EBME Forums Forums Management Medical Equipment Management Evidence-Based PM Strategies

Geoff , that CMS decision relates to the technical performance of equipment – “they” assume more compliant pms will address “risk” associated with these items – we ( or maybe just some of us ) all know , relative to the biggest risk , correct use , the technical issues are the least of our problems ( or the patients in this case ).

Biomeds might make a note of NPF in the workshop but if you look at the regulators ( MHRA , TGA , FDA ) very few reports get back to these organisations and they are instrumental in the decision process related how equipment risk is managed . I see it as been that simple ! , if more biomeds reported NPF to their safety & quality depts. this information would eventually filter through to the regulators and only then will the system kick in to address these real risks .

Thanks for the punt - its 9 pm here so its time for a beer

I can't disagree with any of that, George.

But I would add that the reporting chain tends to be "incident driven" (or, perhaps we could call it "event-driven") and I expect it would be difficult to generate too much excitement by reporting hundreds (thousands) of NPF "non-events". That's just the Nature of the Beast, I would say.

Meanwhile, the "answer" is bound to be "more user training" anyway, and that aspect of our work has (for some*) increasingly been brought to the fore in recent years.

It's 14:00 here now:- time for another brew (that's tea, by the way).

* Although I well appreciate the need, training user staff has never appealed much to me personally, I might add. In fact I have always avoided it, preferring to get on with "the real work" instead! Horses for courses, as they say.

Geoff , no disrespect but your response / observation is that of a technician / a “I need to fix something” guy – if you getting 100s of NPF ( No Problem Found ) – that is the problem !

Think about it – if someone pricks up a infusion pump , sets it up , encounters a problem and decides its faulty , then picks up another ( working pump ) why would the outcome be different and every NPF device received by Biomed was replaced with another working device because there was a clinical need for it in the first place . That’s the issue ? This is a bit like the issue of antibiotic resistance – a lot of educated clinicians know about the problem and at the same time they are the problem ! So in concept, nothing here is new .

We all make mistakes – the worst possible outcome is not letting someone know when they have made a mistake – it’s about the patient – not the biomed , the nurse or the surgeon .

When there is a suspected adverse reaction to a drug , everybody expects it to be reported , a whole range of people get involved and the best possible outcome is – false alarm ? – and it is 99% of the time – but professionals don’t deem it a waste of time.

If a fire alarm goes off in the hospital – 99% of the time it’s a false alarm – but the system still mandates a process kicks in just in case- again , in the big picture it’s not a waste of time .

The benefit of logging 100s , even 1000s of NPF is that if that number reduces over time then whatever you doing is working and if not then there are a whole bunch of people just wasting everybody’s time . ( in-service training , regulators , admin, biomeds etc ) – in fact NPF is the best measure of in-service training effectiveness !

On education – I don’t think it’s a one answer suits all , it must be dealt with locally and adapt & change as and when the circumstances do . It’s an imperfect system - it’s what we’ve got for now. But what I will add is that I personally have been to many biomed service training courses and when I’ve gone back to the workshop to start fixing and pm(ing) these devices I have had to refer to the service manual – and I don’t remember all the service codes, error codes etc – in Biomed there is a culture of referring to the Service Manual – Clinicians on the other hand refer to thousands of reference sources except the User Manual. – That’s what needs to be changed .

What I have noticed ( and the point of the User Manual Library ) is that in the hospitals and units there are a small number of tech savvy clinicians , they not formally recognised by the system , but when they leave or are not around the NPFs increase . By targeting these people and them using the troubleshooting guide in a good user manual – more than half of the issues which are NPF can be addressed at the point-of-care .

And yes , there are a lot of useless User Manuals – but there also a lot of useless Service Manuals – and again that’s what we have.( it’s much easier for a manufacturer to rewrite the manual than change the device ) The idea is that these are tech savvy people who want to be involved with equipment or a specific device and they need all the support they can get – not criticism when trying , which is what a lot of biomeds do ( again from my experience )


The User Troubleshooting Guide is there because the people who designed the device and know it well enough to also supply us Biomeds with a Service Manual , have deemed some issues within the scope of a competent user – and even after training , if someone cannot deal with these issues then they not competent – unless we help i.e. report NPF , give them the feedback they need to focus on these common issues and ultimately gain Make & Model experience ( and hence become competent )

Geoff you are the number one poster on this site so to all others : comments , observations and criticism are welcome as this is the only way to address NPF – Please be constructive but don’t hold back , again the aim is improve patient safety.

Thanks
(I’m going to be at the NAMDET Conference in June if anyone wants to have a look at the Library )

That's all very interesting, George ... but the thread is headed "Evidence-Based PM Strategies"!

Meanwhile, yes ... I consider myself to be a "hands-on" guy. "Patient safety" has been my life for 38 years, but I gave up any attempts to be involved in "management" many years ago. My main (but dwindling) interest these days is in software development. Software can spew out any fault codes you like ... till the cows come home. It's the use that is made of all that data that's important. A guy can only do what he can do. I leave "changing the world" stuff to government funded folk with the security of tenure.

But rest assured, George, that when I was actively engaged in "biomed leadership" roles (Chief Tech, etc.) I was usually pretty proactive when it came to "dialogue with the users" - and I (like you, I guess) would urge all of today's biomeds to act likewise. But if clinicians are too proud (or whatever) to refer to user manuals ... well, as long as I had provided said manuals, what else could I do? "Hand-holding" was never my specialty, I must admit. Patient safety issues aside, those Big-Shots were always paid far more than me!

