Home Articles Downloads Forum Products Services EBME Expo Contact
Previous Thread
Next Thread
Print Thread
Rate Thread
#62563 06/11/12 4:16 PM
Joined: Sep 2008
Posts: 31
Visionary
OP Offline
Visionary
Joined: Sep 2008
Posts: 31
In this months EBME newsletter John Sandham has an article about acceptance testing.

"The Electronic and Biomedical Engineering (EBME) department should ensure processes are in place for acceptance testing. These processes will check that equipment meets safety standards, meets clinical requirements, and the procurement requirements of the Hospital from the day it arrives."

I question as to whether the EBME department can be responsible for ensuring that new equipment meets clinical requirements. Surely this is the case of stable door after the horse is long gone. The clinicians should ensure that the equipment they intend to buy for their use is suitable long before the order is placed i.e. before the item turns up at the hospital. They have to be responsible for their own decisions. If they are capable of spending tax payers money then they should be capable of ensuring that the product they decide on is right for the job that they want to do, not leave it to the EBME department to make clinical assements, something that we are not qualified to do.

Also what is meant by "the procurement requirements of the hospital". It is not the job of EBME departments to oversee the actions of the procurement department who should be adherering to the procurement policy of the establishment with no exceptions.

Joined: Feb 2004
Posts: 14,798
Likes: 71
Super Hero
Offline
Super Hero
Joined: Feb 2004
Posts: 14,798
Likes: 71

I agree with you on both points there, Charlie. smile

But what John actually says is:- "The ... (EBME) department should ensure processes are in place for acceptance testing ..." - rather than being responsible for actually carrying them out.

I would, however, argue against that as well! Surely that's one of the reasons the "higher-ups" in the Trust are being paid mega salaries? think

As a practical note (and in my experience), the biomeds are often best-placed to check incoming kit for completeness against Purchase Orders and such, if only because they are most likely the only ones around who may be able to actually recognise the stuff (all the accessories, etc., etc.) ... and also to take charge of the manuals before they get "lost"!

And (of course) the biomeds are best-placed to inspect and accept the kit from the technical point of view, including basic electrical safety testing, and commissioning it into the Maintenance Scheme. But (and as you quite rightly intimate) all that is done on behalf of the Trust. smile

All this is covered in DB 2006(05), which I believe is the "authoritive document" in this regard (although it may well have been superceded, for all I know).

That is, we are talking about Trust* Policies here - that just happen to be carried out (in this case) by what John loves to call EBME.

* Other terminology applies outside of the UK!

Joined: Jul 2000
Posts: 1,965
Likes: 32
Hero
Offline
Hero
Joined: Jul 2000
Posts: 1,965
Likes: 32
Hi Charlie,

I would argue that EBME department managers are and should be closely involved with authoring of the medical devices policy because they should be at the centre of medical equipment management within the organisation.
Therefore, their knowledge of equipment management must encompass a good understand of business needs of the Trust. The medical devices policy should describe the course of action, and how to do those actions for compliant device management. This involves sitting on a medical devices committee with a broad range of professional colleagues from procurement, medical, nursing, maintenance and governance/management areas within the Trust and discussing policy & processes that need to be actioned.

"should ensure processes are in place for acceptance testing" a policy matter

"These processes will check" a policy matter

Normally, the gatekeeper is the procurement team, but they will not have the expertise to understand the medical equipment technical, clinical or regulatory needs for each piece of equipment ordered.

Every EBME department should manage the acceptance process. They do not set the clinical spec for the equipment, but if a cardiologist orders an ECG with interpretive software, this can add £5K onto the cost. If the technician checking the equipment does not know what the clinical spec required is, how can they check it? Procurement should be discussed and approved in accordance with the policy.

A gate keeper is needed - a policy is needed to set the course of action - within that policy there should be a process for buying - within that process there should be an EBME process for acceptance testing.

A well managed hospital will ensure their EBME dept are at the heart of this process with the support of other professional practitioners.

I would argue it is the job of the EBME dept to work very closely with the procurement dept to ensure equipment procurement strategy is planned. It is not about overseeing, it about teamworking, professionals across depts supporting good inventory management, thereby improving practice, reducing risks to patients, and reducing costs.

I did not say the EBME depts should make clinical assessments, but the EBME dept will want to know if they can get tech training, parts? The EBME dept should be able to give advice on whether the equipment is robust, whether the service costs are fair? i.e. The EBME dept should be involved in buying equipment. A good EBME engineer should offer the clinician advice in areas they do not understand, and the engineer is qualified to do.

I had an incident where a consultant used Trust funds to buy a piece of equipment that was approx £100K. My technician failed it on the acceptance test because it was not CE marked. It had been imported from the USA and did not meet MDD/93/24 regs. He had also broken EU procurement law because it was over the OJEU tender threshold. This was picked up by us, the equipment was returned, and the consultant got a slap on the wrists. The moral of the story - even very experienced clinicians are sometimes
"NOT capable of spending tax payers money ...ensuring that the product they decide on is right for the job that they want to do"

We need to work with other professionals to share our knowledge and assist good procurement practice, this will lead to improved teamwork and improved healthcare organisations.

