supplies to order "an oximeter", they got the model the trust had evaluated, approved and negotiated preferential pricing on. However, if they specified another model/manufacturer of oximeter, they were asked to explain why they didn't want the preferred unit. Many said they weren't aware of the preferred one and accepted this model instead. However, if they had a specific reason why they needed an alternative, the policy allowed sufficient flexibility for purchasing non-preferred units (subject to the EBME department's approval). That way they still had a chance to stop poor quality equipment being purchsed.

I hasten to add that we weren't the supplier of the preferred oximeter range so we didn't benefit directly from this policy but it seems to me that this compromise offers a sensible balance between the two extremes of complete anarchy and over regulation.

Of course, one of the perils of standardisation is the sheer timescale involved in rolling out such a policy across so many departments. Budgets rarely permit simultaneous re-equiping throughout a hospital, so typically, by the time even half the wards have been "standardised", the equipment can have been revised/facelifted/superceeded or simply been overtaken by better new equipment from another manufacturer.

This is particulary true if the pre-purchase assessment process is a long and drawn out affair involving consultation with every Tom, Dick and Harry who thinks their department should be included. A specific "Equipment Review Committee" with representation from procurement and EBME as well as clinicians, training and infection control seems to work well in some trust, less well in others. At the end of the day it often boils down to whether their existence is made known to the staff who contact suppliers direct requesting product info, demos and evaluations, blissfully unaware that they are "bucking the system".....or so they claim!

John, If it is as you suggest, surely refusing to handle this equipment is the right course of action, however we ebme techs are caught between a rock and a hard place aren't we? It is our duty to provide a service to our colleagues, as ultimately it is the patient who suffers in the end.
I'm sure you'll agree, that that is evidently what we are here for... The benefit of the patients.

Alternatively CLOSE THE BACKDOOR ! see to it that no more item enter through it !

I think the first hurdle is to get the Trust to accept an Equipment Standardisation Policy. We almost got that far - but settled on a minuted agreement in the Medical Devices Group, the minutes of which are submitted to the Board.

It's then down to a close working relationship between Supplies and us to police the system. Standardisation only works for people who want standard equipment and you have to allow for special requirements - such as interfacing with something else - or having a built in printer etc etc

I don't think it's practical to achieve total standardisation right accross the hospital - and totally un-achievable accross the whole organisation if that includes Community ! There are some obvious problems with sticking rigidly to one manufacturer but having a mix of manufacturers can bring another set of problems. Many different pulse oximeters use the same plug on the probe, but the pin layout is different and even if the "wrong" probe does work, the results may be entirely arbitrary.

Risk Management have been extremely helpful and have persuaded many "doubters" that sticking with the EBME Recomended product is the safest option.

It's a team effort !

In several postings before I've seen it asserted that we HAVE to help people who buy rubbish or completely novel items of equipment.

I don't see that duty anywhere in my job contract. If someone asks me to service something completely novel I tell them I have no training or technical information on the item, that just "fiddling" is unsafe and refer them to the manufacturer.

There are of course one or two items with no UK service backup that I would help with, but we are not medical staff. Medical staff are obliged to help patients even if they are violent and abusive. We are engineering staff and only have to help if the engineering requirements are in place. (ie we have necessary information, special tools and at least some minimal relevant training)

At the end of the day the user can always mail an item off to the factory for a repair.

We are the staff who will benefit most from standardisation. With the increasing complexity of medical devices the days of popping items open and fault finding to transistor level are pretty well gone. Calibrating, repairing and configuring modern devices requires care and familiarity.

It is imposible to train on non-standard stocks of equipment because the range of makes & models is too large.


Marc