I've taken on board what you're saying about the usefulness of using falling levels of NPF as a metric of maintenance (tech support, whatever) - or perhaps (and mainly) user training - efficacy, and will consider blending that in to the next revision of my database program. So perhaps you can clarify (for my simple mind) when NPF is reported ... by the biomed at the Work Order stage, right (rather than as an equipment status code after completion of PM)?

By the way ... in case you or anyone else is wondering:- I am also an advocate of properly conducted PM. For me (and I dare say many others) that has always been the one and true raison d'être of Biomed. It has always been, and remains, a "hands-on" vocation! All other related activities are, by and large, peripheral - and can generally be undertaken by "others" (that is, non-biomeds).

Lastly:- "tech-savvy clinicians". Yes, there should be one appointed to every user department or unit. That Equipment Co-ordinator (as they are sometimes called) takes responsibility for the equipment within the department, and acts as a point of contact for the biomeds. In some places I have been, only they (the Equipment Co-ordinators) would have the authority to raise RFS (Requests for Service) - one way, at least, of reducing the amount of NPF's! And the more enthusiastic ones can also (and often do) take on the role of training their colleagues, as well.

So there's a constructive suggestion for you, George:- promote the idea of the Equipment Co-ordinator. "More Equipment Co-ordinators requited"!

Quote -'That's all very interesting, George ... but the thread is headed "Evidence-Based PM Strategies"!

My goodness, that's a bit rich coming from somebody who over the years has hi-jacked more threads (mine included) than anyone else on this site.

Very interesting comments though.

I’ll try be brief ;

What’s the point of doing a 100% compliant pm if it just gets mucked in the hospital ? – it’s a system , the strongest point is as weak as the weakest link ( I sailed ½ round the world in my youth )

One day one of those big shot could be cutting you or someone you know open : http://www.risky-business.com/talk-18-story-of-bethany-bowen-2.html?channel_id=4 ( if this doesn’t move you nothing will )

What I am suggesting doesn’t mean you have to hold their hands – just show them the evidence.

Reporting NPF should be consistent and simple ( and on another thread I guess)

The tech savvy clinicians I am referring to don’t have any titles ( in most cases) – they just nurses and drs you see every day , they fiddle around with bits & gadgets , build websites etc – the problem with too much experience invested with one “officially ‘ appointed tech savvy clinician is that it stifles initiative and prevents people who are genuinely interested in a device or technology from getting involved ( also for another thread )

Thanks for taking the time to read and respond to the posts Geoff

OK ... I'll answer my own question:- NPF is just one of the code options to report when closing a Work Order. What the "bosses" do with that information (if anything at all) is a matter for them.

Somehow I can't see the excuse:- "we didn't bother doing PM because the staff don't know how to use the kit anyway" ... leading to:- "OK, let's disband the biomed department" as being valid points, George.

I would suggest that "tech savvy clinicians" of the type you are lauding there could also be regarded (by some) as "folk fiddling about with the kit". Frankly, I can't see that going down too well in NHS hospitals. Enthusiastic amateurs don't really sit well with "dedicated professionals", unfortunately.

Meanwhile, biomeds are not there to police the hospital (however much some may wish that were the case), but rather as a support service providing tech support to the clinical users (and, hopefully, not the weakest link). What the surgeons et al get up to is a matter for them, senior management, and the (various) Regulatory Bodies.

@Mike: point taken (or rather, bounced off Rhino hide) ... but where are your own comments (additions to the debate) ... especially those about how to present the evidence for Evidence-Based PM? Is it a concept you are familiar with? Do you feel it has any merit? And if not, why not (etc.)?

Completely agree with CMS main comments stating that for Critical equipment the PM scheduling has to follow manufacturers schedule. However, I do have issues on the second part of the statement i.e. for non-critical equipment changes to manufacturers scheduling must be evidence based. This is my problem with evidence based scheduling:

Take for example the good old G500 Volumetric Infusion pump. A critical piece of equipment used world-wide. Here,(as I am sure applies in most Biomed workshops) we stick to the manufacturers recommendations for scheduling PM's. This doesn't alter the fact that we get a ridiculous amount of unscheduled work to do on these pumps. This work that we do on these pumps to check them is recorded on a work sheet and inputted on to our database. The vast majority of these problems are so called 'finger problems' associated with the user. No fault found etc..

Please don't suggest that this is a training issue. We have had a Clinical Skills trainer in situ for years and we still get these issues.

If we were to check our database and look for 'evidence' to see whether the PM scheduling for these devices is correct I dare say that a case could be made to suggest that because we see a high number of faults, we should adjust our PM accordingly. We don't of course because our experienced Tech's know what the problem is.

Thanks for that.

Two quick comments, if I may:-

1) I believe that CMS would take the view that infusion pumps are "critical equipment" and therefore not subject to deviation in either PM content or intervals (not that I necessarily agree with that myself, of course).

2) Evidence is (or should be) based upon outcomes at PM only (eg, whether the need for repair was found over a number of consecutive PM visits) and not as a result of Work Orders (RFS, unscheduled work ... whatever).

Your exit codes at PM would make for interesting review, I would suggest.

Your point 1. Yes, I think I did state in my post that I believe that Volumetric Infusion pumps are 'critical equipment'. The point I was trying to make was that if you look at the so called 'evidence' from the database, you could make a case for increasing the frequency of PM on those pumps.

Your point 2. Not sure I agree. Surely if you use an 'evidence based approach' you should use all the evidence available to you from the database i.e. from both scheduled and unscheduled work. Why use only bits of evidence.

Lastly, which so called evidence is more appropriate. The evidence from a database, or evidence from an experienced Techie'. Use the database by all means, but trust the Techie' I say.