I still believe that many EBME depts are under resourced and stuck in basements. Unless we raise our profile and involve our profession in equipment management (buying, training, maintenance, and governance) we will always be stuck in the basement. I believe that we have a lot more to share for the benefit of our profession, and for the benefit of patients and taxpayers. smile


Be Proactive and reactive.
Joined: Feb 2004
Posts: 14,798
Likes: 71
Super Hero
Offline
Super Hero
Joined: Feb 2004
Posts: 14,798
Likes: 71

Care to define "governance" for us, John? think

OK ... I know, I'll crawl back down to the basement. LOL. smile


If you don't inspect ... don't expect.
Joined: Feb 2004
Posts: 14,798
Likes: 71
Super Hero
Offline
Super Hero
Joined: Feb 2004
Posts: 14,798
Likes: 71

Originally Posted By: Geoff Hannis

Care to define "governance" for us, John? think


OK ... it's a start (thank you). smile

But "The Chain Effect of Regulation"? ... looks more like "Pass the Parcel" to me! whistle


If you don't inspect ... don't expect.
Joined: Sep 2008
Posts: 31
Visionary
OP Offline
Visionary
Joined: Sep 2008
Posts: 31
I agree with Geoff that the drafting of policies are the resposibility of the "higher-ups" within the trust. EBME managers need to have an input as the people required to make the decisions do not possess the required knowledge. However whether the opinion of the lowly Mr Fixit being listened to is another kettle of fish.
Having a policy is all very well but must be backed up by a procedure which is agreed to by all involved parties and rigidly adhered to, with no rush jobs or special cases. A resilient and well written procedure should cover all eventualities.

EBME depts. should carry out an acceptance procedure but the question is to what that process should include?
In your example of the ECG machine, hopefully the extra interprative software is detailed on the packing note which can then be reconciled with a copy of the purchase order. But how the technician ascertains whether the additional software is present and functioning is another matter.

On your acceptance test sheet you have listed brief and comprehensive tests listed but which is carried out and when?

For an example a haemofiltration device is delivered to a department with no renal experience for acceptance. Which type of test is carried out? In this case the unit commisioning and acceptance testing would be better left to the supplier with that course of action being decided and arranged at the point of sale.

Originally Posted By: John Sandham

I had an incident where a consultant used Trust funds to buy a piece of equipment that was approx £100K. My technician failed it on the acceptance test because it was not CE marked. It had been imported from the USA and did not meet MDD/93/24 regs. He had also broken EU procurement law because it was over the OJEU tender threshold. This was picked up by us, the equipment was returned, and the consultant got a slap on the wrists. The moral of the story - even very experienced clinicians are sometimes
"NOT capable of spending tax payers money ...ensuring that the product they decide on is right for the job that they want to do"

smile

I hope more people than just the consultant were critisied over the erroneously purchased equipment, the person who placed the order and the one who processed the PPQ are equally culpable. Also I find it amazing that in todays cash starved NHS that £100K could be spent with no business case being made.

Joined: Jul 2000
Posts: 1,965
Likes: 32
Hero
Offline
Hero
Joined: Jul 2000
Posts: 1,965
Likes: 32
Unfortunately Charlie,

There are gaping holes in the procurement of equipment which lead to all sorts of financial and clinical risks. PPQ's are not always used.

Geoff - Defining governance would be a very long forum post, but in summary:
Governance of devices must include many stakeholders. EBME, Procurement. Nurses, doctors, managers, etc. The ultimate goal must be to ensure the equipment bought is right for the patient, is used safely, is maintained safely, and records are available for assurance in all these areas. smile


Be Proactive and reactive.
Joined: Feb 2004
Posts: 14,798
Likes: 71
Super Hero
Offline
Super Hero
Joined: Feb 2004
Posts: 14,798
Likes: 71

Very good. smile

So could we think of it as a shared responsibility to get the right boxes ticked at every stage of the game, then? think

OK ... but who carries overall responsibility (and I don't mean of the "lessons shall be learned" kind) - who carries the can? - when (for example):-

1) The surgeon buys "must have" kit that ends up sitting in the corridor six months later?
2) Overall PM targets never get met?
3) Kit "disappears" out of the building (never to be seen again)?
4) Nurses consistently fail to operate kit correctly?
5) Kit gets damaged through carelessness or willful neglect?
6) Kit is blamed for an "incident" (real or imagined)?
7) Biomeds cannot maintain the kit due to lack of resources?
8) Kit on service contract becomes "no longer supported"?
9) Service contractors do not meet their obligations?
10) Kit is clearly "not fit for purpose" yet was happily "voted through" during so-called "trials"?

OK ... ten should be enough for now. LOL. boggle


Moderated by  DaveC in Oz, RoJo 

Link Copied to Clipboard
Who's Online Now
0 members (), 2,816 guests, and 24 robots.
Key: Admin, Global Mod, Mod
Newest Members
Chris 11, j9_PLC, nece, Vitya, Shenzhen007
10,358 Registered Users
Forum Statistics
Forums26
Topics11,250
Posts74,485
Members10,358
Most Online59,530
Apr 30th, 2026
Powered by UBB.threads™ PHP Forum Software 7.7.5